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DROWNING/ACCIDENT CERTIFICATE

1. No. UK23JDA140936 Rank CADET Name _KARTIK MANKOTIA

Attending _CATC CAMP knows that that there is

deep water near the camp site and that the area near to the water is out of bound. If I go

there I shall be doing it entirely at my own risk.

Date : (Signature of the Cadet)

Permission attested by NCC officer / Principal

As the father / guardian has given the permission to his son / daughter / ward to
attend the above NCC Camp. I therefore also permit him / her for the same.

Date:

_______________ __________________________
(Signature of ANO) (Signature of Head of Institution)

COUNTER SIGNATURE

Date : (Commanding Officer)

Place :

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RISK CERTIFICATE

This is to certify that I No UK23JDA140936 Rank CADET

Name KARTIK MANKOTIA of college/School APS RANIKHET

Volunteer to attend the NCC CATC CAMP

being held at RANIBAGH wef 07-12-2024 to 17-12-2024 at my own risk.

______________________
(Signature of the applicant)

Parent’s Consent Certificate

This is to certify that I have no objection to spare my son/daughter

No. Rank UK23JDA140936 Name KARTIK MANKOTIA

School APS RANIKHET to attend the CATC Camp/ Course being held

At RANIBAGH from 07-12-2024 to 17-12-2024

____________________
Station : (Sig of Parent/guardian)
Name and address
Dated : ____________________
____________________

___________________________
________________ (Signature of Head of Institution)
(Signature of ANO)

COUNTERSIGNED

(Signature of Commanding Officer)

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Annexure I
(Ref to Para 1 (a) of Appx C)

MEDICAL CERTIFICATE

1. (a) Certified that I have examined No UK23JDA140936 Rank CADET

Name KARTIK MANKOTIA of school APS RANIKHET

of Unit 79-UK-BN-NCC-NAINITAL in accordance with the standard

laid in NCC Acts and Rules found him fit to undergo training of CATC CAM to be held at
RANIBAGH wef 07-12-2024 to 17-12-2024

(b) I also certify that the above mentioned cadet has been inoculated / vaccinated.

(c) That the cadet has been protected against small pox, typhoid and cholera.

(d) Signature of cadet ____________________

(e) Signature of cadet ____________________ is attested.

Station: Signature of Medical Officer

Name in block letters
Date: Designation
PractionerLicensee No.

“COUNTERSIGNED BY THE OC UNIT”

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Annexure III
(Ref to Para 1 (c) of Appx C)

INDEMNITY BOND
In consideration of my being nominated either by NCC authorities or at my request to undergo all
types of training and also participate in any Camp/Course/Adventure Training activities/in/outside NCC and
traveling, I undertake and agree that neither I nor my executor or administrator will make any claim against
the Govt of India or against any Officer, JCO/OR, Armed Forces/Civilian MT Driver or against any injury
(including injury resulting in death) which I may suffer while or in consequence of my being in
Training/participation in any camp/course/adventure training activities in/outside NCC and traveling, and I
understand that no compensation will be paid by the Govt of India or any Officer, JCO/OR, Armed
Forces/Civilian MT Driver against any in the Govt. of India and in respect of such loss or injury (including
injury resulting death) and agree so as to bind myself, executors and administrators to indemnity the Govt. of
India any Officer, JCO/OR, Armed Forces/Civilian MT Driver and any person in the service of Govt. of India
against my claim which may be made by any third party against them or any of them arising out of any act of
default on my part during or in connection of said training/camp/course/adventure training and journey by
road/rail/sea/river and flight.

______________________
Station _________________ (Sig of the Applicant)
Date _________________ Name in block tters____________________

With address _______________________

`
_________________________

_________________________

In presence of Witness

Signature 1: Signature 2:
With date : _____________________ With date : ___________________________

Name in Block letter__________________ Name in Block letter_____________________

With address ____________________ With address ________________________
____________________ ________________________

Father (Guardian)
Name in block letters______________
Address ________________________
________________________

____________________
____________________________
(Signature of ANO) (Signature of Head of Institution)

Countersigned CO Unit

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