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FORM I Affix Passport Size Photo Here NATIONAL CADET CORPS,Appendix A/B
SENIOR DIVISION/JUNIOR DIVISION/SENIOR WING/JUNIOR WING ENROLMENT FORM(See Rules 7 and 11 of NCC Act,1948)
1
Name (in BLOCK LETTERS)
SURYA NARAYANAN T D
2
Nationality&Date of Birth(DD/MM/YYYY)
INDIAN
3
Father's/Guardian's Name
T N DINESHAN
4
Mother's Name
SHEELA T V
5
Permanent Address
THUNDIPARAMBIL HOUSE
28/11/2001
GURUNAGAR ROAD KACHERIPADY PALLURUTHY KOCHI 682006 6
Mobile/Landline Number
7902891740
7
Email id
[email protected]
8
Blood Group
A+
9
Sex
Male
10
Nearest Railway Station
ERNAKULAM SOUTH RAILWAY STATION
11
Nearest Police Station
PALLURUTHY POLICE STATION
12
Educational Qualifications& Marks in percentage
+2,60%
13
Identification Marks (Atleast 2)
A MOLE ON THE NECK, A MOLE ON THE LEFT LOWER ARM
14
Have you ever been convicted by a criminal court& if
NO
so in what circumstances & what was the sentence?Attach relevant documents 15
Name of the School/College and
St Alberts College, Ernakulam
Stream(Arts/Science/Commerce) 16
Willing to be enrolled and undergo training under the
Yes
National Cadet Corps Act,1948 17
NCC Unit to be enrolled in
21(K) BN
18
Have you been enrolled in NCC earleir.If Yes,your
Yes
19
Enrolment No.
KER JD 15 166414
Have you been dismissed from NCC/the Territorial
NO
Army/the Indian Armed Forces;please provide details 20
Next of Kin with address(with relationship)Telephone
MIDHUN PRADEEP
No.(O)/(R)(as applicable)
NIKARTHIL HOUSE GURUNAGAR ROAD PALLURUTHY KOCHI
21
Banker's detail/IFSC Code
682012004
22
Bank Account Number of Cadet/Parent
8020100009264
23
Aadhar/UID(If alloted)
650726273704
24
PAN Card(If allotted)
25
N.C.C. Number
KL20SDA155077
26
Date of enrolment
19/11/2020
27
Signature of the applicant
Page 1
DECLARATION ON ACCEPTANCE FOR ENROLMENT
* 1.I solemnly declare that the answers I have given to the questions in this form are true and that no part of them is false and that I am willing to fulfill the engagement made. 2.I .........SURYA NARAYANAN T D............. promise that I will honestly and faithfully serve my country and abide by the Rules and Regulations of the National Cadet Corps that I will, to the best of my ability, attend all parades and camps as may be required by the Commanding Officer from time to time. *3.I ...........SURYA NARAYANAN T D............ further promise that after enrolment, I will have no claim on authorities for any compensation in the event of injury or death due to accident during training camps, courses, travelling and while on YEP or any other such NCC events like RDC, IDC.
*Place: Date : Signature of the Applicant *Note:- These are not included in the Form II of NCC Act & Rules.
DECLARATION BY PARENT/GUARDIAN
1. I solemnly declare that the answers given in this form are true and that no part of them is false and that my son/daughter/ward is willing to fulfil the engagement made. 2.I ....................T N DINESHAN .............................. Promise that after the enrolment of my son/daughter/ward, I will have no claim on authorities for any compensation in the event of any injury or death due to accident during training camps, courses, travelling and while on YEP or any other such NCC events like RDC and IDC. 3.I understand my son/daughter/ward has no service liability.
*Place: Date : Signature of Parent/ Guardian
Page 2
CERTIFICATE
* 1. Certified that the applicant understands and agrees to the conditions of enrolment. 2. Certified that the applicant and his parent/guardian understand and agree to the conditions of enrolment.
*Place : Date of enrollment : (Unit Seal) Signature of Enrolling Officer *For Minors Only. Score out inapplicable portion
TO BE COMPLETED BY MEDICAL OFFICER BEFORE ENROLMENT
I have examined (Name) ..............SURYA NARAYANAN T D............... on …………………………………………. (date) and consider him/her fit/unfit for enrolment as a Cadet in the National Cadet Corps.
*Place : Date : Signature of Medical Officer Designation (Medical Officer)
Page 3
TO BE USED FOR EXTENSION OF ENROLMENT (See Rule 13)
My son/daughter/ward agrees to extend the enrolment for one year and is willing to fulfil the engagement made.
*Place : Date : (Unit Seal)
Signature of Cadet
Signature of Parent/Guardian
Confirmed
Signature of Headmaster/Principal
*Place : Date from which extension starts : ………………………………………………………….. Note :- This form will be retained in the school in which the unit is located.
(Commanding Officer)
Page 4
APPENDIX ‘D’ ANNEXURE TO FORM II (Application for Enrolment) INDEMNITY BOND (for Minor Applicants only)
To,
The President of India In consideration of my ward No ........KL20SDA155077...... Name .......SURYA NARAYANAN T D........ being nominated either by the NCC authorities or at his own request as a participant in any NCC camp (which includes Republic Day Camp and Independence Day Camp in Delhi),Course, Adventure Training (including Army, Navy and Air Wing activities, as the case may be) and while travelling (in Domestic/International Surface, Air and Water Transport) and attending Youth Exchange Programmes abroad, I undertake and agree that neither I, nor my other legal representatives will make any claim against the Government or against NCC authorities including Officers, JCO’s/ NCO’s or equivalents from Navy and Air Force, civilians, MT Drivers or against any other such person in the service of the Government, in respect of any loss or injury – to the property or person, including injury resulting in death, due to any reasons whatsoever which my ward may suffer, while or in consequence of his participation in the above activities and I understand that no compensation will be paid by the Government or NCC authorities including Officers, JCO’s/NCO’s or equivalents from Navy and Air Force or Civilian, MT Drivers in respect of any/such loss or injury and I agree as to bind myself, my executors and administrators and other legal representatives to indemnify the Government or NCC authorities including Officers, JCOs/NCOs or equivalents from Navy and Air Force, Civilians, MT drivers or any person in the service of Government against any claim which may be from any third party against them or any of them arising out of any act of default on my part during or in connection with the said camps, courses, adventure training, travelling and while on Youth Exchange Programme or any other such NCC activities as may be organized from time to time within or outside the Union of India.
Witness :
1.Signature Name Address
2.Signature Name Address
Place : Date : Address (NOTE: In case of SD applicant being a minor, Indemnity Bond applicable to Minor will be used) Signature of Parent/Guardian Name Address
Page 5
APPENDIX ‘B’ ANNEXURE TO FORM I (Application for Enrolment) INDEMNITY BOND (for Minor Applicants only)
To,
The President of India In consideration of my being nominated either by the NCC authorities or at my own request as a participant in any NCC camp (which includes Republic Day Camp and Independence Day Camp in Delhi),Course, Adventure Training (including Army, Navy and Air Wing activities, as the case may be) and while traveling (in Domestic/International Surface, Air and Water Transport) and attending Youth Exchange Programme (YEP) abroad, I undertake and agree that neither I, nor my executors or administrators or other legal representatives will make any claim against the Government or against NCC authorities including officers, JCO’s/ NCO’s or their equivalents from Navy and Air Force, civilians, MT drivers or against any other such person in the service of the Government, in respect of any loss or injury – to the property or person, including injury resulting in death, due to any reasons whatsoever which I may suffer, while or in consequence of my participation in the above activities and I understand that no compensation will be paid by the Government or NCC authorities including officers, JCO’s/NCO’s or their equivalents from Navy and Air Force or Civilian MT drivers in respect of any such loss or injury and I agree as to bind myself, my executors and administrators and other legal representatives to indemnify the Government or NCC authorities including officers, JCOs/NCOs or their equivalent from Navy and Air Force, civilian MT drivers or any person in the service of Government against any claim which may be from any third party against them or any of them arising out of any act of default on my part during or in connection with the said camps, courses, adventure training, travelling and while on Youth Exchange Programme or any other such NCC activities as may be organized from time to time within or outside the Union of India. Signature of Applicant ……………………………………………… No ……………………………………………………………….. Name ……….………………………………………………………… Unit/Group …………………………………………………………..
Witness :
1.Signature Name Address
2.Signature Name Address
Place : Date : Address (NOTE: In case of SD applicant being a minor, Indemnity Bond applicable to Minor will be used) Signature of Parent/Guardian Name Address
Page 6
APPENDIX ‘B’ (Refer to Para 4 of DGNCC LETTER 19952/DGNCC/CWS Dated 09 April 2012) NOMINATION FORM FOR MEMBERSHIP OF THE NCC CADETS WELFARE SOCIETY (To be retained at NCC Group HQ) Section – I 1.I, Cadets (name in block letter) ................SURYA NARAYANAN T D...............Son/daughter of Shri (name in block letter) ....................T N DINESHAN.............................. a student of class ..........+2,60%....... of (name of School) ...........St Alberts College, Ernakulam...... On my enrolment with the NCC on (Date) .......19/11/2020...... with (Name of the Unit) .........21(K) BN ......... apply for membership of the NCC Cadets Welfare Society and hereby subscribe a sum of Rs 15 (Rupees Fifteen only) towards its membership fee. 2.My Father/Mother/Guardian’s occupation is ………………………………………… and the annual income of my family from all sources is Rs ……………………. Per annum. 3.I understand that I shall be entitled to financial relief as determined by the Governing Body/Managing Committee of the above Society in the event of partial or permanent disablement sustained by me while participating in an organized NCC activity. I hereby accept that the decision of the Governing Body/Managing Committee with regard to the quantum of relief to be paid to me in the event of my partial/Permanent disablement will be final and binding on me. 4.I hereby nominate the following person/persons who will receive financial assistance as per the share indicated and as determined by the Governing Body/Managing Committee of the above Society, which will be final and binding on the following person (s) in the event of my death while participating in an organized NCC activity.
Sl
Name of the Nominee/
No.
Nominees(in block letter)
Age Relaionship with the Cadet
Permanent Address of the nominee
%of the fin. assistance payable
1. 2. 3.
(To be filled by the Cadet in own handwriting) 5.My membership in the Welfare Society and his Nomination form will be valid only till such time I remain a Cadet in the Division or Wing of the NCC to which I have been enrolled. Dated : Place : Full Signature of the Cadet
Section – II Dated : Signature of the ANO/Head Of Institution
CWSF Form Page 1/2
Section – III
I am willing to allow my son/daughter/ward name ............SURYA NARAYANAN T D............. to become members of the NCC Cadets Welfare Society under the terms and conditions and rules in force of the society. I also approve of the nomination made in section I (4). Dated : Place :
(Full signature of the father/mother/ guardian with complete address)
Witness :
Witness :
1.
2.
(Full name and address or office seal of the Witness)
(Full name and address or office seal of the Witness)
Note :- The Witness should be either Gazetted Officer, Head of Institution /ANO/Sarpanch/Village Head.
Section – IV Received a sum of Rs 15 (Rupees Fifteen only ) as on time subscription and enrolled as a member of the NCC Cadets Welfare Society during the cadetship in the Junior/Senior Division/Wing. Dated:
(Signature of the OC Unit with office seal)
Section – V (To be filled in by the NCC Unit) Date of dispatch of the Nomination form to Group HQ ………………………………………………..................................................... Note :- The Nomination form will be printed on both sides of a single leaf.
CWSF Form Page 2/2