Appendix A

(Ref Para 4 (a) (viii) of DG Rtg letter No

B/60601/ACC-124/Rtg/SE dt 18 Nov
2020)

PRELMINARY SCREENING OF ACC APPLICATION

TO BE CHECKED BY OFFICER COMMANDING

1. Personal Number :

2. Rank :

3. Trade :

4. Name :

5. Unit :

6. Unit :

7. Command :

8. Postal Address of the unit in full, nearest : 41 Veh Coy

Railway station PIN- 909041, c/o 56
APO, Rly Stn - Guwahati

9. Date of Birth (As in matriculation cert) :

(a) Age (as on 01 Jun 2021) : Yrs Months days
(b) Date of enrolment :
(c) Total years of service : Yrs Months days
(as on 01 Jun 2021)
10. Place of Birth, District and State to which the :
candidate belongs.

11. Name in order with date of entering and :

leaving the place of education the candidate attended.

12. Educational Qualification :

13. Are you free from Debt :

14. Centre at which appeared for the written :

entrance exam and Index No.

15. Recommendation of the COs/ OCs as per :

part III of the application.
16. Declaration to be signed by the individual :
17. Medical Examination Report as per :
part II of the application.
18. Red Ink Entry/Entries to be checked :
(as per sheet roll/field conduct sheet & debarring list)

Station : c/o 56 APO

Date :
 Appendix B
(Ref Para 4 (a)(viii) of DG Rtg letter
No B/60601/ACC-124/Rtg/SE dt 18
Nov 20)

TO BE CHECKED BY RECORD OFFICE

1. Date of birth (as in Matriculation Certificate) :

2. Educational Qualification :

3. Particulars of service
(a) Army No :
(b) Rank :
(c) Name :

(d) Arms/Services :
(e) Unit (Where serving) :

4. *Date of Enrolment :
5. (a) Total service (as on 01 Jul 2020) :

(b) **Disciplinary case, if any :

6. Courses attended since joining the Army :

7. Did the individual apply for any type of :

commission and have the candidate ever
been debarred at any examination.

8. Red ink entry/entries to be checked from :

sheet roll/Field conduct sheet and debarring
list (IAFK-1155).

9. ACR grading of last five years (at the time of

filling of application) as per Para 2 (e) (iv) of :
IHQ MOD (Army) letter No B/60601/ACC-107/
Rtg/SE dated 13 Mar 2012.

Year Grading Note 1 : Ratio of ratings should be as follows

IO RO
ACR Earned*** Army
AA/High Average
(a) (a) 5 ACRs 3:2
(b) (b) 4 ACRs 3:1
(c) (c) 3 ACRs 2:1
(d) (d) 2 ACRs 2 : Nil
(e) (e) 1 ACR 1 : Nil

*As per Sheet Roll

*As per Sheet Roll/ACRs/Fd Conduct sheet
*** For Navy and Air Force ACR eligibility criteria as mentioned in para 2(e) Sub Para V to be
considered.
Station : c/o 56 APO Signature of the
Senior Record Officer
Dated :
 No of Course: ACC-124

APPLICATION FORM IN RESPECT OF PERSONNEL SERVING IN THE

REGULAR ARMY AND THE TERRITORIAL ARMY/AIR FORCE FOR
ADMISSION TO THE ARMY CADET COLLEGE

PART - I

(TO BE FILLED BY THE CANDIDATE IN HIS OWN HAND WRITING)

All columns should be completed and all answer should be given in words NOT by
dashes and Dots.

Note: Concealment of any information or furnishing of false particulars will result in the
cancellation of the candidature and may also debar the candidate from applying for
future courses.

1. (a) Name in full (BLOCK LETTERS) :

(as given in the service records)

(b) If applying again, exact name as :

given in previous application.

(c) Name in full (in CAPITAL :

LETTERS) as given in matriculation/
higher secondary or equivalent
certificate.

Note : Any difference in the name (a) (b) and (c) above will be explained By giving detailed
reasons, if necessary on a separate sheet or Paper attached to the application form
with the supporting documents, otherwise candidature will be cancelled.

2. Personal Number and Rank :

3. Unit/Regt or Corps (including these to :

which attached)

4. (a) Postal address of Unit in full :

(b) Nearest Railway Station :

(c) Nearest Telegraph Office :

Note :- All communications will be addressed to the applicant’s Commanding Officer.

5. Date of birth in Christian Era :
(according to Higher Secondary/
Matriculation or equivalent
certificate). Candidate whose
Matriculation/ School certificate/
documents shown the date of birth
Malayalam Era, will obtain a cert
from the Public Library Trivandrum
of university concerned
showing the corresponding date of birth
in Christian Era and submit the same
with their application.

6. (a) Place of birth and state in which :

it is situated

(b) District to which you belong :

(c) State to which you belong :

7. (a) In case of candidate

belonging to regular army:-

(i) Date of enrollment :

(ii) Date of attestation as a :

trained soldier/airman

(iii) Date of promotion to NCO :

rank/date of appt as LNK

(iv) Date of appt of LAC :

(b) In case of candidate belonging :

to Territorial Army :-

(i) Date of Enrollment :

(ii) Whether having :

continuous service in
Territorial Army, if so date
of joining continuous
service.

8. Name in order with date of entering and leaving the place of education, you have
attended:-

Place of education and names of Class upto Month/year of Month/year of

Institution in which you were which you entry leaving
educated studied
9. Give particulars of examinations (if any) you have passed and the class division
or other distinctions obtained commending with the Matriculation or equivalent
examination:-

Examination Class or Year Subject Name of the School/

division College and
University

10. What is your father’s name and :

address? If died state his last address

11. Give the name and address of :

next of kin showing relationship.

12. Give below full details of service in the Army/Territorial Army/Air Force.

Period Rank Appointment Place Unit

From To

13. Course attended since joining the Army :-

Type Place From To Grading Remarks

14. Particulars of any decoration or mention in :

dispatches received.

15. What games do you play :

16. (a) Did you ever apply or attend a :
selection Board interview for any type of
commission in the Army, Navy, Air
Force or State Forces ? If no, give the
following particulars in respect of each
interview :-

(i) Type of commission applied for :

(ii) Dates of interview by service :

Selection board (s)

(iii) Date of birth declared on the :

previous occasion. If different from
the previous, change must be given

(b) Also state if you have been selected :

in the Armed Forces (Now National Defence
Academy, Military College/ Military Wing (Now
Indian National Academy) Army Cadet College
or Air Force, as officer, give details.

(c) Have you ever been remove from :

an earlier course at the National Defence
Academy/Military College/ Military Wing
(Now Indian Military Academy/Air Force
Flying college? If so, state reason for
removal.

(d) Are you also a candidate for any :

other type of course/commission in the
Army or Air Force ? If so give full
particulars (in case of Short service
commission, Roll No must be indicated)

(e) Have you any relative, indicated? :

known person serving in any of the
selection centre/service selection boards,
if so give particulars.

(f) Have you ever been debarred from :

appearing at any examination/selection
conducted by union public service
commission/Govt of India/State Govt/
University/Board of any other educational
Institution/Authority? If so give details.

Note : The information as required must be clearly indicated and no column/sub

para be left blank.

17. (a) Are you free from debit :

(answer Yes/No)

(b) If you are under liability to repays :

money advances by any institution or for
other purposes, state the particulars, if answer
to (a) is YES, answer (b) clearly.
18. (a) Have you ever served in the National :
Cadet Corps as the cadets or university
Training Camp?

(b) If so give particulars of period served :

and ranks attended, State also your Corps
Number and names of the school or college
from which you were enrolled.

(c) What certificate of training have :

gained (attach your discharge certificate
or a type copy of its to this application).

WARNING : Concealment of the information required against column 16 and 17 will

result in cancellation of candidature and may also debar the applicant either
permanently or for specific period for applying for admission to future
course/commission.

19. Give the list of the documents candidate should not that in absence of requisite
certificate aggregate for their service selection board interview will not been made :-

(a)

(b)

(c)

(d)

(e)

(f)

NOTE : The Commanding Officer of the Unit will ensure that the details of the
original or attached copies of documents/certificate attached with the application tally
with the particulars furnished under this column.

20. Centre at which appeared for the written :

entrance examination.

(Signature of candidate)

Place : c/o 56 APO

Dated : (Signature of Commanding Officer)

 PART - II

MEDICAL INSPECTION REPORT

(To be completed by a Medical Officer of AMC in the case of all applicants)

1. I have today examined, No Rank Name and

formed the opinion that he is FIT/UNFIT (give a general opinion on his degree of fitness to
undergo severe physical and mental strain).

2. His medical category is : .

3. His visual standards are Rt Lt .

4. I have been in medical charge of him for

¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬¬ during which time he has :-

(a) Never reported sick.

(b) Suffered the normal amount of minor sickness.

(c) Complained of more than the usual amount of casual

illness. (Strike out the statements which are not applicable).

Place : c/o 56 APO Signature of MO

Rank
Dated : Designation
 PART- III

RECOMMENDATION BY THE COMMANDING OFFICER

1. Certified that (No, Rank and Name)

has satisfactory records of service an extract of the red ink entry/entries
recorded in his Fd Service document (IAFF-958) is/are given below :-

Ser Date of offence Nature of Punishment Authority who awarded

No offence awarded with date punishment

2. (a) I hereby certify that to the best of knowledge, the particulars furnished by
(No, Rank and Name) are correct and
these have been verified with his field service document (IAFF-958).

(b) I also certify that the date of birth shown in column 5 of part I, i.e
has been duly verified by me from the documents detailed below:-

(i) Matric or equivalent cert.

(ii) IAFF-958 (Record of Services – JCOs/OR).
(iii) AB-64(Pay Book).

(c) I further certify that the action to rectify the discrepancy in the date of birth
recorded in the Matric Cert and sheet roll (IAFK-1155) has been initialed in
accordance with the existing instructions and the accepted date of birth for all
intents and purpose will be .
Note:-

1. The date of birth will be verified from the following docus :-

(a) Matriculation certificate of the secondary school leaving cert, or a

certificate recognized by an Indian University as equivalent to Matric or failing
that.

(b) Municipal Birth Cert or an extract from the Municipal birth Register duly
certified by proper authorities or failing that.

(c) The records of admission in the register of the school in which the
individual got admitted in the School.

2. (a) Reason for the non-availability of documents of sub para 1 (a) to (b)
above will be fully explained.

(b) Original documents together with an attested copy there of will be

submitted with the application.

3. Recommendation of the Commanding Officer.

RECOMMENDED/ NOT RECOMMENDED

Station : c/o 56 APO

Dated :
 PART –IV

RESULT OF WRITTEN ENTRANCE EXAMINATION

(Sub para (i), (ii) & (iii) to be filled in by the candidate)

(i) Number, Rank & Name of the candidate :

(ii) Centre of examination :

(iii) Date of examination :

(iv) Marks obtained (both in words as well as :

in figures)

(v) Qualified/Rejected/Disallow :
(as the case may be)

Place : Signature

Dated : (Director of Army Education)

IHQ of MoD (Army)
 PART - V

SERVICE SELECTION BOARD REPORT

(To be completed by the president, service Selection Board)

1. No, Rank and Name of the candidate

2. Batch No Candidate No

3. Marks awarded (Both in words as well as in figures)

.

Station : Signature

Dated : President No
 DECLARATIONS TO BE SIGNED BY THE CANDIDATE

1. I hereby declare that the statement made in this form are true to the best of my
knowledge and belief, that I am No Rank Name

(with one/more than one wife living/ unmarried/ a widower)

(insert whichever is applicable). I undertake that I will not marry while I am under pre-
course training at ACC or training at the Indian Military Academy not shall I ask for
married accommodation or permission to live with family until rules and regulations of
Army permit.

Note: - A candidate who married/re-married while under training will be discharged and
will be liable to refund all expenditure incurred on him by the Government.

2. I am fully aware that if it is found at any stage that I have knowledgely furnished
any particulars, which are false or have apprised material information, I shall be
disqualified and if already admitted in the ACC/IMA, removed.

3. I further declare that once selected, if for any reason within my control I wish to
withdrawn from the Army Cadet College/Indian Military Academy at my own request or
do not accept a commission if offered, I will be liable to refund the whole or such
portion of expenses incurred on my training or money paid to me in the form of pay and
allowances and TA/DA as may be decided upon by Government.

(Signature of Witness) (Signature of Candidate)

Full Address Full Unit Postal Address

Date : Date :

COUNTERSIGNED

Station : c/o 56 APO

Dated :
 Appx ‘A’

ELIGIBILITY CERTIFICATE

Certified that No Rank Name unit

who has applied for ACC-124 Course has been personally verified
by me and that his educational qualifications is in order in terms of IHQ of MOD (Army)
letter No A86547/GS/MT-15 (B) dated 08 Jan 1987 and he is eligible to apply for ACC
Course on educational grounds.

Station: c/o 56APO

Dated :
 Appx ‘A’ to AO 64/78

PERMISSION CERTIFICATE

Index No :
(To be allotted by the exam Centre)

1. It is certified that the candidate, whose particulars are given below, fulfills all the
conditions of eligibility to appear in written entrance exam (ACC-124) to be conducted
at HQ 51 Sub Area HRDC being nearest to the location of his duty station.

(a) Army No :

(b) Rank :

(c) Name :

(d) Arms/Service :

(e) Trade/Grade :

(f) Civil Educational qualification :

(g) Date of birth :

(h) Date of enrolment :

(j) Present Unit & Postal Address :

2. It is further certified that the date of birth claimed by this candidate has been verified
by me from his original High School Certificate as well as from service documents and no
discrepancy has been found.

Station : c/o 56

APO Dated :
 CERTIFICATE

It is certified that No Rank Name has availed

chance for / has not availed any chance of SSB for any type of
commission.

Station: c/o 56

APO Dated :
 DETAILS OF PREVIOUS APPLICATION VERIFIED BY RECORDS AOC
FOR THE COMMISSION IN RESPECT OF NO
RANK NAME

Ser Type of commission Quota Remarks

No

Station : c/o 56 APO Signature of

CRO/SRO Dated :
 APPENDIX A TO A1 55/73

(Not be detached from the application form)

ARMY CADET COLLEGE COURSE – PREVIOUS CANDIDATE

Form of checking previous candidature

Registration No

(TO BE COMPLETED BY THE CANDIDATE)

1. Army No, Rank and Name of candidate :

2. Date of birth as given in column 5 of the :

application

3. Educational qualification :

4. Present Arms/Services :

5. Unit/Regt or Corps (including those to :

which attached)

PORTION BELOW THIS LINE TO BE USED BY IHQ OF MOD (ARMY)

Remarks

Initials of checking Asstt/Clerk

 DETAILS OF PREVIOUS INTERVIEW IF ANY

To be used by IHQ of MoD (Army)

Type of SSB Batch SSB/AFSA Result Date of Name of

Commission/Course Number Birth Interviewing
Testing Officer

Remarks :-

(Initial of checking asst, clerk)

 Appendix C
(Ref Para 4 (a)(viii) of DG Rtg letter
No B/60601/ACC-124/Rtg/SE dt 18
Nov 20)

Initials of Candidate's Signature

CO/OC/unit

RECORD OF SERVICE: APPLICANT ACC SER NO 124 COURSE

1. Personal Number: 2. Rank:

3. Name in full, in capitals):

4. Trade : 5. Previous Unit:

6. Command: HQ Northern Comd

7. Postal address of Unit: 41 Veh Coy

PIN 909041
c/o 56 APO

8. Date of Birth (as in Matriculation Certificate):

9. Age of first day of the month of which course due to commence:

10. Education Qualification:

11. Matriculation Certificate No:

12. Present Medical Status:

13. Date of Enrolment:

14. Units/Hqs served in, since enrolment, in chronological Order:-

Name of Unit/HQ From To Type of Emp

(Regt/ERE/Instr/
Deputation/ Foreign
Assignment)
 -2-

15. Total Service on first day of month in which course due to commence

16. Centre and Index No of ACC written Exam:

17. Contact No (Mobile):

18. E mail ID

Declaration:- I hereby declare that the above information provided by me is true to the
best of my knowledge. I understand that in case any of the information mentioned
above is found to be incorrect at a later stage, my candidate will be cancelled and
necessary disciplinary action will be imitated against me.

Place : c/o 56 APO

(Signature of Candidates)
Date :

COUNTERSIGNED

Place : c/o 56 APO

(Signature of CO/OC)
Date :
 Appendix D
(Ref Para 4 (a)(viii) of DG Rtg letter
No B/60601/ACC-124/Rtg/SE dt 18
Nov 20)

CERTIFICATE BY CANDIDATE FOR NO OF EARLIER SSB ATTEMPTS

No: Rank: Name:

Present Unit: 41 Veh Coy

1. I have earlier appeared before the following SSBs/AFSBs/NSB as per details

given below:-

Type of Entry SSB/AFSB/NSB From To Remarks

Year (Recommended/Not
Recommended)

2. I fully understand that appearance in stg 1 of SSB also counts as one attempt and I
have given complete details of the same where applicable.

Declaration:- I hereby declare that the above information provided by me is true to the
best of my knowledge. I understand that in case any of the information mentioned
above is found to be incorrect at a later stage, my candidate will be cancelled and
necessary disciplinary action will be imitated against me.

Place : c/o 56 APO

(Signature of Candidates)
Date :

COUNTERSIGNED

Place : c/o 56 APO

(Signature of CO/OC)
Date :
 Appendix D
(Ref Para 4 (a)(viii) of DG Rtg letter
No B/60601/ACC-124/Rtg/SE dt 18
Nov 20)

No Rank Name Unit

DETAILS OF RED INK ENTRIES IN FD CONDUCT SHEET OF

CANDIDATE

Ser No Date of Offence Details of Offence Punishment Awarded

DETAILS OF BLACK INK ENTRIES IN FD CONDUCT SHEET AWARDED

UNDER ARMY ACT 63 WHICH IN THE OPINION OF COMMANDING OFFICER/
OFFICER COMMANDING ARE SERIOUS AND AFFECT HONESTY,
CHARACTER AND MORAL FIBER OF THE CANDIDATE

Ser No Date of Offence Details of Offence Punishment Awarded

(if nature of offence under AA Sec 63 is serious and affects honesty, character and
moral fiber of the candidate, the CO/OC unit will cancel his candidature for ACC
course)

Note. It is to be noted that :-

(a) Candidates having more than one red ink entry are not eligible to apply.

(b) Candidates who have been awarded punishment under debarable

offences as given at Appendix A to adm instr issued vide DG Rtg letter No B/60601/
ACC- 123/Rtg/SE dt 16 Mar 2020 are not eligible to apply.

(c) Even in case of one Red Ink Entries, the candidates will not be eligible for one
year from the date of punishment.

(d) This provision will apply to candidates at any stage of their selection i.e to
say that even if they are awarded this punishment after submitting their
applications and before induction into ACC.

Declaration. I hereby declare that the above information provided by me is true to the best
of my knowledge. I understand that in case any of he information mentioned above is
found to be incorrect at a later stage my candidature will be cancelled and necessary action
will be initiated against me. Non-involvement cert is encl at Annx 1.

Place: c/o 56 APO

(Signature of Candidate)
Date :

COUNTERSIGNED
Place : c/o 56

APO Date :
 Annx 1
(Ref Para 4 (a)(viii) of DG Rtg letter
No B/60601/ACC-124/Rtg/SE dt 18
Nov 20)

NON INVOLVEMENT CERTIFICATE

1. It is certified that there is no case pending against me in any

Civil/Criminal/Military Court/establishment

OR

2. The following cases are pending against me in any

Civil/Criminal/Military Court/establishment

(a)

(b)

(c)

(d)

Declaration. I hereby declare that the above information provided by me is true to the
best of my knowledge. I understand that in case any of he information mentioned above is
found to be incorrect at a later stage my candidature will be cancelled and necessary action
will be initiated against me.

Place : c/o 56 APO Signature of

Candidate Date :

COUNTERSIGNED

Place : c/o 56 APO

Date :