FORM OF INDEMNITY FOR NCC OFFICERS/OFFICERS CADET/CADETS

OF ARMY/NAVY/AIR AND GIRLS DIVISION

In consideration of my being nominated at my request to undergo all types of training and also
participate in any Camp/Course/Adventure training activities in/outside NCC and travelling. I undertake and
agree that neither I nor my executor no administrator will make any claim against the Govt. of India or against
any officer. JCO/OR, Armed Forces / Civilian MT Driver or person (including injury resulting in death ) which
I may suffer while or in consequences of my being in training/participating in any camp /Course/Adventure
training activities in/outside NCC and travelling 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 person in the Govt of
India and in respect of any such losses or injury (including injury resulting death) and I 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 India against any 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
the said training/camp/courses/adventure training and journey by road/rail /sea/river and flight.

The Govt. has agreed to bear the stamp duty on this document.
Signed by the Applicant.

Rank _________ Name _______________ Signature of Applicant ___________________

Address __________________________________
_________________________________________
WITNESS

(1) Signature
(with date)____________________________
Name in Block Letters___________________
Address______________________________
____________________Ph. ______________ __________________________________________
Countersignature of father/Guardian with date

(2) Signature Name in Block Letters______________________

(with date)_____________________________ __________________________________________
Name in Block Letters____________________ Address___________________________________
Address_______________________________ __________________________________________
____________________Ph. ______________ ____________________Ph. __________________

WILLINGNESS CERTIFICATE

I ______________________________________________ SD/JD Cadet Rank _____________________________

Regt No. ________________________________College/School ________________________________________
and willing to proceed for the ____________________________________________________________________
to be held in the month ________________________from ___________________ to ____________________
____________________________________________________ my exams are over there for I may kindly be
allowed to attend the camp

Signature_________________________________
Name ____________________________________
(IN BLOCK Letters)
Address __________________________________
__________________________________________
__________________________________________

Appendix ‘B’
 MEDICAL FITNESS CERTIFICATE

Certified that I have examined No. __________________________ Rank__________________________

Name _________________________________ of College/School_______________________________________
Unit __________________________________ in accordance with has standard laid down in NCC Act and
Rules Appendix ‘A’ and found him fit to undergo training of ______________________________________________
With _____________________________________________________which is of strenuous nature and to be
held at_________________ from __________________ to ___________________.

I also certify that the Officer/Cadet has been inoculated against TB Small Box.

Date_______________ _____________________________
Signature of Medical Officer
Name in BLOCK Letters

COUNTERSIGNATURE OF Sign ______________ Rank ________ Designation______________

OC UNIT

Appendix ‘C’
RISK CERTIFICATE

This is to Certified that I No. ________________________________Rank__________________________

Name __________________________________of College/School______________________________________
Unit _________________________________ volunteer to attend________________________________________
With ___________________ to be held at __________________ from ______________ to ____________
at my risk.

Date _____________ Place ______________ Signature of NCC Officer/Cadet______________

Countersignature of Cadet’s Parent/Guardian Signature of father/Guardian _________________
for cadets only)
Name in Block Letters____________________
Address_______________________________
______________________________________
______________________________________
Attested by the principal of the college (Seal)
Date ____________ Place ________________
COUNTERSIGNATURE OF OC UNIT
Appendix ‘D’
SAFETY PRECAUTION CERTIFICATE

I know that there is a deep sea water near the camp site and the area is OUT OF BOUNDS, if I dare
to go there, I will be responsible.

S. NO Date College/School Regt NO Signature

Certificates signed in my presence

Date___________ Place ______________ Signature of OC unit _______________

Rank & Name_____________________
 DROWNING/ ACCIDENT CERTIFICATE

I know I Participate in the Water Spots : I know Swimming well, deep water is
‘OUT OF BOUNDS’ If I go there w/o caretaker, I shall so at my own risk.

I have been explained the orders regarding the precaution to be taken against drowning, accident
and have understood these. I have been told not to go near deep water in the vicinity
the In-charge. If I go to any of these ‘OUT OF BOUNDS’ areas, I shall do so at my own risk.

Name of Unit : 20 GUJ BN NCC,NAVSARI

Name of Group HQ : NCC GROUP HQ,VADODARA

Name of Directorate : NCC DIRECTORATE GUJARAT, AHMEDABAD

Sr

No.

Ser Regt No Rank Name of Cadet Signature of Cadet

No

Recommended

Certified that I have explained to the cadets to the orders regarding ‘OUT OF BOUND AREAS’ and
precautions to be taken against drowning/accident. The cadets have signed in presence of ANO/Unit
Commander.

Station : (Signature of CO/OC Unit with stamp)

Date :