Appendix 'A '

MEDICAL FITNESS CERTIFICATE

1. Certified that I have examined No …………………………… Rank …………………………...

………Name …………………………………………Son/Daughter/Ward of

………………………………………… In accordance with the standards laid down in NCC Act and Rules

Appendix ‘A’ and found him fit to undergo training of strenuous nature in ……………………………….. at

…………………………. being conducted from …… 2023 to ….. ….2023.

2. I also certify that the above mentioned Officer /Cadet has been inoculated / vaccinated against: -
(a) Typhoid (TAB)
(b) Tetanus (TT)
(c ) Tuberculosis (BCG)

3. It is confirmed that child is not suffering from (Swine Flu)

Station : Signature of Medical Officer (Name

in Block Letters
Date : with Designation & Seal)
 Appendix ‘B ’

INOCULATION/VACCINATION CERTIFICATE

PART – I
1. I Number __________________ Rank _______________ Name __________________
Father’s Name ________________________ Institution ________________________________
Unit 3 Punjab Girls Bn NCC, Ludhiana do hereby declare that: -
(a) I have not suffered from typhoid, chickenpox or any other infectious diseases during last
three months.
(b) I am not suffering for any chronic disease such as dysentery.
(c) I have not undergone any operation amputation to me for active life in past.
(d) I have been protected against cholera, typhoid by inoculation.
2. I also certify that the above mentioned officer/cadet has/have been inoculated/vaccinated against
Smallpox and Typhoid.

Station:
Date : Signature of Cadet
PART – II

1. Certified that I have examined Number ____________ Rank ______ Name __________ _
Found him/her to undergo …………………… to be held at ……………………………… from … …….
2023 to … ……. 2023.
2. I hereby certify that the above mentioned individual has been inoculated / vaccinated.

Station : Signature of Medical Officer (Name

in Block Letters
with Designation & Seal)
__
 Appendix ' C '

VOLUNTEER / RISK CERTIFICATE

This is to certify that I, No. ………………………………………. Rank…………………………….

…Name …………………………………………………… Institution ………………………………….

Unit……………………………….. am a volunteer to attend …………………….

at………………………………. from ……….. 2023 to ………… 2023 at my own risk.

Station: (Signature of the Applicant)

Dated:
PARENTS CONSENT CERTIFICATE

This is certified that I have no objection to spare my son/daughter, Regtl

No.______________________Rank_____________Name_________________________________________

_College/School_____________________________Unit ………………………… to attend the

………………..

Station:
Dated
Signature…………………
Relation with Cdt …………………
Name in Block Letters…………………...
Address………………………………………

TO BE ATTESTED BY PRINCIPAL / HEADMASTER

Certified that No ……………………………… Rank ……………….. Name of cadet

……………………………….. is on the role of the School / College and can be spared to attend
………………. at ………………………………………. From ………….... 2023 to ….………. 2023.

Station: (Signature of the Principal / Headmaster)

Dated : Office seal of the Institution

COUNTERSIGNED

CO Unit (With seal)

 Appendix ‘D ’
(Refers to Para of Adm
Joining Instructions)

FORM OF INDEMNITY FOR OFFICERS/ CADETS

NCC No_____________________Rank_________Name__________________________
Institution________________________________________________________________
Place ____________________PIN_________________ Contact Tele No____________
in consideration of my being nominated at my request to undergo all types of training and
also participate in any camp, courses, adventure training activities in/ outside NCC and
during traveling, I undertake and agree that neither I, nor my executors nor administrators
will make my claim against any Officer/ JCO/ OR of Armed Forces/ Civilian/ MT Drivers in
respect of injury to the property or person including injury resulting in death which I may
suffer while or in consequence of my being in training/ participating in the camp/
courses/ 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 of Armed
Forces/ Civilian/ MT Driver or any person in the service of the Govt of India or State
Govts in respect of any such loss or injury (including injury resulting in death) and I agree
so as to bind myself, executors and administrators to indemnify the Govt India or any
person in the service of the Govt of India or State Govts against any claim which may be
made by any act of or default on my part during or in connection with the said training
camp/ courses/ adventure training and journey by road/ rail/ sea and flight:
The Government has agreed to bear the stamp duty on this document:

In presence of Witnesses:-

Witness 1: Witness 2:

Signature ___________________ Signature______________________

No: ________________________
No:___________________________
Rank_______________________
Rank__________________________
Name ______________________
Name______________________ ____

Sign of Applicant______________ Sign of Guardians________________

No:_________________________ Name _________________________
Rank______________________ _ Relation________________________
Name______________________ _` Address________________________
Mob No:_____________________ _______________________________
Mob No:________________________
COUNTERSIGNED BY CO UNIT

Place :
Date :
 Appendix ‘ E ’
(Refers to Para of Adm
Joining Instructions)

NON DROWNING/ ACCIDENT CERTIFICATE

I know that there are deep water areas nearby the camp and locations of the
conducted tours: These areas are ‘OUT OF BOUNDS’ to me: If I go there, I shall do so,
entirely at my own risk: I have been explained the precautions to be taken against
drowning and have understood them: I have been told that going near the reservoir or
canals in the vicinity shall be entirely at my own risk:

NCC Unit : ___________________

Name of Gp HQ Ludhiana

Name of NCC Dte Chandigarh

S/No NCC No Rank & Name (Surname & Initial) Signature of Cdt

Certified that I have been explained the orders regarding the precautions to be taken
against drowning accidents and have shown all ‘OUT OF BOUNDS’ areas to all the cadets
in my charge: The cadets have signed in my presence:

Place : Signature of CO Unit

Date : (NCC Unit)