6AvlAniplecIGHGelsPT applicant)

LIASTI
1LAST Code)GIAURAVINALAsolAEClEiPANoArn
AAlkAWG the
of(Sighature
2013) 1948)
MUDDLEL
PREMCHANDRARA SA1449H323d
(Revised Act. 14Alu
NCC KSATH
AKAA NALLALoeA2IAL
CIALLASolpAAAL
'A of MAGH|ANh
Appendix 11and
Rules7
CORPS
CADET'
NATIONAL
S
TNDEAN FIRsTI 15H1N
A14MAL YN
TFLR
(Seo
A
FORM Territorial
FORMI court
the
ENROLMENT yes,
1948 earlier,IfNCC/therelationship)
Was
criminal training
Pin (%)
City/Vill, in
whatdocuments. Please applicable)
Stream undergo
Act,
Marks two) by and
a Parent
DIVISIONWING convicted
circumstances Corps NCC fromForces;
LETTERS) Taluka, (with CODE allotted)
& least
Qualifications relevantandCommerce)
(Arts/Science/
andCadetin in dismissedaddress
(as allotted)
Birth Name
Fathers/Guardian's Schoo/College enrolled
enrolled /
Cadet (2022
12|to
Date:
Distt Station
Railway
Nearest
Nearest (at
Station
Police enrolled Amed (0)/(R) IFSC (If bai
um
Place:
BLOCK of Address
Residential Marks been National No. Enrolment
Your No. (If
Date(DDIMMYYm State, Attach
be been been details:
Provide
Indianwith /detail ofNo. Aadhaar/UID
everWhat
Identification No. No.
SENIOR Mothers
Name
Educational
(IN
&
Nationality
(Landmark,
Mobile
No.
Group
Blood
youin
sentence? beto thetoUnit you you Kin TelephoneBanker'Acct. s Card
of Arm/the
Name Willing
id
e-mail under to
Name
so
Have NCC Have Have Next Bank PAN
Sex if
&
14. 15. 16. 17. 18. 19. 20. 21. 22. 23. 24.
6. 7. 8. 9. 10 11 12. 13
1 2 3 4 5
 -2
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 Akanhsha Ojha promise that I will honestly and faithfully serve my
country and abide by the Rules &Regulations of the National Cadet Corps thatI 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 Akonksha Ojha. further promise that after enrolment, I willhave no
claim on authorities for any compensation in the event of injury or death due to accident
during training camps, courses, traveling and while on YEP or any other such NCC events
like RDCand ID C.Iunderstand I have no service liability.
Place 12 ||ol2022 /M Umbai
Date
Signature of the applicant

2.

1. Isolemnly
DECLARATION BY PARENT / GUARDIAN
declare that the answers given in this form are
them is false and that my true and that no part of
son/daughter/ward is willing to fulfillthe
engagement made.
2.
IPeencha ndaa
Iward, I will have no oiha promise that
claim on authorities for any
after the enrolment of my son /
daughter
death due to accident during compensation in the event of any injury or
training camps, courses, travelling and wvhile on
other such NCCevents like RDC and IDC. YEP or any
Place : umbai
Date 12o2022 Signature of Parent / Guardian
9.
 (3)
OFFICER BEFORE ENROLMENT
TO BE COMPLETED BY MEDICAL

Ihave examined (Name) AKANKS HA QTHA On

Corps
enrolment as a Ccadet in the National Gadet
and consider bim7 her Fit / Unit for

FRTRT /Sbnahure
UT- Place MUMBAT RDesignatio
ÜG Date (ert aery Medical OfMoar
AGARWAL
DR. ASHWDA KUMAR MbS.
CERTIFICATE Bas 074372

and his parent/ guardian understand and agree to the conditions of

Cerfified that applicant
enrolment.

T- Place CTO BHALCHANDRA SAVARDEKAR

Sgnatg0Y6CEMMAyRer
Date of enrolment RO OORLEGECHURCHGATE
(Unit Seal) MUMBAI -400020
(ge te)
(See Rule 13)
TO BE USED FOR EXTENSION OF ENROLMENT

A. lagree to extend my enrolment for one year and am

willing to fulfill the engagement made

RUT- Place: - lo nbai

fratn-Date:- (2|10|20 22
Confirmed. (yfe à sT t)

RR- Place: Signature the Commanding Officer

feRT5- Date:

B. lagree to extend the enrolment of my son/ daughter / ward for one year and am wiling to fulifi

RTT- Place:- umba SorgargahParent /I Guardian

rat- Date: - 2o[2 022
Confirmed :-(fr â ST¥à)
- Place i
Date from which extension starts (Signature of Headmaster/Principal)

Note. This form will be retained in the school in which the unit is located
 Appendix BRefers to para 3of
DGNCCletters 19952/D GNCCCWS dated 28.Apr. 2000
Nomination Form
For Membership of the NCC Cadets Welfare Society
(to be retained at NCC Group HÌ)

(Section-1)
1
(/a )

5) (

I, Cadet (name in block letters) FlH ANKSHA yAghter of Shri

(name in block letter) RECHANDRA THP studenttof class of (Name) of
NCC on (Date) lab]22with
College/School) .KS.COLLEGE on my enrolment with the NCC Cadets Welfare Society
(Name of the Unit) 1Mah.Gn.Nc.apply for membership of the
only) towards its
and hereby subscribe a sum of Rs. (Rupees
membership fee.
2
3114
My father/ Mother/Guardian's, ocgupation is Efa ales oncgshd the annual income of
Rs90Q0O per annum.
my family from all sources is
3

I understand that l shall be entitled to financial relief as detemined 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 organised NCC activity. Ihereby 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

Aufa sTT |
Ihereby 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
Soceity, which will be final and binding on the following person(s) in the event of my death while
participating in an organised NCC activity :

(ire HerRT )
S.No. Name of the nomince(s) Age Relationship Permanent address %of financial
(in block letters) with the cadet of the nominee assistance Payable
G06, Anand
1. |DetMcEONORE fATHER 100/

3.

he ERI a 4RT Y (To be filled by the Cadet in own hand writing)

5.
till such time I
Society and this Nomination Form willbe valid only
My membership in the Welfare the NCC to which I have been enrolled.
Wing of
remain a cadet in the Division or

(Full Signaguge gfthe Cadet)

fRis Date : 12 | \0 2o2 2
FeITT Place : Mum bai
(Section-ID
6t6 BHALCHANDRA

FeT Place :
IÑT Date : MäMBAI- 400020
(Section-IID)

Iam willing to allow my son/daughter/ward name Alkankaha..ajha. to become a

Society. I
Welfare Soceity under the terms & conditions and rules in force of the
member of the NCC Cadets
also approve of the nomination made in Section 1(4).

FeTT Place : Mumba (Full Signature of the father/mother

Guardian with complete address)
TIA Date : 12(o[2o22
CTO BHALCHANDRA SAVARDEKAR
Witness 2. COY.COMMANDER.
1.
KC COEE8E CHURCHGATE
(ERTIER)
(Signature) QigNBAP) 400020
Full nanme and address with office seal of the
Full name and address with office seal of the
Witness. Witness.
Note :- The Witness should be either gazetted officer, head of institution/ANO/Sarpanch/Village Head.

Section-IV

(5
Received a sum of Rs. ... (Rupees .only) as one time
subscription and enrolled as a member of the NCC Cadets Welfare Society during the cadetship in the
Junior/Senior Division/wing.

7e Place : (Signature of the OC Unit with office seal )

GIA Date :
Section-V

(To be filled in by the NCC unit)

Date of despatch of the Nomination Form to Group HQ ..
Note:- The Nomination Form willbe printed on both sides of asingle lead.