MEDICAL CERTIFICATE (NCC OFFICER’S AND CADETS)

1. Certified that I have examined No.AP23J F3000 Rank: Cdt Name:___________________________

Son/daughter/ward of ___________________________College/School SKPVVHH SCHOOL

and Unit: 8(A) AIR SQN NCC in accordance with the standard laid down in NCC Act& Rules and found him fit to
undergo training of strenuous nature on the ATC camp/course being held at SVS EMH SCHOOL ,VUYYURU
from 16-05-2024 to 25-05-2024.

2. I also certify that the above mentioned officer/cadet has been inoculated / vaccinated against : -

(a) Typhoid (TAB).

(b) Tetanus.
(c) Tuberculosis.
(d) Hepatitis.
Note: Strike out same if not applicable.
3. It is further certified that the above mentioned person/cadet does not have symptoms of H1N1 virus.

Station :VIJAYAWADA-1 (Sig. of Medical Officer)

Date:15-05-2024 (Name & Stamp)

COUNTERSIGNED BY

(OC Unit)

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RISK/ WILLINGNESS CERTIFICATE

This is to certify that I No. AP23J F3000 Rank Cdt Name:_____________________________

Father’s Name Sri ____________________________ College/School SKPVVHH SCHOOL
Unit: 8(A) AIR SQN NCC volunteer/willing to attend ATC Camp being held at SVS EMH SCHOOL ,VUYYURU
from16-05-2024 to 25-05-2024 at my own risk.

Countersigned by Sig. of Cadet

(Father/ Guardian) Address

Name in Full________________________
Address:KOTHAPETA
VIJAYAWADA1-520001
PARENT’S CONSENT CERTIFICATE
This is to certify that I have no objection to spare my son/ward No. _________________ Rank: Cdt
Name:__________________________________ College/School SKPVVHH SCHOOL
Unit: 8(A) AIR SQN NCC to attend the ATC Camp being held at SVS EMH SCHOOL ,VUYYURU
from16-05-2024 to 25-05-2024

Station VIJAYAWADA-1
Dated : 15-05-2024 (Sig. of parent/guardian)

(Sig. of ANO) (Sig. of Head of the Institution with stamp)

COUNTERSIGNED BY

(OC Unit)
 INDEMNITY BOND
In consideration of my being nominated at my request as a participant in Camp/Course/Adventure Trg
activities (like Mountaineering, Rock-Climbing, Trekking, Hiking Sinking, Cycling & Expeditions & Travelling, I
undertake and agree that neither I, nor my executor, nor administrator will make any claim against the Govt. of India
or against any Officer JCO/OR, Civilian MT Driver or any loss or injury to the property or person (including injury
resulting in death) which I may suffer while or in consequence of my participation and I understand that no
compensation will be paid by the Govt. of India or any officer JCO/OR Civilian MT Driver 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 camp and journey by road/rail.
_____________________________
Station: VIJAYAWADA-1 (Signature of the applicant)
D a t e : 15-05-2024 Name in block letters ______________
with address KOTHAPETA
VIJAYAWADA1-520001

in presence of (Sig. of ANO)

witness Signature with date

and address 1.____________________________
Address SKPVVHH SCHOOL
KOTHAPETA,VIJAYAWADA-520001
2.____________________________
Address SKPVVHH SCHOOL
KOTHAPETA,VIJAYAWADA-520001

Countersignature of Father/Guardian
with date_________________

Name in block letters _______________

(Signature of Head of the Institution)
Address KOTHAPETA
VIJAYAWADA1-520001
COUNTERSIGNED BY

(OC Unit)

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DROWNING/ACCIDENT CERTIFICATE
1. I know that there are deep water areas and wells near the camp site and that these areas are “OUT OF
BOUNDS”.
2. I have been explained the precautions to be taken against drowning/accident and I have understood them. I
have been told not to go to any unauthorized water areas in the vicinity of the camp. If I go to any of these “OUT OF
BOUNDS” area specified I shall do so entirely at my own risk.
Name of Unit : 8(A) AIR SQN NCC,GURUNANAK COLONY,VIJAYAWADA
Name of Gp HQ : KAKINADA
Name of NCC Dte :SECUNDRABAD
Ser Regtl No Rank Name of the Cadet Institution Signature Remarks
SKPVVHH
SCHOOL,VJA-1
AP23J F3000 Cdt

Certified that the orders regarding precautions to be taken against drowning/accident and orders regarding out of
bound areas have been explained to the cadet and the cadet has signed in my presence.

Station: VIJAYAWADA-1 Signature of OC Unit

Date :15-05-2024