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6 KAR AIR SQN NCC, MANGALORE

.5NROLMENT FOR:M: SENIOR 01v'1s10N

I WING
(See Rules 7 and 11 of NCC Act, 1948)

ENROLMENT NUMBE -
I
(Alloted by ANO)
I '
Sign of ANO ~~: :;:µ t;f4 :!:i, u.._ Fg C A . , ..
,.

St ~. __ _: -- .. - ~- ,· __ __.. ~o110 s)
· - Mangaluru - 575 003

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2. Nationality & Date of Birth / I INIDII I4 INI / [I@ [il l [Link] /o i:,J
(DD/ MMMYYY) ,__.... ( - f
I I I
I
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LJ'
3. Father's / Guardian's Name IRI>' rJ N I I
I I
'
: '
~C- 1H (j N Cr, b u /R I

L~_j__c/_I I< u I l - L' ____ I ! I I

4. Mother's Name

5. Residential Address
(Landmark, State , Dist,
Taluka, City Nill, PIN Code)

_ P ()_ . _ _l~I~~

6. Mobile No. r2nf1s1£1d1, 1illim 1T IT r- ·1 1 1 1 11

E-mail ID Ufki1r"J IRl 1ls lrlc _l ~t lolNlilnlulB..lc IHIt IRlul
i
7.

8. Blood Group [DJT□ ?·

I 9. Sex ftilal LIEI I I
I
10. Nearest Railway Station /1V/ Ift INIG7 I11 IL Io IIQ IEl IRIA Ir IL IlJ I1r
IY I IS IT.!
11 . Nearest Police Station I13 /A IRIRIEI IP IO IL / I It IE I IsIT Ifl IT /I /o INI
~ / ~/ c; I s1 l I I I I I I l I I I I ·I I ]
I 12. Educational Qualification
~ /
& Marks in(% )

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 -■1 m■■.-W
l·o F [Link]~[0il--
.. 13. Identification Mark~: I

---~ --
I _L..--------_

-~ -
iii -• -

14 _ Have you ever b~e~

convicted by a cnmrnal court
& if so in what circumstances
~ 0
----------
-
1-------
- -
--
-
- · -- --
-
-

-and what was the sentence ? -

Attach relevant documents. -
L L £
15. Name of School/ College and
Stream (Arts / Science I
lliilJAJZ~4~~'-P-blm·Rtilfr
Commerce)

16. Govt/ Govt Aided

17. Willing to be enrolled and

undergo training under the
IY I ?J N !
National Cadet Corps Act, 1948.~ ~-.----,---- --,------.--, -,-,-r-=-r:= -r:--:-i-~ ~ T rl i f\ 7]
18. NCC Unit to be enrolled in J 6 I I K I A IR I IA I I I R I I S Ia \N \ \N \C \C \ -

19. Have you been enrolled in

NCC earlier if yes, Your
Enrolment No.
lyl 1 N 1✓1 1 , 1 1 1 1 1 1 1

20 · tri~e;ic!T
H u he beenTe~ritorial
d "smissed Army/ ._:,I I I 0
1_ 11
_ _ 11_ _ 11 _ I_ \ I 1 1 1 1 1 \ \\
the Indian Armed Forces.
Please provide detai Is
L.
1 1
l --l---1----l--1----+-----l---+\-+-+\-+\-+-\--+-\
_j_.....i--l----
1 1
L---1._L____.!. __.l__.L__J___ _j__j___J_....L. .__.L____l__J__ L .__L___J___.l.
_J\1--i\-t\---t\- \
1 1

..__J.___J..__

21 . Next to Kin with address

ft\"- \f}I~\' \ ajrJ
(with relationship) Telephone
No. (0) I (R) as applicable l-~_€- _tvl<r _J _J~dJslT\ l&!Li oh ls 11 lol.J l I
J\TE- \W I I\ I I\ \ \

· 22. Bank Details C E N T R. A L 8 R rv I<_ 0 F 1 N D\L \

(Bank Name & Branch)
0 r $ t\l u p u R l?J r:z A N C H I I
23. J3ank Ac. No. of the Cadet
(First page of pass book)

24. IFSC Code /c I13 I 1 I NIO12/'B \ li IE, \1 \1 \ \ \ \ \ \ \ \ \ \

25. Aadhaar I UID No. (if allotted) I2 I0 I3 I1171 1Ii, I8 \ / \ 6 \0 \1 \ \ \ \ \ \ \ \ \
26. PANCard No.(ifallot ted) IDIE /NIPIC. l.2. \8]S\J. \H\ \ \ \ \ \ \ \ \ \ \
' .

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Place: l18Al &fllDR[

Date : /12 / r!J?/ 2-{) ~
 TS WELFARE SOCIETY
I cv~
MEMBERSHIP QF T:ciM~~r.;~~QRM !ii· .
..._,_ ~
(;JV &'
SECTION-I ~~
1. ~ Cadet (name in block Lette rs).t.
11
J.M0 .8.I.~ 1 C0. Q~&,d).uP.,......... Sorv'Oaughter ot
..... ..
Sm (Name in block letters) ..f};[Link] t....C. &. .. · tuden
· · V/'
t of class r. M i rM 5 l 1..,, f
••,.'i...... •;" 0
-[Link].D.U. · ' a 5
( er.
Name of College/School)~ fll "' ·
NCC on (Date) J')lc ") / i t-, wi'th
..
. .),. ...:,. ........
.1:11..D.Y..~l./
c
)..J ...
p_, 1 c..au.e& Eon my enrolme
••
(Name of 1h8 unit)
w.... . ·
.6..... ~

nt With the
f.t.d?:-......5.Q..IJ!...6/C(_
..... ···...
\
apply for memberslip of the National nd he b
sli>scribe a sum of Rs. 41. (R~ees
2. V
My Father/Mother/Guardian's occu
arnual ircome of my family from all so11

Cadet Corps Cadets Welfare Society

Foll Only) towards its membership
pation Is....~ /.~

fee.
......................~ the

a re Y
'
ces Is Rs ..... J.. l ./..1..0..0/J........... per anrun.
3. I \n:ierstaro that I shall be entitled
to financial assistance as dete rmined by the
Goverring Body/Managing committe
e of the above Society in the even
permanent disablement sustained by t of partial or
me wlile participating in an organised
hereby accept that the decision of the NC actMty. I
Goverring Body/Managing Committee
the quantun of assistance to be with regard to
paid to me \n the evert of permanerupar
wil be final ard birding on me . tial disablement
4. I hereby oominate the folloWing person(s)
determined by the Govening Body/Man wro will receive financial assis tance, as
aging Com mittee of the abov e Society,
final ard birding on the following perso which will be
n(s) in the event of my death wlile parti
organised NCC acti'Jity.- cipating in an
Ser. Name of Age Relationship Permanent Address of the Percentage
No Nominee(s) with the Nominee(s) of Financial
Cadet
Assistarce
payable
R:tflN C1ff/Roi /Cf/vll.,,EN
Sot, f4TH1:R v :~ , p.o 1... _oK..rt:1 1(_ -- -r.
U1 oN&JtuR. .:::;;O
p~ I (VJIWIPUI<.
CW!-f<Oi te/ft lll- EN V t"L .
5o f
11-&J IH tffl
~°' MDTHfR..
111JN1PVR.
p,o l-vv fr/C pRo 7 e c...T
(To be filled by the cadet in his own hard
writing)
5. My mernbersnp In the Wettare Society
ard this Nomination Form will be valld ortf till
such time I remain a cadet in the Di'tis
lon or Wing of the NCC to which I ha'v'8
been enrolled
Date: 12- lrn /).0 ~r ~
Place: /VI ~ &7 JI LoR E
(Full Signature of the Cadet)
 TO BE USED FOR EXTENSION OF ENROLMENT
{See Rules 13)

A. 1agree to extend my enrolment for one year and am willing to fulfil the
engagement made.

Place: ...................................................
Date: Signature of Applicant

Confirmed

Place: ............................................... ·····................

Date of Enrolment: Signature of Commanding Officer

B. I agree to extend the enrolment of my son/daughter/ward for one year an

am willing to fulfil the engagement made.

Place: ............................ . . . . . . . . . . . . ................................ .

,

Date: Signature of Parent/Guardian

Confirmed

Place:
Date from which Extension Starts:
..................... ················ . . . . . . .......
Signature of Principal
 I
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/

4.
T
BEFORE ENJ,'.OLMEN
ER
ICAL OFFIC
LETED B Y
MED
(date)~ - ::
f- ~~
IQ B E COMP M r. ~.U
on.
·
JGlJCJR C
ame) 4 fV
loJ2t-5T CH-of\ . .
a d e t C o rp s
ational C
.

~
1
xamined.(N
have heim ~ . n t a s a c a d e t m th e N
er I e n ro lm e
a n d c o n s id ht I 1.#R#ff to r

-- ---
Signa ure- - ; - - - - -

DesigHM?TAO

Sea/
- ~ f 'I [Link]
~w,.;,[Link]~{ r==-~-
!ni~rtrri8
ic1 Rosp
Wealock .Distr 15001 '"'--.;,
r-e, _;.
·&&.n,a!a
 f I t i

DECLARATION ON ACCEPTANCE FOR ENROLMENT

1· I soll~mnly declare that the answers I have~ given to the queistions in this form are
the engag emen t
true and that no part of !hem is false, and that I am willing to· fulfil
made.

2. 1.~ iJ:. ..... ~ .b ...~... promise that I will honestly ~nd faithfully
National Cade t
serve my country and abide by the rules and Regulation of the
Corps that I will, to the best of my ability.

will ~ve no cl~im

3. [Link]::c,.v1C..0.1&~1.1,,tf urther promise that after enrolment, I
accident dunng
on authorities forl any compensation in the event of injury due to
train~ng-~amps;: c6yrse.s, travelling and while on YEP or any other such NCC
events like RDC and IGC. I understand I have no service liability.

Place: MIJN (J)AL tJRt

Date: 11J-./ O'J-/ 'JD'J.-'1

DECLARATION BY PARENT/GUARDIAN
and that no
1. I solemnly declare that the answers given in this form are true
to fulfil the
part of them is false, and that my sorv'daughter/wars is willing
engagement made.

2. I ... ~~ ~....... ............promise that after enrolment of my

o n in the
ensati_
sorv'daughter/ward, I will have no claim on authorities for any comp
s, courses,
event of any injury or death due to accident during training camp
and IGC .
travelling and while on YPE or any other such NCC events like Rpc

Place: l'?lfJ1\l-6J rrwl!& .. .. . . ........ ......... ~.~~ .•.•L

Date: 12- / o 'l /U )-t, Signature of Par~ ~UG~ ·ian

CERTIFICATE

and agree to the ·

Certified that the applicant and his parent/gua{C\~ understand
conditions of enrolment. , ~f
(Parveen BishnoiJ
Wing Commander
Commanding Officer
Place
Date ·········si~~~;~~t~ i;~·otti~~~····
(Unit Seal)
 f I
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Date:
( l_ /01/24
SECTiON-11 y
e,•~
Place:
rY/81\J&t A LOR_ t (Signature of PTO/ Head of nstitution)
Vi ce Ch ::i ri cell or . :
St Aloysius (f' ~e m:- r; ''l': Univr. rs 1ty) :

SECTION-IIIVi a11ya1ur u- 3
1 .... ~ ~ --~
am wimng to allow my son/daughter/ward (Name)
s Cadet Welfare Society under the terms
to beco me a member of the National Cadet Corp
& .conditions and the rules in force of the Society.
I also approve the nomination(s) made in
// Section I (4).

Date: I 1--/.b?j UJP'-/ 7101~_

(Full Signature of~Father/Mother/Guardian)
Place: f'7 lfJ1v c;. ra-wR f5

Witness Witness

(Signature)
~
1....... ........ ...
. , .. • ~ '-i.c\\ X: ,,?J:._J
C· ·\I- I ., I I I''CC Orit
. c•,..?te
1•.sso . . . J OR
coY COL~t;!At·?~~
. "' "
t-r-•
(~ig~;; ··~~·£3t:::-:~~ NCC / 06120 015
Assoc iate ~~Ge Officer
NC.::, -~~ 11011 ,
0 1
e51 Full Nam e~~f rc#.~r·~iH~:-'al u:it NC~
Full Name & AdgressyQ'(Js ~70; lfil~'tA,.,,ohe9e ,;,,Ub Unit
Office Seal of theAWitn~ss'J o Office Sea O Mlfno~lffit~~75 003

officer/head of institution /Associated NCC _

Note: - The witnesses should be either gazetted
Officer/Sarpanch/Vi llage Head.

SECTION-IV
one time slbscription & enrolled as a
Received a sum of Rs. 4/- (Rupees four only) as
Society during the Cadetship in the
member of the National Cadet Corps Welfare
~/S eni or DivisiorvWing.
~ ~
Date· {P.1rveen Bishnoi)
'!{i1JQ..CoVJ m#1 ndltl·
(Signature of~ ~ijf fig'6ttrc~ cial Seal)
6 ,(at Air Sqn NCC
Mangaluru - 575 002
SECTION-V
(To be filled by the NCC unit)

4
.............................. ........ ....... ...
Date of despatch of the Nomination form to Group HQ
 •
INDEMNITY uoND

To,
The President of India . thoritie s or at my own request
CC
. . . d 81·ther by the N
au d Indepe ndence Day
In consideration of being nomin_ate. Re ublic Day Camp ~n . Win 9 activitie s
as a participant in any NCC camp (wh1_c~ in~ludes_ p , Navy and Air '.orce
Camp in Delhi),Course, Adventure Tra1rnng(mclud!ng ArmYtional surface ' s art'
, air and water _tran P )
-J as the cas~. may be) and while tr~velling (in domesticfinterna
dertake and agree th~t neith_er I, nor
and attending Youth Exchange Programme(YEP) abroad, 1~n t
my executors or administrators or other legal repr~sentative~ ~'~cO'
Government or against NCC authorities including officers, JCO 5
.11 make ariy claim aga1nS the
s or their equiva lents from
on in the service of the
\
Navy and Air Force, civilians, MT drivers or against any other such per~
luding injury resultin g
~overn ment, in respect of any loss or injury to the property or per~on,
,n_c conseq uence of my
in d~~th , _du~ to any reasons whatsoever which I may 1
suffer, while or ~ ill be aid by the
part1c1pat1on 1n the above activities and I understand that no compen
Govern ment or NCC authorities including officers, JCO's/N CO's or their
s~tion '!' t5pf Navy
equival en rom b. d
and Air Force or Civilian MT drivers in respect of any such loss or injury
and I awee as ~o in
myself, my executors and administrators and other legal represe ntatives th
to indemn ify e
nd
G_overnme~t ?_r NCC authorities including officers , JCOs/N COs or their
Air Force. c1v1han MT drivers or any person in the service of Govern ment
equiv~l ent from ~a'-: ~
against any claim which
mat be fr~m any third party against them or any of them arising out of any act of default
on my part
dunng or in connection with the said camps, courses , adventure training
, travellin g and while on
~outh [Link] Programme or any other such NCC activities as may
be organiz ed from time to
time w1th 1n or outside the Union of India.

~ ~( ' / , , ~
Witness Signature of~~~li gant

1. Signatu re No.: _ _ _ _ _ _ _ _ _ _ _ _ __

Name : Name. : A:MoRH:.1 CJ:bN61DoR,

Addres s : l\\-oo8~L- Qk(}~ ~J-l~~ ,( 0 ~Unit :,G kQP, (J]'Q :7:q N NCC
2. Signatu re j v ~ ~ o . _ ~tar(\.OJl, o.m,-......,'

Name : ~~~ 13""'-"-'of<Y'- --;/n, ~

Addres s : . - v ~A\.. ~ PJAN 1 o N&t \', A Signature □mrent I G ~; _rdi~n
00
Name : f+}ty , ~ l<f vD • ,
Place: MfrN& ,r'iL0'/ 2.l .
Address £f fvl,,~g/r,~ q~_s.. IJ,9-/
Date: /:2--/ lYr/ :;..D~ m ~uv-1. ~ {)CJ.2:,

(NOiE : In case of SD applicant being a minor, Indemnity Bond applicable to ~inor will
be used)
 li&ii:i@iiQ)
Jil ►-5 ;g 41'P.1111!111mibdUNQQD$iiiMlty armi:lla-
Mloristrt,_ ,, .
Date of vuvuwdur Chlru
Mele/ ~~B: 28103/'l009 Address:
S/O: Ryan Chongdur Chin, Chafol l(hullen

I Pci· ~oktak PrOjeCI.

VIHage, Charol Khullen

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DIST: Churachandpur ' •

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lspn,olof
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Manlpu( • 795124 '

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"-Id be used wfth w,1
or sann1,. of QJI codt _ katlon (onllne
1~mnt!XMI). I
2431 7148 1507
2431 7148 1507 VID : 9120 11o40 0920 8971

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