Enrolment No.

_________________
APPENDIX 'A' Revised 2013)
FORM –I
NATIONAL CADET CORPSE

SENIOR DIV/ WING ENROLMENT FORM (See Rules 7 and 11 of NCC Act 1948

1. Name (IN BLOCK ATTESTED PP

LETTERS) SIZE COLOR
PHOTO

2. Nationality & Date of Birth I N D I A N

(DD/MM/YY)

3. Father’s/Guardian’s F I R S T M I D D L E L A S T
Name

4. Mother’s Name F I R S T M I D D L E L A S T

5. Residential Address
(Landmark, State,
DisttPin)

6. Mobile No.

7. G Mail ID.

8. Blood Group.

9. Sex.

10. Nearest Railway

Station.

11. Nearest Police Station.

12. Educational
qualification
& Marks in %
 -2-

13. Identification Marks (at least

two)

14. Have you ever been

convicted by a criminal court
& if so in what circumstances
and what was the sentence ?
Attach relevant documents.

15. Name of School/College and

Stream (Arts/Science/
Commerce

16. Willing to be enrolled and Y N

undergo training under the
National Cadet Corps Act 1948.

17. NCC Unit to be enrolled in

18. Have you been enrolled in NC

EARLIER, If yes, Your
Enrollment No.

19. Have you been dismissed from

NCC/the Terrtorial Army/ the
Indian Armed Forces, Please
Provide details

20. Next of Kin with Address

(with relationship) Telephone
No. (O) /(R) as applicable

21. Banker’s detail/IFSC Code

22. Bank Acct No. of Cadet/Parent

23. Aadhaar/UID No. (If allotted)

24. PAN Card No. (If allotted)

Place : Signature of the applicant

Date :
 -3-

DECLARATION ON ACCEPTANCE FOR ENROLMENT ¼HkrhZ ds fy, Lohd`r gks tkus ij ?kks’[Link] i=½

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.
eSa lR;fu’Bk ls ?kks’[Link] djrk gw¡a@djrh gw¡a fd bl QkeZ esa iz”uksa ds fy, esjs }kjk fn, x;s mRrj lR; gSa vkSj dksbZ Hkh
va”k xyr ugha gS A vkSj eSa fn;s x;s dk;Z dks iwjk djus ds fy, lger g¡w A
2. I, -----------------------------promise that I will honestly and faithfully serve my country and abide by
the Rules and Regulations of the National Cadet Corps that I will to the best of my ability, attend all
parades and camps as may be required by the Commanding Officer from time to time.
eSa &&&&&&&&&&&&&&&&&&& ok;nk djrk gw¡a@djrh gw¡a fd eSa bZekunkjh vkSj fu’BkiwoZd vius ns”k dh lsok
d:axk@d:axh rFkk jk’Vªh; dSMsV dksj ds fu;eksa dk ikyu d:axk@d:axh vkSj eSa viuh iwjh ;ksX;rk ls vius deku vf/kdkjh ds
vkns”kkuqlkj ijsM o f”kfojksa esa Hkkx yqx
a k@ywx
a hA
3. I, -----------------------------further promise that after enrolment, I will have no claim on authorities
for any compensation in the event of injury or death due to accident during training camps, courses,
travelling and while on YEP or any other such NCC events like RDC and IGC, I understand, I have no
service liability.
eSa &&&&&&&&&&&&&&&&&&& iqu% ok;nk djrk gwa¡@djrh gw¡a fd HkrhZ ds i”pkr izf”k{k.k f”kfojks]a ikB;dzeksa] ;k=k
;qok vknku&iznku dk;Zdze ds nkSjku rFkk [Link]= fnol f”kfoj vkSj LorU=rk fnol f”kfoj tSlh ,ulhlh dh vU; xfrfof/k;ksa ds
nkSjku nq?kZVuko”k ?kk;y gksus ij ;k e`R;q gksus ij {kfriwfrZ gsrq izkf/kdkfj;ksa ls fdlh izdkj dk nkok ughsa d:axk@d:axh A eSa bl
ckr dks le>rk@le>rh gw¡ fd eq> ij fdlh izdkj dh lsok dk nkf;Ro ugha gksxk A

Place ¼LFkku½ : ___________________________

Date ¼fnukad½ : Signature of the Applicant
¼vkosnd ds gLrk{kj½

DECLARATION BY PARENT/GURDIAN ¼firk vfHkHkkod }kjk ?kks’[Link]½

1. I, solemnly declare that the answers given in this form are true and that no part of them is false
and that my son/daughter/ward is willing to fulfit the engagement made.
eSa &&&&&&&&&&&&&&&&&&&lR;fu’BkiwoZd ?kks’[Link] djrk gwa¡@djrh gw¡a fd bl QkeZ esa fn;s x;s lHkh mRrj lR;
gSa vkSj mudk dksbZ Hkh va”k vlR; ugha gS A vkSj esjk iq=@iq=h@vkfJr fn;s x;s dk;Z dks Hkh djus ds fy, lger gSa A
2. I, -----------------------------promise that after the enrolment, my son/daughter/ward, I will have no
claim on authorities for any compensation in the event of any injuries or that due to incident during
training Camps, course, traveling and while on YEP or any other such NCC events like RDC and IGC.
eSa &&&&&&&&&&&&&&&&&&& ok;nk djrk gw¡a@djrh gw¡a fd esjs iq=@iq=h@vkfJr dh HkrhZ ds i”pkr izf”k{k.k
f”kfojks]a ;k=k vkSj ;qok vknku&iznku dk;Zdze ds nkSjku rFkk [Link]= fnol f”kfoj vkSj LorU=rk fnol f”kfoj tSlh vU; ,ulhlh
xfrfof/k;ksa ds nkSjku nq?kZVuko”k ?kk;y gksus ;k e`R;q gks tkus ij izkf/kdkfj;ksa ls fdlh izdkj dk nkok ughsa d:axk@d:axh A

Place ¼LFkku½ : ___________________________

Date ¼fnukad½ Signature of Parent/Guardian)
¼firk@vfHkHkkod ds gLrk{kj½
CERTIFICATE ¼izek.k&i=½
Certified that the applicant and his parent/guardian understand and agree to the conditions of
enrollment.
] ¼[Link] fd;k tkrk gS fd vkosnd vkSj mlds firk@vfHkHkkod HkrhZ dh “krkZsa dks le>rs gSa vkSj os muls lger gSa A½

Place ¼LFkku½ : ___________________________

Date of Enrollment ¼HkrhZ dh rkjh[k½ : Signature of Enrolling Officer)
Unit Seal ¼;wfuV lhy½ : ¼HkrhZ vQlj ds gLrk{kj½
 4
TO BE COMPLETED BY MEDICAL OFFICER BEFORE ENROLMENT
¼HkrhZ ls igys fpfdRlk vf/kdkjh }kjk Hkjk tk,½

I have examined (Name) ________________________________________ on

________________________ (date) and consider his/her fit/unfit for enrolment and cadet in the
National Cadet Corps.
eSaus &&&&&&&&&&&&&&&&&&&¼uke½++ &&&&&&&&&&&&&&&&&&&¼fnukad½ dks tkap dh vkSj esjs fopkj ls ;g jk’Vªh;
dSMsV dksj esa HkrhZ ds ;ksX;@v;ksX; gSa A

Place ¼LFkku½ : Signature ¼gLrk{kj½ _______________

Date ¼fnukad½ Designation ¼inuke½ __________________
Medical Officer ¼fpfdRlk vf/kdkjh½

TO BE USED FOR EXTENSION OF ENROLMENT

¼HkrhZ dh vof/k c<kus ds fy, iz;ksx fd;k tk,½
(See Rule 13) ¼fu;e 13 ns[ks½a

A. I agree to extend my enrolment for one year and a willing to fulfil the enrolment made.
eSa HkrhZ dh ,d c’kZ dh vof/k c<kus ds fy, lger gw¡ rFkk fn;s x;s dk;Z dks iwjk djus ds fy, lger gwa¡ A

Place ¼LFkku½ : ___________________________

Date ¼fnukad½ : Signature of Applicant)
¼vkosnd ds gLrk{kj½

Confirmed ¼iqf’V dh tkrh gS½

Place ¼LFkku½ : ___________________________

Date ¼fnukad½ : Signature of Commanding Officer)
¼dekUfMax vkfQlj ds gLrk{kj½

B. I agree to extend the enrolment of my son/daughter/ward for one year and an willing to fulfil the
enrolment made.
¼eSa vius iq=@iq=h@vkfJr dh HkrhZ dh vof/k dks ,d o’kZ rd c<kus ds fy, lger gwa vkSj fn, x, dk;Z dks iwjk
djus ds fy, lger g¡wa ½

Place ¼LFkku½ : ___________________________

Date ¼fnukad½ : Signature of Parent/Guardian)
¼firk@vfHkHkkod ds gLrk{kj½
Confirmed ¼iqf’V dh tkrh gS½

Place ¼LFkku½ : ___________________________

Date ¼fnukad½ : Signature of Headmaster/Principal)
¼iz/kkuk/;kid ds gLrk{kj½
Date from which extension starts ________________________
HkrhZ dh vof/k fdl rkjh[k ls “kq: gksrh gS A
NOTE : This form will be retained in the school in which the unit is located
Note : @ These are not included in the Form I of NCC Act & Rules.
 5
INDEMNITY BOND ¼bdjkjukek½

To ¼lsok es½a ]
The President of India ¼Hkkjr ds jk’Vªifr½]
In consideration of my being nominated either by the NCC authorities or at my own request as participant in any
NCC Camp (which includes Republic Day camp and Independence Day camp in Delhi), Course, Adventure Training
(including Army, Navy & Air Wing activities, as the case may be) and while traveling (in domestic/international surface, air
and water transport) and attending Youth Exchange Programme abroad, I undertake and agree that neither I, nor my executors
of administrators or other legal representatives will make any claim against the Government or against NCC authorities
including officers, JCO’s/NCO’s or their equivalents from Navy and Air Force/Civilians, MT Drivers or against any other
such person in the service of the Govt in respect of any loss or injury to the Property or person, including injury resulting in
death, due to any reasons whatsoever which I may suffer, while or in consequence of my participation in the above activities
and I understand that no compensation will be paid by the Government or NCC authorities including officers, JCO’s/NCO’s
or their equivalents from Navy and Air Force or Civilian MT Drivers in respect of any such loss or injury and I agree as to
bind myself, my executors and administrators and other legal representative indemnify the Govt or NCC authorities including
Officers JCOs/NCOs or their equivalents from Navy and Air Force Civilians 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 camps, courses, Adventure Training, traveling and while on Youth Exchange
Programme or any other such NCC activities as may be organized from time to time within or outside the Union of India.

jk’Vªh; dSMsV dksj izkf/kdkfj;ksa }kjk ukekafdr djus vFkok Lo;a vuqjks/k ij fdlh f”kfoj ¼ftlesa fnYyh esa gksus okys
[Link]= fnol f”kfoj vkSj LorU=rk fnol f”kfoj “kkfey gSa½ ikB;dze lkgfld izf”k{k.k ¼;Fkkuqlkj lsuk] ukSlsuk vjSj ok;q lsuk
xrfof/k;ksa lfgr½ vkSj ;k=k ¼lrgh] ok;q vkSj ty ifjogu }kjk Lons”kh@vUrjk’Vªh;½ vkSj fons”k esa ;qok vknku&iznku dk;Zdze esa
Hkkx ysus gsrq esjk p;u gksus ij] eSa opu nsrk gwa vkSj Lohdkj djrk gwa fd Åij fyf[kr xfrfcf/k;ksa esa Hkkx ysus ds nkSjku fdlh
Hkh dkj.k ls lkeku ;k O;fDrxr fdlh Hkh izdkj dh {kfr vFkok pksV] blesa pksV yxus ls e`R;q Hkh “kkfey gS] yxus ij eSa vkSj esjs
vkfJr] vf/kdkjh ;k iz”kkld vFkok vU; dksbZ oS| ljdkj ds f[kykQ ;k vQljks]a tslhvks] ,ulhvks ;k ukSlsuk vkSj ok;qlsuk esa
buds lerqY; vQlj] flfofy;uks]a ,eVh Mªkbojksa lfgr ,ulhlh izkf/kdkfj;ksa ds fojks/k esa ;k ljdkjh lsokjr O;fDr ds fojks/k esa
nkok ugha djsx a s vkSj eq>s Kkr gS fd bl izdkj dh fdlh {kfr vFkok pksV yxus ij ljdkj vFkok vQljks]a tslhvks@,ulhvks
lfgr ,ulhlh izkf/kdkfj;ks]a flfofy;u] ,eVh Mªkbojksa ;k ljdkjh lsokjr O;fDr dks fdlh Hkh izdkj ds nkos ds fy, bdjkjukesa ds
fy, eSa] Lo;a] esjs vf/kdkfj;ksa vkSj iz”kkldksa vkSj vU; fdlh oS| izkf/kdkfj;ksa dks ck/; djus ij eSa lger gwa A ;g nkok buds
fojks/k esa fdlh rhljh ikVhZ ls gks ldrk gS vFkok esjs }kjk fdlh izdkj ls nks’kh gksus ij gks ldrk gS ;k dfFkr f”kfojks]a
ikB;dzeks]a lkgfld izf”k{[Link]]a ;k=k vkSj ;qok vknku&iznku dk;Zdzeksa ;k Hkkjr ;k Hkkjr ls okgj le;&le; ij lapkfyr dh
tkus okyh jk’Vªh; dSMsV dksj xfrfof/k;ksa ls lEcfU/kr gks ldrk gS A

___________________
Signature of Applicant ¼vkosnd ds gLrk{kj½

Witness lk{kh
(1) Signature ¼gLrk{kj½ No ¼la[;k½_____________________________
Name ¼uke½ _____________________________ Name ¼uke½_____________________________
Address ¼irk½____________________________ Unit/Group¼;wfuV@xzqi½ ____________________

(2) Signature ¼gLrk{kj½________________________ Signature of Parent/Guardian ¼firk@vfHkHkkod ds gLrk{kj½

Name¼uke½ ____________________________ Name ¼uke½ _____________________________
Address¼irk½____________________________ Address ¼irk½_____________________________

Date: ¼fnukad½
Place: ¼LFkku½
(Note: In case of SD Applicants being a minor, Indemnity Bond applicable to Minor will be used)
 Appendix ‘B’ (Refers to para 3 of DG NCC letter No. 19952/DGNCC/CWS Dated 28 April 2000
and No. 10056/5/DGNCC /Rajaya Bhasha Dated 09 Sep 2002)
NOMINATION FORM ¼ukekadu QkeZ½
For Membership of the NCC Cadets Welfare Society
,ulhlh dSMsV dY;k.k laLFkk dh lnL;rk ds fy;s

TO BE RETAINED AT NCC GROUP HQ ¼,ulhlh xzqi eq[;ky; esa j[kk tk;s½

Section – I ¼[k.M – I ½
1. I, Cadet (name in block letters) ___________________________ S/D/O Shri (name in block
letters) ______________________________ a student of class _________________ of (name of
College/School) ________________________________________ on my enrolment with the
NCC on (Date) _________________ with (Name of the Unit)
_________________________________ apply for membership of the NCC Cadets Welfare
Society and hereby subscribe a sum of Rs. 10/- (Rupees Ten only) towards its membership fees.
eS dSMsV ¼uke eksVs v{kjksa esa½ &&&&&&&&&&&&&&&&&&& iq=@iq=h Jh &&&&&&&&&&&&&&&&&&&&dk
Nk=@dh Nk=k fnukad ------------------------------------------------- dks ,ulhlh esa -----------------------------------------------------------¼;wfuV dk uke½ esa viuh
HkrhZ gksus ij ,ulhlh dSMsV dY;k.k laLFkk dh lnL;rk ds fy, vkosnu djrk@djrh gwa rFkk ---------------------------:0 ¼:I;s½-------
---------------------------------------------dsoy½ dk lnL;rk “kqYd vnk djrk@ djrh gwa A
2. My Father/Mother/Guardian's occupation is _________________ and the annual income of my
family from all sources is Rs. __________ per annum.
esjs ekrk@firk@laj{kd dk O;olk;------------------------------------------------gS rFkk lHkh lalk/kuksa ls gksus okyh vk;---------------------------- :0
izfr c’kZ gS A

3. I understand that I shall be entitled to financial relief as determined 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 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.
eSa le>rk@le>rh gwa fd ,ulhlh dh fdlh Hkh xfrfof/k esa Hkkx ysrs le; esjs }kjk vkaf”kd vFkok LFkk;h fodykaxrk
gks tkus ij eSa mi;ZqDr laLFkk ds “kklh fudk;@izcU/kd lfefr }kjk fu/kkZfjr foRRkh; jkgr dk ik= jgwx
a k@jgwx
a h A eSa
Lohdkj djrk@djrh gwa fd esjs }kjk vkaf”kd] LFkk;h fodykaxrk gks tkus ij foRrh; jkgr ds ifjizs{; esa “kklh@fudk;
izcU/ku lfefr }kjk fn;k x;k [Link]; vfUre o ok/; gksxk A
4. I hereby 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
Society, which will be final and binding on the following person(s) in the event of my death while
participating in an organised NCC activity.
eSa fuEufyf[kr O;fDr@C;fDr;ksa dks ukekafdr djrk@djrh gwa tks ,ulhlh dh fdlh xfrfof/k esa Hkkx ysus ds nkSjku esjh
e`R;q gks stkus ij mi;qZDr laLa Fkk ds “kklh fudk;@izcU/ku lfefr }kjk fu/kkZfjr foRRkh; lgk;rk ds fy, muds uke ds
lkeus bafxr va”k ds vuq:i /kujkf”k ds gdnkj gksx a s A “kklh@fudk; izcU/kd lfefr }kjk fu/kkZfjr foRrh; lgk;rk dk
;g [Link]; fuEufyf[kr O;fDr;ksa ij ck/; o vfUre [Link]; gksxk A

Sl.N Name of the Age Relationship Permanent address of the nominee Percentage of
nominee/nominees vk;q with the cadet ¼ukekafdr O;fDr dk LFkk;h irk½ financial
(in block letters) dSMsV ds lkFk assistance
ukekafdr lEcU/k payable
O;fDr@O;fDr;ksa ds uke ¼eksVs v{kjksa es½a ¼ns; foRrh;
lgk;rk dk izfr”kr

(To be filled by the Cadet in own handwriting)

5. My membership in the Cadets Welfare Society and this Nomination Form will be valid only till
such time I remain a cadet in the Division or Wing of the NCC to which I have been enrolled.
dY;k.k laLFkk esa esjh lnL;rk rFkk ;g ukekadu QkeZ rHkh rd oS| gksxk to rd fd eSa ,ulhlh izHkkx vFkok laLFkk
dk@dh dSMsV jgwx a k@jgwx
a hA

Date (fnukad½ % (Full Signature of the Cadet)

Place (LFkku½ % (dSMsV ds iwjs gLrk{kj)
 2

SECTION – II ¼[k.M – II)

Place ¼LFkku½ %
Date ¼fnukad½ % % Signature of ANO/Head of Institution
¼,,uvks@laLFkk izeq[k ds gLrk{kj½

SECTION – III ¼[k.M – III)

I am willing to allow my son/daughter/ward name ____________

__________________________________ to become a member of the NCC Cadets Welfare
Society under the terms & conditions and rules in force of the Society. I also approve of the
nomination made in Section 1(4).
dY;k.k@laLFkk dk lnL; cukus ds fy, lger gwa A eSa [k.M ¼4½ ds vUrxZr fd, x, ukekadu ij Hkh viuh lgefr iznku
djrk@ djrh gwa A

Place ¼LFkku½ %
Date ¼fnukad½ % (Full signature of the father/mother/
Guardian) with complete address)
¼ekrk@firk vfHkHkkod ds iwjs gLrk{kj½
iwjk irk

Witness ¼lk{kh½ Witness ¼lk{kh½

1. _______________________ 2. _______________________
(Signature) ¼gLrk{kj½ (Signature) ¼gLrk{kj½
Full name & address or office seal of Full name & address or office seal of
the witness the witness
lk{kh dk iwjk uke vkSj irk ;k vkfQl lhy lk{kh dk iwjk uke vkSj irk ;k vkfQl lhy
----------------------------------------------------------------------------------- -----------------------------------------------------------------------------------
----------------------------------------------------------------------------------- -----------------------------------------------------------------------------------
NOTE : The witness should be either Gazetted Officer / Head of Institution/ANO/ Sarpanch/ Village Head.
uksV % lk{kh jktif=r vf/kdkjh@laLFkk izeq[k@,ulhlh ,,uvks@ljiap@xzke izeq[k gksuk pkfg, A
_______________________________________________________________________
SECTION – IV ¼[k.M – IV)

Received a sum of Rs. 15/-(Rupees Fifteen 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.
Dfu’B@cfj’B izHkkx@LdU/k esa dSMsVf”ki ds nkSjku ,ulhlh dSMsV dY;k.k laLFkk ds lnL; ds :i esa ,d eq”r “kqYd : 15&:I;s
iUnzg :I;s½ dssoy½ dh jkf”k izkIr dh x;h
Place ¼LFkku½ %

____________________________
Date ¼fnukad½ % (Signature of the OC Unit with office seal)
lhy lfgr ;wfuV ds deku vf/kdkjh ds gLrk{kj

SECTION – V ¼[k.M – V)
To be filled in the NCC Unit
,ulhlh ;wfuV }kjk Hkjk tk;s A

Date of dispatch of the Nomination Form to the Group HQ ------------------------

xzqi eq[;ky; dks ukekadu QkeZ Hkstus dk fnukad ------------------------