FORM II

NATIONAL CADET CORPS

JUNIOR DIVISION/WING ENROLMENT FORM (See Rules 7 and 11 of NCC Act, 1948)
1 Name (IN BLOCK LETTERS) ATTESTED
PASSPORT SIZE
COLOUR
2 Nationality & Date of Birth I N D I A N
PHOTO
(DD/MM/YYYY)
3 Father's/Guardian's Name

4 Mother's Name

5 Residential Address (Landmark,

State, Distt, Taluka, City/Vill
Pin Code)

6 Mobile No.

7 E-mail ID

8 Blood Group
9 Sex
10 Nearest Railway Station
11 Nearest Police Station
12 Educational qualifications &
Mark in (%)
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 S A I N I K S C H O O L T I L A I Y A
Stream (Arts/Science/Commerce
16 Willing to be enrolled and Y E S
undergo training under the
National Cadet Corp Act 1948
17 NCC Unit to be enrolled in I N D E P C O Y N C C ( J D ) S S T
18 Have you been enrolled in NCC N O
earlier. If yes, your Enrolment No
19 Have you been dismissed from N O
NCC/the Territorial Army/the
Indian Armed Forces. Please
provide details
20 Next of kin with address
(with relationship) Telephone
No. (O)/(R) (as applicable)

21 Bankers details/IFSC Code

22 Bank Acct No. of Cadet

23 Aadhar/UID NO. (if allotted)
24 PAN Card No. (if allotted)

Place : Tilaiya
Date : Aug 2020 (Signature of Cadet)
 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 fulfil the
engagement made.
2. I _______________________ promise that I will honestly and faithfully serve my country and abide by the Rules & 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.
3. ________________________ 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, traveling and while on YEP or any other such NCC events like RDC and IDC

Place : Signature of the Applicant

Date :
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DECLARATION BY PARENT/GUARDIAN
1. I solemnly declare that the answers I have given to the question in this form are true and that no part of them is false and that my
son/daughter/ward is willing to fulfill the engagement made.
2. I ________________ further promise that after the enrolment my son/daughter/ward, I will have 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 RDC and IDC.

Place : Signature of Parent/Guardian

Date :
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CERTIFICATE
1. Certified that the applicant understands and agrees to the conditions of enrolment.
2. Certified that the applicant and his parent/guardian understand and agrees to the conditions of enrolment.

Place : Tilaiya Signature of Enrolling Officer

Date of Enrolment _____________________
(Unit Seal)
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TO BE COMPLETED BY MEDICAL OFFICER BEFORE ENROLMENT
I have examined (Name) _________________________ on (date)________________ and consider him/her fit/unfit for enrolment
as a cadet in the National Cadet Corps.
Place :
Date : Signature ……………………
Designation …………………..
Medical Officer
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TO BE USED FOR EXTENSION OF ENROLMENT
( See Rule 13)
I agree to extend my son’s/daughter’s/ward’s enrolment for one year and am willing to fulfill the engagement made

Place Signature of Parent/Guardian

Date
Confirmed
Place Signature of Headmaster
Date from which extension starts
NOTE: This form will be retained in the College/school in which the unit is located
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INDEMNITY BOND
FOR MINOR APPLICANTS ONLY
To
The President of India
In consideration of my ward No. __________________ Name _________________ being nominated either by the NCC authorities
or at his own request as a 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 Programmes abroad, I undertake and agree that neither I, nor my other legal
representative will make any claim against the Government, or against NCC authorities including Officer, 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 Government, in respect of any loss or
injury-to the property or person, including injury resulting in death, due to any reasons whatsoever which my ward may suffer, while, or in
consequence of his 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 equivalents from Navy and Air Force or Civilian MT drivers in respect of any such loss or injury
and I agree as to bind my self my executors and administrators and other legal representatives to indemnity the Government or NCC
authorities including Officers, JCO’s/NCO’s or equivalents from Navy and Air Force, Civilian MT drivers 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 his part
during or in connection with the said camps, course adventure training, traveling and while on Youth Exchange Programme or any other
such NCC activities as may be organised from time to time within or outside the Union of India.
Witness
1. Signature _______________
Name _______________ _______________________
Address _______________ Signature of Parent/Guardian
________________________________
2. Signature _______________
Name _______________
Address _______________
________________________________
Date :
Place :
NCC REGIMENTAL NUMBER _________________________

(Revised)
Appendix ‘B’ (Refer to para 3 of DG NCC letter No. 19952/DGNCC/CWS dated 28 Apr 2000
and No. 10056/5/DGNCC/Rajaya Bhasha Dated 09 Sep 2002)
NOMINATION FORM (ukekadu QkeZ)
FOR MEMBERSHIP OF THE NCC CADETS WELFARE SOCIETY
,ulhllh dSMsV dY;k.k laLFkk dh lnL;rk ds fy;s
(To BE RETAINED AT NCC GROUP HEADQUARTERS) (,ulhllh xzqi eq[;ky; esa j[kk tk,)

1. I Cadet (Name in block letters)___________________________________________________________

Son/daughter of Shri (Name in block letter) _________________________________________________
a student of class _______ of (Name of College/School) _____________________ on my enrolment with
NCC on (Date) _____________ with (Name of Unit) Indep Coy NCC (JD) Sainik School Tilaiya apply
for membership of the National Cadet Corps, Welfare Society and hereby subscribe a sum of 15/-
(Rupees fifteen only) toward its membership fee.
eSa dSMsV (uke eksVs v{kjksa esa )------------------------------------------------------------------------------------------------------
iq=@iq=h@Jh (uke eksVs v{kjksa esa) ………………………………………………………………………………………….
(Ldwy@dkWyst dk uke) --------------------------------------------------------- dh d{kk ------------------- dk Nk=@Nk=k
fnukad ------------------------- dks ,ulhlh esa-------------------------------------------(;wfuV dk uke) esa viuh HkrhZ gksus ij
,ulhlh dSMsV dY;k.k laLFkk dh lnL;rk ds fy, vkosnu djrk@djrh gwWa rFkk ---------------- ------------------ dsoy)
dk lnL;rk 'kqYd vnk djrk@djrh gwWa A

2. My father/Mother/Guardian’s occupation is ___________________ and the annual income of my family

from all sources is _______________ per annum.
esjs firk@ekrk@laj{kd dk O;olk; --------------------- gS rFkk lHkh lalk/kuksa ls gksus okyh vk;---------------------- izfr
o"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 NCC activity. I hereby accept that the decision of the Governing
Body/Managing Committee with regards to the quantum of relief to be paid to me in the event of my partial
or permanent disablement will be final and binding on me.
eSa le>rk@le>rh gwWa fd ,ulhlh dh fdlh xfrfof/k esa Hkkx ysrs le; esjs }kjk vkaf'kd vFkok LFkk;h fodykaxrk gks tkus
ij eSa mi;qZDr laLFkk dh 'kklh@izca/ku lfefr }kjk fu/kkZfjr foRrh; jkgr dk ik= jgwWaxk@jgwWxh A eSa Lohdkj djrk@djrh gwW fd
esjs }kjk vkaf'kd] LFkk;h fodykaxrk gks tkus ij foRrh; jkgr ds ifjis{k esa 'kklh fudk;@izcU/ku lfefr }kjk fn;k x;k fu.kZ;
vfUre o ck/; 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@O;fDr;ksa dks ukekafdr djrk@djrh gwWa tks ,ulhlh dh fdlh xfrfof/k esa Hkkx ysus ds nkSjku esjh e`R;q gks
tkus ij mi;qZDr laLFkk ds 'kklh@izcU/ku lfefr }kjk fu/kkZfjr foRrh; lgk;rk ds fy, muds uke ds lkeus bafxr va'k ds
vuq:i /kujkf'k ds gdnkj gksaxs A 'kklh fudk;@izcU/ku lfefr }kjk fu/kkZfjr foRrh; lgk;rk dk ;g fu.kZ; fuEufyf[kr
O;fDr;ksa ij ck/; o vfUre fu.kZ; gksxk A
Ser Name of the Age Relationship Permanent Address of the Percentage of
dze Nominee/Nominees vk;q with the Nominee financial
la[;k (In block letters) cadets Ukkekafdr O;fDr dk LFkk;h irk assistance
Ukkekafdr O;fDr@O;fDr;ksa ds dSMsV ds lkFk payable
uke lEca/k eksVs v{kjksa ns; foRrh; lgk;rk
esa dk izfr'kr

(To be filled by the cadet in own hand writing) (dSMsV }kjk Lo;a Hkjk tk,)
5. My membership in the Welfare Society and this Nomination From 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 oS| gksxk tc rd fd eSa ,ulhlh izHkkx vFkok laLFkk dk@dh dSMsV
jgwWaxk@jgwWxh A
Place (LFkku) : Signature of the Applicant
Date (fnukad): (vkosnd dk gLrk{kj)
 SECTION-II ([k.M&II)

Place (LFkku) : Signature of ANO/Head of Institution)

Date (fnukad): (,,uvks@laLFkk izeq[k dk gLrk{kj)

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SECTION-III ([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 and conditions and rules in force of the Society. I also approve the
nomination made in Section-1(4)

eSa vius iq=@iq=h@vkfJr uke ------------------------------------- dks laLFkk ds fu;eksa o 'krksZa ds v/khu ,ulhlh dSMsV
dY;k.k laLFkk dk lnL; cukus ds fy, lger gwWa A eSa [k.M 1 (4) ds vUrxZr fd, x, ukekadu ij Hkh viuh lgefr iznku
djrk@djrh gwWa A

Place (LFkku) : (Full signature of the Father/Mother/Guardian)

With complete address
Date (fnukad): (firk@ekrk@vfHkokod ds iwjs gLrk{kj)
Full Address iwjk irk ____________________
_____________________________________
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Witness (lk{kh) Witness (lk{kh)

1. Signature (gLrk{kj) ___________________ 2. Signature (gLrk{kj) _________________

Full Name & Address or office seal of the witness Full Name & Address or office seal of the witness
lk{kh dk iwjk uke vkSj irk ;k vkWfQl lhy lk{kh dk iwjk uke vkSj irk ;k vkWfQl lhy

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Note : The witnesses should be either Gazetted Officer/Head of Institution/ANO/Sarpanch/Village Head.
uksV& lk{kh jktif=r vf/kdkjh@laLFkk izeq[k@,ulhlh ,-,u-vks-@ljiap@xzke izeq[k gksuk pkfg, A

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SECTION-IV ([k.M&IV)

Received a sum of 15@& (Rupees fifteen only) as one time subscription and enrolled as a member of
the NCC Cadet Welfare Society during the cadetship in the Junior/Senior Division/Wing.
dfu"B@ofj"B izHkkx@LdU/k esa dSMsVf'ki ds nkSjku ,ulhlh dSMsV dY;k.k laLFkk ds lnL; ds :i esa ,d eq'r 'kqYd Lo:i
15@& (:i;s iUnzg dsoy) dh jkf'k izkIr dh xbZ A

Place (LFkku) : Tilaiya Signature of OC Unit with Office seal)

Date (fnukad): (lhy lfgr ;wfuV ds deku vQlj ds gLrk{kj)
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SECTION-V ([k.M&V)
To be filled by the NCC Unit
(,ulhlh ;wfuV }kjk Hkjk tk,)

Date of dispatch of the Nomination Form to the Group HQ ……………………………………………………………..

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

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