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 DETALSOFCIVIL DEFENCE VOLUNTECRSSIAIDARADISTRICT

1. AADHAAR CARD NO0.

2. ENROLLIMENT NO.
PASSPORT SIZE
3. NAME PHOTO

4. GENDER

5. FATHER NAME

6. MOTHER NAME

7. DATE OF BIRTH

8. ADDRESS

9. PERMANENT ADDRESS

10. MOBILE NO.

11. BLOOD GROUP

12. DONATE YES OR

NO

13. HEIGHT

14. WEIGHT

15. CHEST

16. BANK BRANCH

17. A/C NO.

18. IFSC CODE

19. MICR CODE

NOMINEE
20. NAME OF

BIRTH
21. DATE OF

RELATIONSHIP WITH NOMINEE

22.

23. LANGUAGE

24. B.T.C

SIGNATURE

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WORK PERFORMANCE REPORT CALENDAR YEARS.
**a**************°°****°**°*******************

NAME
FATHER'S NAME/HUSBAND NAME ****************a***** ase i***st*ee
sae**s sss**,
ENROLLMENT NO. *ee*****e ********* ***te*****°********* ******0*0*°009**

RANK *************************e********* ****************

DATE OF BIRTH es ******** ************************** ********e***

ACTIVITIES
1. MEETING & MUSTERING ATTENDED esteoseeeseqonsooe ********* *********s0a*aneo***

2. MOCK DRILL
3. DEMONSTRATION **'****°**.0ee0***eeseeoo **********°******°********

4. INCIDENT es**********e************** *********************

TRAINING
1. BASIC TRAINING COURSE * * * * * * * * * * * * * * * * * * * * * e s * * * * * * * o * * * * * * * * s * * * * * * * * *

*********°°

2. ADVANCE COURSE * * * * * * * * * * *
*****s 9**
**********°****** *°*****

3. TRAINING AT NAGPUR BANGLORE

ENROLLMENT
**********°°

. *****
o** ***

1. NOS. OF ENROLLMENT *****

Aae****°**e*****e

ANY OTHER ACTIVITIES

1. DUTY WITH OTHER DEPTT.:

e****** ********************* **************************°**"*********t'sae************°*******************************

seo*ee***************** *********************°°'*****************°*°***********************************************°*

********°'***°*******°***°*'**°*oo°**
****** *****ee*o*e* **
*****°°°.°°°*°°**°°°****°*
******
********************°*****°"**********************************°***********°° ************ a****** **** o

********p*****e*******°********** * * * 0 9 **e***** *pe e b o l U p

2. ARRANGEMENT

3. INCIDENT

REMARKS
RECOMMENDED BY
s s n n sst eas sn* *s* ****** *** *** ***************** *eneoesns
1. DIVISIONAL WARDEN

2. DY. C.w. (ZONAL) ****e***********. ********s e n t 0 e o a * * e s ********e

3. DY. C.w.(HQJ/C.W./SR. CW

SIGNATURE OF APPLICANT ** *0a s**eo**** **e*******e****** ******e*******ee********

NAMEOF APPLICANT *********0sDipe*** ps*oes ******************* *** *** **o*negp

CONTACT NO.: ******************* * ** ****** ****** **********e* *** ****'°

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 DIRECTORATE OF CIVIL DEFENCE : GOVT. OF N.C.T. OF DELHI
District Magistrate (East) Office Complex, B- Block, L. . Bund,
Krishan Kunj, Shastri Nagar, Delhi - 110031
Tel: 011-22422855, E-mail: [email protected]

33. Self Declaration : FORM-"B

() I have read the "Civil Defence Act and Civil Defence Regulations 1968.
(i) As far as know, I am physically fit to render efficient service as member of the Corps
(in) lf my application is accepted, I am prepared to serve as a whole-time/part-time member of the Corps, i.e. to
undergo the appropriate training and, in the event of an emergency occurring whilst I remain a member of the
Corps to carry out my obligation as a member thereof. There is no pending case against me in any court.

(iv) I swear/solemnly affrm that I will be faithful and bear true allegiance to India and to the Constitution of India as by
law established, and that I will loyally carry out duties entrusted to me.

(v) am neither a member of any Political Party nor have any inclination to any political party.
(vi) I hereby declare that the details furnished above are true and correct to the best of my knowiedge and belief and
nothing has been concealed therein. I know that am liable for penali criminal action for giving wrong/incorrect
information.

Date 20

Place Applicant's Signature