The Southern Railway State Bharat Scouts Guides Paste a

State Head Quarters Chennai 600 003 Passport Size

Photo in
Uniform
Application for Registration for Heerak Pankh &
Golden Arrow Award
Reg.,
No.

1 Name (in block letters) 2. Date

of Birth*
3 Father’s Name &
Design & Office
4 Mother’s Name &
Residential Add
5 Name of the District
6 Name of the Unit &
Address.
7.Contact. No. 8.Aadhar No.

9.Email ID 10.Date of Passing 11. Date of Passing 12. Date of Passing 13. Date of Passing
Pravesh Komal Pankh Rajat Pankh Swarna Pankh
(3months) (3months) (3months) (9months)

14 Date of Completion of 15.Heerak Pankh

Heerak Pankh Certificate No.
Tests(9months) (Issued By SHQ ) & Date

Details of requirements completed

A. Komal Pankh (3 MONTHS)

A.1 Date of Good turn activity done (item no.iii)

1.

2.

3.

Contd: 2
 -- 2 --

B. Rajat Pankh (3 MONTHS)

B.1 Date of completion of – follow a trial Place from: to

Half to 1 km(item no.x) Date:

B.2 Date of participation in two prayer meetings 1. 2.

(item no. xii)

C. Swarna Pankh (9 MONTHS)

C.1 Preparation of useful Handicraft item Date of Presentation
(item no.i)
C.2 Participation in a Day Hike ( item no.vii) Place:
Date:

C.3 Proficiency badge Earned(item no. ix) Name of the Badge:

Name of the Examiner:
Date :
C.6 Date of completion of – follow a Marked Place from: to
track for 1 km (item no.xi/ c) Date:

D. Heerak Pankh (9 MONTHS)

D.1 Participation in overnight Flock Holiday Place:
(item no.i)* Date from : to:
D.2 Participation of Flock Expedition (item Place:
no.ii)* Date:

D.5 Proficiency badge earned Name of the Badge :

(item no.vi) * Date:
Name of the Examiner:
D.8 Observation of Pet animal for 3 months Name of the Animal:
(item xii) Observation period from: to:

*Enclose certificate

Signature of the Flock Leader Signature of Dist Commissioner

Signature of DOC/Guides
Name: Name: Name:
Scouting Qualification: