ADVENTURE AWAITS

NATIONAL INSTITUTE OF MOUNTAINEERING AND ADVENTURE SPORTS

DIRANG, WEST KAMENG, ARUNACHAL PRADESH - 790101
ARRIVAL REPORT
(All column must be filled in block capital letters)

1. Name of Course with Ser No ________________________ Basic / Advance / Adventure

2. Name of student Mr/ Smt/ Miss ________________________________________________

3. Date of Birth _____________________ 4. Place of Birth ________________________

5. Occupation ______________________ 6. Father’s Name _______________________

7. Aadhar No _______________________ 8. Mob No ____________________________

9. Departmental / Private Candidate ______________________________________________

10. Personal No Rank & Name (if defence persons) __________________________________

11. Name of School / College _________________________ Class _____________________

12. Particulars of sponsoring agency ______________________________________________

______________________________________________________________________________

13. Your full address including pin code by which you wish to receive your certificate

______________________________________________________________________________

______________________________________________________________________________

14. Name and address of Next of Kin with telephone Nos if any _________________________

______________________________________________________________________________

______________________________________________________________________________

Certificate of Undertaking by the candidate

1. Certified that information mentioned above are correct.

2. I further certify that: -
(a) I have come to NIMAS to undergo this course at my own risk.
(b) In case of my accident, injury, mishap or death. I will not hold that institute or its staff
responsible for the same, the expenditure for hospitalizations, if any during the course will
be borne by me / my / sponsoring agency.
(c) In case of any loss or damage of equipment issued by NIMAS the cost of the same
will paid by me.
(d) I will leave NIMAS only after handling the clearance certificate.
(e) Neither I will consume alcohol nor be in possession during the course. I know that I
be withdrawn from the course on this lapse.

Date …………………… Signature of the trainee

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Note: - All valuable must be deposited to the Vice-Principal / Account’s Officer / Cashier on day
prior leaving the institute for field training.