NOMINAL ROLL OF CADETS

TO BE HELD AT............................................
WEF .....................................................

Institution : _______________________________________ Unit : 1 CG Bn NCC, Korba (CG)

Ser Regt No Rank Name of Father’s DOB Name of Date of

No. Cadet Name (dd/mm Institution Enrolment
/yy) with Location
1. 2. 3. 4. 5. 6. 7. 8.

Year of Cert Other Veg/ Mob No of Name of Remarks

NCC Passed Camps Non Veg Cadet NOK With
Training Attended Address &
Earlier Mob No.

9. 10. 11. 12. 13. 14. 15.

Signature of ANO/CTO Signature of Principal

 FORM OF INDEMNITY BOND

To,
The President of India

In consideration of my being nominated either by the NCC authorities or at my own request

to participate / attend the NCC Camp to be held at ...................................................... and
while traveling for the purpose, I undertake that neither I, nor my heirs, executors, administrators
nor other legal representatives will make any claim against the Government of India or against
NCC authorities including Officers, JCOs, NCOs, Civilian Staff, Mechanical Transport Drivers or
against any other such person in the service of the Government of India in respect of any loss or
injury to the property or person, including injury resulting in death, due to any reason whatsoever,
which I may suffer while or in consequence of my being in / participating in the above activities
in and outside NCC or while traveling for the purpose, and I understand that no compensation
will be paid by the Government of India or NCC authorities including Officers, JCOs, NCOs,
Civilian Staff, Mechanical Transport Drivers or any person in the service of Government in respect
of any such loss or injury and I agree so as to bind myself, my executors, administrator and legal
representatives to indemnify the Govt of India and persons in the service of Govt of India against
any claim in connection with the said camp which may be made by any third party against them,
or any of them, arising out of any act or default on my part during or in context of the said camp,
training and journey or any other such NCC activities as may be organized from time to time
within or outside the Union of India.

The Govt of India has agreed to bear the stamp duty on the documents signed by the applicant.

Signed on day of (month) (Year) in the presence of

following witnesses.

Signature of Cadet
No…………………………….Rank……………….
Name

Address

Signature of Witness No 1 Signature of Parent/Legal Guardian

Name Name
Address Address

Signature of Witness No 2 Signature of ANO/CTO

Name Name

Address _ Address

COUNTERSIGNED BY CO UNIT

Station : Korba (CG)

Date : Jul 23
 MEDICAL FITNESS CERTIFICATE

1. Certified that I have examined No.__________________ Rank _______ Name

_____________________________________________________________, the Cadet of Institution

_____________________________________________________ Unit 1 CG Bn NCC, Korba (CG) and

I have found him / her fit to undergo training of strenuous nature at NCC Training Camp.

2. I also certify that above mentioned individual is free from any contagious
disease and has been inoculated & vaccinated.

Signature of Medical Officer

/ Registered Medical
Practitioner

Place : Name__________________________
(In Block Capital letters)
Designation
Dated : Registration No.
Seal
 VOLUNTEER / RISK CERTIFICATE

This is to certify that I , No.______________________ Rank __________ Name

__________________________Son/Daughter of _____________________________ Student of
__________________________________________________ ,Unit 1 CG Bn NCC, Korba volunteer
at my own accord to attend ............................ from ................................................. at my
own risk, which may result in loss, damage or injury to property of person (including
injury resulting in death) which I may suffer while journey or in consequence of such
training and will hold nobody responsible for the same.

Place: Signature of Cadet

Date :

COUNTERSIGNED BY THE APPLICANT’S PARENT/GUARDIAN

Signature of Parent/Legal Guardian

Name in Block Letters

Relation with Cadet

Address

Date

ATTESTED BY PRINCIPAL/HEADMASTER OF THE INSTITUTION

Place : Korba (Signature of Principal/Headmaster)

Date : 23 (Office Seal)

COUNTERSIGNED BY CO/OC UNIT

Place : Korba
Date: 23

(Signature with designation Seal)

 PARENTS CONSENT CERTIFICATE

I,____________________________________________________resident of ___________
_______________________________________________being the father of
No._____________________, Name of Cadet __________________________ College
_______________________________________________ Unit 1 CG Bn NCC, Korba (CG),
do hereby give my consent to my son ward to participate in NCC Camp to be held
at ........................................................................................ I also agree to all terms and
conditions of the NCC organization that relate to participation of cadets in NCC
camps and activities.

Signature of Parent/Guardian
Name :
Mobile No:
 DROWNING / ACCIDENT CERTIFICATE

I, No.__________________________________Rank_______________________Name
________________________________ have been instructed and am aware that all water
bodies including Rivers, Canals, Wells, Ponds and sources of deep water in the
camp area or in places near the camp site or enroute to the camp site are OUT
OF BOUNDS and I am forbidden to go near any such water bodies. I go near any
such source during the camp I will do so at my own risk and shall be liable for
disciplinary action as the Camp Commandant deems appropriate. I have been
explained the orders regarding the precautions to be taken against drowning
accidents and have understood them.

Date: Signature of the Cadet

Institute
Unit

Certified that I have explained to the cadets the orders regarding “OUT OF BOUND
AREAS” and precautions to be taken against drowning accidents. The cadets have
signed in my presence.

Place : Korba Sig of ANO

Date : 2023

ATTESTED BY PRINCIPAL/HEADMASTER

Place : Korba (Signature of Principal/Headmaster)

Date : 2023 (Office Seal)

 WILLINGNESS CERTIFICATE

This is to certify that cadet Regtl_________________________________

Rank____________________Name___________________________________________Institution_
Name_____________________________________Unit_________________________________Volunteer to
attend ........................................ at my own risk

Station : Korba Signature of the Cadet

Date : 2023

ATTESTED BY PRINCIPAL/HEADMASTER

Place : Korba (Signature of Principal/Headmaster)

Date : 2023 (Office Seal)
 CERTIFICATE FROM THE OC NCC UNIT

Certified that _________________________________ Rank ______________, Name

_______________________________ Son/Daughter of __________________________ is borne on
Dec 2020 strength of the unit and has been properly kitted as per the Adm and Joining
Instructions. I have explained the orders regarding precautions to be taken against
drowning / accidents and explained to the cadets not to go to locations / areas that have
been designated by the Camp Commandant as ‘OUT OF BOUNDS’. The cadet has signed in
my presence.

Signature of Cadet Signature and Stamp of the OC Unit

Station: Korba (CG)

Date : 2023
 BONAFIDE STUDENT CERTIFICATE

This is to certify thatNo................................................Rank......................

Name.........................................................S/o....................................................

Resident of .........................................................................................................

is a.................................................................................regular Bonafied Student

(Name of School/College.....................................................................................

and he is studying in class............................

Place: Korba Signature of ANO Signature of Head Inst

Date : 23

COUNTERSIGNED BY CO

Place : Korba (CG)

Date : 2023