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FORM OF INDEMNITY
Regtl No…………………………………… Rank ………………………….. Name ……………………………………………………

In consideration of my being nominated either by the NCC authorities or at my 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 domestics/international surface, air and water transport) and attending Youth
Exchange Programmes abroad. I undertake and agree that neither I, nor my executors or
administrators or other legal representatives will make any claim against the Government or against
NCC authorities including officers, JCOs/NCOs or their equivalents from Navy and Air Force, Civilian
MT drivers or against any other such person in the service of Government, in respect of any loss or
injury to the property or including injury resulting in death, due to any reasons, whatsoever which I
may suffer while or in consequence of participation in the above activities and I understand that no
compensation of my participation in the above activities will be paid by the Government or NCC
authorities including Officers, JCOs/NCOs or the equivalents from Navy and Air Force, Civilian MT
drivers or any person in the service or Government against any act of default on my part during or in
connection with said camps, courses, adventure training traveling and while on Youth Exchange
Programme or any other such NCC activities as may be organization from time to time within or
outside the Union of India.

Signed by the applicant Signature of the Applicant……………………..

Name……………………………………………………

Presence of witness At…………………………………………………………

Sig…………………………… Po…………………………………………………...........

Name & Address…………………………………… PS………………………………………………………....

Dist………………………………………………………

Counter Signature of Parent/Guardian

Sig……………………………………………… ……………………………………………………………..

Name (Father): D/O………………………………

Name & Address…………………………………… Signature of Coy/Troop Cdr…………………….

(ANO/CTO)

COUNTERSIGNED
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SAFTY PRECAUTION CERTIFICATE

Name of Camp/Course…………………………………………………………………………………………………………
from…………………………… to …………………………………………… I, No…………………….…………. Rank ……………
Name …………………………………………………………………….……… water near the camp site and that to area
that water is not “OUT OF BOND”. If I go there I shall do so entirely at my own risk.

Place:

Date: (Signature of the Candidate)

Name in full Block letters

Signature of Parent / Guardian

Date: Signature with Seal of Coy/Troop Cdr

(ANO/CTO)

MEDICAL CERTIFICATE
1. Certified that I have examined Regimental No…………………………………….. Rank ……………………..

Name ………………………………………………………………………………………. of Institution………………………………

……………………………………………………………………………………for undergoing training of strenuous nature

on………………. ……………………………………………………………………………………………………… (Name of Camp)

from…………………. to …………………………

Station: Signature of Medical Officer

Name in Block letter with
Date: Designation and Seal
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PARENTS CONSENT CERTIFICATE

1. This is to certify that I have no objection to spare my son/daughter/ward No ………………………

Rank …………..... Name ………………………………………………………………………………… to attend the ……………..
……………………………………………………………………………… (Name of the Camp) held at …………………………..
…………………………………………………………….from ………………………………………. to …………………………………

Station: Signature of Parent/Guardian

(Name in Block letter with full Address)
Date:

TO BE ATTESTED BY PRINCIPAL/HEADMASTER

Station: Signature of Principal/Headmaster

with Seal
Date:

RISK/VOLUNTEER/WILLINGNESS CERTFICATE

1. This is to certify that, I Regtl No ………………………… Rank ……………….. Name …………………………

…………………………………. of Institution …………………………………………………………………………………………….
Unit: 1(O) Inf Indep Coy NCC, Jeypore volunteer/willing to attend to the ………………………………………...
……………………………………………………………….. (Name of the Camp) from ………………………. to ………………
at my own risk.

Station: Signature of Applicant

Date:
TO BE ATTESTED BY PRINCIPAL/HEADMASTER

School/College with Office Seal Signature of Principal/Headmaster

With Seal

COUNTERSIGNED BY OC UNIT
Station: Jeypore
Date:
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DROWNING/ACCIDENT CERTIFICATE

1. I know that there is deep water at the camp site and en-route and the area of the water is out
of bound. If I go there, I shall do so at my own risk.
2. I have been explained the orders regarding precautions to be taken against drowning/
accident and have understood them. I have been told not to go near deep water the vicinity by the in-
charge. If I go to any of these out of bound areas, I shall do so at my own risk.

Name of the Unit : 1(o)Inf Indep Coy NCC, Jeypore

Name of Group HQ : Berhampur , Dist - Ganjam
Name of NCC Dte : Bhubaneswar, Odisha

Regtl No ……………………………….. Rank ………………… Name ………………………………………………………………..

3. Certified that I have explained the orders regarding precaution & to be taken against
drowning/accident.

Station: Signature of Applicant

Date:

ATTESTED BY PRINCIPLA/HEADMASTER

Certified that the above named Officer/Cadet is on the strength of its College/School and can
be spared for ……………………………………………………………………………………………………………………………….
(Name of the Camp) from ……………………………….. to ……………………………..

Station: Signature of the Principal/Headmaster

Date: with Seal