Form No. XXVI SHQ Serial No RHQ Serial No..
THE BHARAT SCOUTS & GUIDES
Registration Form for Rashtrapati Scout/Guide Award
Name of the STATE _____________________________________________________
1. Name of Scout/Guide_________________________________________________ PHOTO IN
(In Capital letters) UNIFORM
2. Fathers Name (In Capital letters) ___________________________________________
3. Mothers Name (In Capital letters) __________________________________________
4. Date of Birth D D M M Y Y Y Y
(Supported by Birth Certificate from Head of the Institution, if he/she has appeared in the Board Examination attested copy of Board
Certificate should be attached)
5. Home Address (In Capital letters) ______________________________________________________
_________________________________________________________________________________
District _________________________ State _________________________ Pin Code____________
Tel/Mob No. if any ____________________ Email ID ______________________________________
6. Name of the Unit ___________________________________________________________________
7. Address of the Unit _________________________________________________________________
_________________________________________________________________________________
District ________________________ State _________________________ Pin Code ____________
8. Date of Completion of Pravesh Test ___________________
9. Date of Investiture ___________________
10. Date of Completion of (a) Pratham Sopan ___________________
(b) Dwitiya Sopan ___________________
(c) Tritiya Sopan ___________________
(d) Rajya Puraskar ___________________
11. Rajya Puraskar Testing Camp held at ____________________________________________________
From ____/____/_______ to ____/____/_______
12. Rajya Puraskar Certificate No. ______________________________ Date of Issue ________________
13. Details of Proficiency Badges earned for Rajya Puraskar Award:
Sr. No. Name of Badge Date of Passing Name of the Examiner
1.
2.
3.
4.
5.
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14. Details of completion of Ambulance Man/Ambulance Badge:
Sr. No. Name of Badge Date of Passing Name of the Examiner
1. Ambulance Man / Ambulance
15. Details of Proficiency Badges earned for Rashtrapati Scout/Guide Award:
Sr. No. Name of Badge Date of Passing Name of the Examiner
1.
2.
3.
I will produce my Individual Progress card, all relevant records, Log Book and Certificates related to
Rashtrapati Award during the Testing Camp.
_________________________________
Signature of Scout/Guide
Date: ________________
Name ____________________________
Certified that the information given above is correct as per the Unit records.
Date: ________________ _________________________________
Signature of Unit Leader
Name of Unit Leader _____________________________________
Scouting/Guiding Qualification _____________________________
Warrant No. _____________________Valid upto ______________
Certified that the information given above is correct as per the District Records
______________________________________________
Date: ________________ Signature of District Organising Commissioner (S)/(G)
_______________________________________
Signature of District Secretary/Joint Secretary
Date: ________________ Scouting/Guiding District _______________
The above information checked and found correct as per the Records.
____________________________________________
Date: ________________
Signature of State Organising Commissioner (S)/(G)
____________________________________________
Date: ________________
Signature of State Secretary/ Joint Secretary
FOR USE AT NATIONAL/REGIONAL HEADQUARTERS
Date of Receipt of above Information ______________________________________________________________
Remarks______________________________________________________________________________________
Checked by (Name) _______________________________ Designation __________________________________
Signature _________________________
Countersigned by AD _____________ __________________________________
Signature of Deputy Director (BP/GP)
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DATE OF BIRTH CERTIFICATE
(To be produced only in case of students not completed class X Board examination)
This is to certify that ..
S/O or D/O is a student of ..
School studying in class ..
in the year . His/ Her date of birth is D D M M Y Y Y Y
. (in words) as per the School record.
Signature
Date.. (Office Seal) Head of the Institution
NOTE: To be submitted only if the Scout/Guide is a regular student of the School and not appeared for class X
Board examination, all others to submit attested copy of Admit Card or Board Mark Sheet/Certificate with Date
of Birth.
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