NOMINATION FORM
FOR MEMBERSHIP OF THE NCC CADETS WELFARE SOCIETY
(TO BE RETAINED AT NCC GROUP HEADQUATERS)
1 I C . SECTION-1 \ .,...-
, adet (Name 111 block letters) ~ ~ Son /Daugnter of (Name in
block letters)Sh LAI I T ARctR-O...a student of class S5++) of School
/Gollag"1) . S P . Stl:lcol On my enrolment with the NCC on (Date) Q+n M"'122. With
-x Haryana Battali on NCC, xxxxx (Unit) apply ro, membership of National Cadets Corps
Welfare Society and hereby subscribe a sum of Rs 101- (Ten only) toward s ,ts membership
fee.
V'
2. ,Bill)') NE.$$ MAN.
My father's /Mother/Guardian 's occupalion is
and annual income of my family from all sources is Rs SIX: I AKHS
3 I understand that I shall be enlilled lo fini cal relief as determined by the
Governing Body/ Managing Committee of the above society in the event of p~rti al or permanent
disablemenl sustained by me while parlicipating in an originated NCC activity. I hereby accept
that the decision of the Governing Body/Managing Committee with regards to th e quantum of
relief to be paid to me in the event of my partial /permanent disablement will be final and binding
on me.
4. I hereby nominate the following person /persons who will receive financial
assistance as per the share indicated and as determined by the Governing Body/Managing
Committee of the above society .which will be final and binding on the following persons in the
eveni of my death while participating in and organized NCC activity .
Name of Nominee Age Relationship Permanent Percentage of financial
~no with the address of assistance payable
/Nominees (In Block
Letters) Cadets the nominee
--
1- -- -·-- MR. lAL-rT i".-AI\-IE,R. #(.1D.S .C.. 100•/·
I ARoR.I 4~
#Ci. ,1H,.'- \eo"/ ·
MR.$ . S1-\AILJA \.iy tvtoTue.'li?
2
S~TI-\ER. #C:.i.t'l.S .(
1...,,,
3 AN.S~ A'RP'RP1 l~
.
(To be filled by the cadets in own hand writing)
I
5. My membership in the welfare Society and this nomination Form will be
valid only till such time I remain a cadets in the Division or Wing of the NCC to which I
have been enrolled l\ l -
Date: q-lh M~J.1.. . ~ .: .. { _
Station : KARNAL (Full Sign of the Cadet)
r
I -2-
. ~)
~ /
SECTION-II
A ssoi:Ja te NCC Offi cer
Date: Dyal Singh PubJJc School
DSC , KARNAL
Place: KARNAL (Sign Of ANO /Headoffnstitute)
SECTION-Ill
I am willing to allow my Son /DaJghter Ward Name AKANKSHA /'.'.l'.Ro'RA
to become a members of the NCC ·cadets Welfare Society Under the term & condition and the
rules in force of the society·. I also approve of the nomination made in section -1 (4)
Date : Cj+h M :'i:f )JD 'J.2..
-~, _J..i~-* C..1 .~S1~~~ N i . ~RNA
Place: KARNAL (Sign Of Father /Mother /Guardian ) \I
With complete address
Witness : /:f~J/;?"~~ r 1
(U'tb~wAA--
(Signature) P~ (Signature)
Full name & address or o~eal of the witness Full name & address or office seal of
the witness _ _ _ _ _ _ _ _ _ _ _ _ __
No<o,- ,.,. w,,o~, -"ooW .,. .,• ., G,_,, offiea, ' " "~ ol
institute/ANO/SarpanchNillage Head Dyal Singh pobfic Sctlo
KARN\!.
SECTION-IV
Received a sum of Rs 14/-(Ten Rupees Only) as one time subscription and emuiled as a
members of the National Cadets Corps welfa(e society du(ing the cadetship in the junic,r /~enior
division wing
Date:
Place: KARNAL (Sign Of QC Unit with office seal)
SECTION-V
(To be filled by NCC Unit)
1
Date of dispatch of the Nomination for