Revised IAF (TA-9A) (i) (2010)

APPLICATION FOR COMMISSION IN THE TERRITORIAL ARMY

FOR NON DEPT INF TA

1.Candidate’s Name
(To be filled in BLOCK CAPITALS in blue ball point pen. In case of variation in Name as given in Metric Certificate attach
an affidavit)
2. Father’s Name

3. Permanent House No. Block/Pkt.

Address. Village/Town Post Office
(Furnish
domicile Tehsil District
certificate
issued by State Pin Code
DM/DC) Mobile No. Land Line No.

4. Present House No. Block/Pkt.

Address. Village/Town Post Office
(Furnish
domicile Tehsil District
certificate
issued by State Pin Code
DM/DC) Mobile No. Land Line No.

5. Date of Birth in per metric certificate 6. Gender 7. No. of attempts already made in
(Strike out whichever is not SSB for:
applicable )
NDA
CDSE
TA

8. Educational Qualification 9.Education Stream 10. Nationality

*(Attach attested Mark Sheets & Code: Arts -01,
Cert from Metric onwards)
Science-02,
Commerce-03, Engineering – 04,
Code: Graduation- 01, Post Graduation-02
Medical – 05, MBA-06 & Any
other - 07

11. Marital Status:- 12. Next to kin 12(a). Name of Next of kin
Single /Married/ Divorcee Code: Father-01,
(Strike out which ever not applicable) Mother-02, Wife-03,
Son-04, Daughter-05 & Other -06

15. 14. Details of previous Commissioned Service in the

13. Nature of employment: Armed Forces (Furnish Discharge / Release Certificate)
(Write Code)
b) Service
Employment Code :-
Central Govt /Union Territory -01 Code : Army–01, Air Force-02, Navy-03,TA-04
c) Category
State Govt/ Semi Govt -02
Code : Officer – 01, JCO/Equivalent-02, OR-03
Self Employed -03
d) Rank
Pvt Sector -04
e) Army/Service No

15. Reason for Discharge (Write Code)

Code : Med Bd Out -01, Voluntary Discharge -02, Disciplinary Ground-03, On Superannuation-04 & Any Other-05
 16. DECLARATION TO BE SIGNED BY CANDIDATE

(i) In the event of my selection for a commission in the Territorial Army, I am willing to serve anywhere in India for
longer duration also, whenever required or as per the rules and orders in force from time to time.

(ii) I clearly understand that if at any time during the period of probation I am not found suitable, I shall have to resign
my commission in accordance with the rules and orders in force from time to time and in case I decline to do so I am
liable to be discharged /removed from the Territorial Army.

(iii) I am fully aware that if it is found at any stage that I have knowingly furnished any particular which is / are false
or have suppressed material information or I fail to comply with the above undertakings, my candidature will be
rejected summarily and if already commissioned ,I shall be liable to be discharged/removed from the Territorial
Army.

Signature of Witness ___________________ Signature of Applicant_________________________

Name _______________________________ Name ______________________________________
Address of Witness ____________________ Address ____________________________________
____________________________________ ___________________________________________

_____________Mob /Ph No ____________ ___________________________________________

Date: ____________________________ Date ______________________________

17. CERTIFICATE TO BE RENDERED BY CANDIDATES EMPLOYED IN CENTRAL GOVT/UNION

TERRITORY/ STATE GOVT/SEMI GOVT DULY AUTHENTICATED BY HEAD OF OFFICE.

(a) I certify that Shri_________________________________ S/O___________________________________

employed under me as___________________________________ for the last______________ years and that his
character as far as known to me is good. He is /is not recommended for the grant of commission in the TA.
(b) It is also certified that Shri__________________________________ will be made available for training or
embodiment for service in a Provincial/Urban unit (any of the two types of units) of the Territorial Army as and
when required.

(c) It is further certified that Shri_____________________________________ does not hold and /or is not likely to
hold in the foreseeable future a key-post in________________________ (Department/ Organization) which could
affect the minimum essential functions of this Department/ Organization. However in the event of this becoming a
key man subsequently the Additional Director General Territorial Army New Delhi shall be requested immediately
to release or discharge him from the Territorial Army.

Place: Signature

Date: Designation______________________________

Stamp/Seal of Office

18. CERTIFICATE TO BE RENDERED BY SELF EMPLOYED PERSONNEL TO BE

AUTHENTICATED BY
GAZETTED/ COMMISSIONED OFFICER/DM

(a) I certify that Shri _______________________________________ S/O_________________________________________

is known to me for the last _______________ years and bears good moral character to the best my belief and knowledge. He
is /is not recommended for the grant of commission in the TA.

Place: Signature

Date: Designation______________________________

Stamp/Seal of Office
 19. CERTIFICATE TO BE RENDERED BY CANDIDATES EMPLOYED IN PRIVATE SECTOR (TO
BE AUTHENTICATED BY HEAD OFFICE)
Certified that :-

(a) Any difference between the civil and military pay and allowance of the applicant Name___________________________
Son of _____________________________ an employee of this organization will be paid by us for the period of his military
duties in the Territorial Army.

(b) On return from military duty in the Territorial Army Shri____________________________ will be absorbed in the same
or equivalent post which he would have held if his service in the civil had not been so interrupted and the such military
service would count for all benefits in his civil job, like seniority for promotion, increments of pay, bonus and Provident Fund
etc. To which he would have otherwise been entitled.

Place: Signature

Date: Designation______________________________

Stamp/Seal of Office

20. Recommendation of Interview Board at Command

(To be completed by Presiding Officer Preliminary interview Board)

(Recommended/ Not recommended for a Commission in the Territorial Army )

Place: Signature

Date:
President PIB (With Rubber Stamp)

Office Seal