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Appendix 'A'
NOMINAL ROLL: ATC – 06 CUM IUC PREPARATORY AT ANNAMALAI UNIVERSITY, CHIDAMBARAM

FROM 01 JUL 2024 TO 10 JUL 2024
Dte : HQ NCC Dte (TN, P & AN), Chennai

Gp HQ : NCC Group HQ Puducherry
Unit : 5 (TN) Naval Unit NCC, Cuddalore
S. Regtl Rank Name of Father's Date of Present Name of Govt/ Swimmer/ Veg Remarks
No No. the Cadet Name Birth Address with the Pvt Non /
. Mobile No. Institutio Swimmer Non
n Veg
Signature of the ANO (with seal) Office seal Signature of the HoI (with seal)
COUNTERSIGNATURE OF CO
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Appendix ‘B’
MEDICAL FITNESS, VACCINATION AND INOCULATION CERTIFICATE
1. Certified that I have examined No. _____________________ Rank ________

Name ________________________ Son/Daughter of ________________________
of School/College _______________________________________ as per laid down
standards in NCC Act & Rules, 1948, Appendix ‘A’ and found him/her FIT / UNFIT to
undergo training of strenuous nature of Annual Training Camp to be conducted at
Annamalai University, Chidambaram from ______________ to ______________.
2. I also certify that the above mentioned Cadet has been inoculated /
vaccinated against small pox and typhoid and is free from all diseases.
Signature of Medical Officer

Station: (Name in Block letters with
Designation and seal)
Date :
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Appendix ‘C’
RISK/VOLUNTEER CERTIFICATE
This is to certify that I, No. _____________________ Rank ___________

Name _______________________ of Institution ____________________________,
Unit 5 (TN) Naval Unit NCC, Cuddalore am a volunteer to attend ATC-06 Cum IUC
Preparatory Camp to be conducted at Annamalai University, Chidambaram from
_______________ to _______________.
Signature of the Applicant
PARENT’S CONSENT CERTIFICATE
It is to certify that I have no objection to spare my son/daughter Regtl

No. ____________________ Rank ________ Name _________________________
to attend ATC-06 Cum IUC Preparatory to be conducted at Annamalai University,
Chidambaram from _______________ to _______________.
Station: Signature of Parent / Guardian

Name in Block letters & Address
Date : _________________________
_________________________
_________________________
TO BE ATTESTED BY PRINCIPAL/HEAD MASTER
(Office Seal) Signature of Principal/Head Master

(with seal)
COUNTERSIGNED BY OC UNIT
Station: Signature of the CO/OC Unit
Date :
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Appendix ‘D’
DROWNING / ACCIDENT / SAFETY PRECAUTION CERTIFICATE
1. I know that there is deep water near the campsite, 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 in the vicinity by the in-charge. If I go to or near any one of these out of bound
area, I shall do so at my own risk.
Signature of the Applicant
TO BE ATTESTED AND CERTIFIED BY PRINCIPAL / HEAD MASTER
Certified that the above named cadet is on the roll of the College/School and
has been spared for ATC-06 Cum IUC Preparatory to be conducted at Annamalai
University, Chidambaram from _______________ to _______________. It is also
certified that I have explained the orders regarding precaution to be taken against
drowning accidents and visiting any out of bound areas .The cadet has signed in my
presence.
(School/College Seal) Signature of Principal/Head Master

(with seal)
COUNTERSIGNED BY THE OC UNIT
Station: Signature of the CO/OC Unit
Date :
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Appendix ‘E’
No. _____________________ Rank _____ Name: __________________________

Institution: __________________________________________________________
FORM OF INDEMNITY CERTIFICATE/BOND FOR NCC OFFICER AND CADETS
In consideration of my being nominated at my request to undergo all types of

training and also participant in any travelling, I undertake and agree that neither I nor
my executor nor Administrator will make any claim against the Govt of India or
against any Officer, JCO/OR, Civilian MT Driver or against any person in the service
of the Govt of India in respect of loss or injury to the property of person (including
injury resulting in death) which I suffer while or in consequence of my being in
training/participation in any Camp/Course, adventure training activities in/out side
NCC and travelling and I understand that no compensation will be paid by the Govt.
of India or any Officers, JCOs/Other Ranks of Armed Forces/Civilian MT Driver or
against any person in the service of Govt of India and in respect of any such loss or
injury (including injury resulting in death) and I agree so as to bind myself, executors
and administrators to indemnify the Govt of India and Officer, JCO/Other Ranks of
Armed Forces/Civilian MT Driver and a person in the Govt of India against claim
which may be made by any third party against them or any of them arising out of act
of default on my part during or in connection of the said
training/camp/course/adventure training and journey by road/rail/sea/river and flight.
The Govt. has agreed to bear the stamp duty on this document.
……………………………
(Signature of the Applicant)
Address
Signed in the presence of Witnesses
1. Signature ………………………… Signature ……………………

Name & Address ……………………...… (Father/ Guardian with date)
……………………………………………… Name (in Block letters) &
……………………………………………… Address ………………………
…………………………………
…………………………………
2. Signature …………………………
Name & Address……………….…………
………………………………………………
………………………………………………
COUNTERSIGNED BY OC UNIT
Station:
Date :
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NOMINAL ROLL: ATC – 06 CUM IUC PREPARATORY AT ANNAMALAI UNIVERSITY, CHIDAMBARAM

Dte : HQ NCC Dte (TN, P & AN), Chennai

MEDICAL FITNESS, VACCINATION AND INOCULATION CERTIFICATE

1. Certified that I have examined No. _____________________ Rank ________

Signature of Medical Officer

This is to certify that I, No. _____________________ Rank ___________

Signature of the Applicant

PARENT’S CONSENT CERTIFICATE

It is to certify that I have no objection to spare my son/daughter Regtl

Station: Signature of Parent / Guardian

TO BE ATTESTED BY PRINCIPAL/HEAD MASTER

(Office Seal) Signature of Principal/Head Master

Station: Signature of the CO/OC Unit

DROWNING / ACCIDENT / SAFETY PRECAUTION CERTIFICATE

2. I have been explained the orders regarding precautions to be taken against

Signature of the Applicant

TO BE ATTESTED AND CERTIFIED BY PRINCIPAL / HEAD MASTER

(School/College Seal) Signature of Principal/Head Master

COUNTERSIGNED BY THE OC UNIT

Station: Signature of the CO/OC Unit

No. _____________________ Rank _____ Name: __________________________

FORM OF INDEMNITY CERTIFICATE/BOND FOR NCC OFFICER AND CADETS

In consideration of my being nominated at my request to undergo all types of

1. Signature ………………………… Signature ……………………

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