Indemnity Medical Risk Drowning Cert

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FORM OF INDEMNITY

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


types of training and also participate in any camp/Course/Adventure Training
activities in out side NCC and traveling I undertake and agree that, neither I
nor, my executor nor administrator will make any claim against the Govt. of
India or against my Officer, JCO or of Armed Forces/Civilian MT Driver or
against any other person in the service of the Govt. of India in respect of any
loss or injury to the property of person (including injury resulting in death)
which I may suffer in a Camps/Courses/Adventure training activities outside
NCC and traveling and I understand that no compensation will be paid by the
Govt. of India or any Officer, JCO or Armed Forces/Civil MT Driver or against
any person in the services of the Govt. of India and in respect of any such
loss or injury (including injury resulting death) and I agree so as to bind
myself, executors and administrator to indemnity the Govt. of India any
Officer, JCO or Armed Forces/Civilian MT Driver and any person (Third party
against them arising but of any set of default in my part during or in
connection with said training/Camps/Courses/Adventure and injury by road /
rail / river / flight.
The Govt. has agreed to bear the stamp duty on the documents.

Signed by the applicant in Signature of


applicant.
Present of shri

Witness : Countersignature of Parent/


Guardian with date.

Signature with date

Name in block letters Name in block capital letter


Address :

SIGNATURE OF THE HEAD OF INSTITUTION

COUNTERSIGNED BY CO

VOLUNTEERS / RISK CERTIFICATE


It is certified that I, No.___________________
Rank________Name________________ of
_______________________________________ (College / School) volunteer to
attend (Name of Camp) __________________________
__________________________________to be held at (Location)
_____________________________ from _____________ to ______________ at my
own risk.
Station:
(Signature of Cadet)
Date :

TO BE ATTESTED BY PRINCIPAL / FATHER / GUARDIAN

(Signature of Father/Guardian)
Name in Block Letters:

Name and Address:

Address with Phone Number :

Signature of ANO with seal Signature of Head of Institution with


seal

COUNTER SIGNATURE BY CO UNIT


MEDICAL CERTIFICATE

I Certified that I have examined No.________________Rank_________

Name_____________________________ Son of__________________________________

Institution Maharishi Vidya Mandir ,Hosur of 11 (TN) Sig Coy NCC, Salem

In accordance with the standard laid down in NCC Act & Rules and found
he/she is Fit

to undergo Training of strenuous nature in


_______________________________________

(Name of Camp) being conducted from


____________________to____________________

2. I also certify that the above mentioned Officer / Cadet has been
inoculated/Vaccinated against:-

(a) Typhoid (TAB)

(b) Tetanus (TT)

(c) Tuberculosis (BCG)

(d) Hepatitis ‘B’

3. I also certify that the above mentioned Officer / Cadet has been
screened for HINI

Signature of the Medical Officer

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