Appendix B' Refers to para 3of
DGNCC letters 19952/DGNCCICWS dated 28 Apr. 2000
Nomination Form
For Membership of the NCC Cadets Welfare Society
(to be retained at NCC Group HQ
1
(Section-1)
HTE 314RT ) ****
Ta/T/ (
************snneetans************************** imnatsannp
***s*e**********
/3DTCiT TT ***********************************************5.) *********sat*0**********
37RET/3Tl
1, Cadet (name in block letters) KANKS... ...son/daughter of Shri
name in block letter) KeLICH.ANRRA.CNHA a student of class.. . . of (Name) of
College/School) . . . IS.g. on my enrolment with the NCC on (Date) iial2.2. with
(Name of the Unit) .Mah.m.MC...apply for membership of the NCC Cadets Welfare Society
and hereby subscribe a sum of Rs. ..Rupees ..only) towards its
membership fee.
2. HR fCT/TCT/IRETT arr
311
T..
My father/Mother/Guardian's occupation is .D£.acá.eng'änd the annual incomeof
my family from all sources is R s . a 9 . . 9 . . per annum.
3
understand that I shall be entitled to financial relief as determined by the Governing
Body/Managing Committee of the above Society in the event of partial or permanent disablement
sustained by me while participating in an organised NCC activity. I hereby accept that the decision
of the Governing Body/Managing Committee with regard to the 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
of the above
the share indicated and as determined by the Governing Body/Managing Committee
the following person(s) in the event of my death while
Soceity, which will be final and binding on
participating in an organised NCC activity
35.Hi 1e HeRT )
Permanent address % of financial
S.No. Name of the nominee(s) Age Relationship
(in block letters) with the cadet of the nominee assistance Payable
Yaghuwan
Psemcha ndra |41 Father CaUav Co mplex. 100 0/
Qiha_
2.
3.
c e ERT RI TTY (To be filled by the Cadet in own hand writing)
valid only till such iime 1
5. Nomination
Form will be
this
Society and becn enrolled.
My membership
in the Welfare which I have
or Wing
of the NCC to
Division
remain a cadet in the
of the Cadet)
(FullSignature
ACha
fH5 Date: 1 o |2022
achQndra
FeTT Place: uMbai Eg-II
2) 102
(Section-lI)
CroRALHENDAASAVARAFMAR
Signatur&6YABIOMIUINPiution
KC COLLEGE CHURCHGATE
Fe Place: u m bai
MUMBAI-400020
arRE Date: 12|[o|22 U-1II
(Section-1I1)
3 9 A/Tl/3TPATT TH
to become a
name..AKanks.ha..OJn9..
son/daughter/ward I
allow force of the Society.
to my conditions and rules in
amthewilling
NCC Cadets Welfare Soceity
under the terms &
member of
made in Section
also approve of the nomination
* * 2 s5A**************adsa*****ase********************
BIIET)
(FET TuT/ufAra afather/mother/
(Full Signature of thc
FeTTPlace : 11||o I2022 Guardian with complcte address)
IRR Date: u m bai C ale hondve
CTOHALCHANDRA SAVARDEKA 22
MGarttnq 2. COY COMMANDE...
Witness
1. -onone*******
IcPrincipal KC COSEEOE CHURCHGATE
Kishichan8Chellaram College KAUnanrc400020
seal of the Full name and address with office seal of the
Fyll name and address
wrRecngale, Muhbai- 8 Witness.
Head.
Note-The Witness should be either gazetted officer, head of institution/ANO/Sarpanch/Village
UE-IV
Section-IV
**asmosos*senosenoo***********
**********s*essssrene*************
-.only) as one time
Received a sum of Rs, **********************ss*s*********
(Rupees rorooo**************
subscription and enrolled as a member of the NCC Cadets We!fare Society during the cadetship in the
Junior/Senior Divisíon/wing
o***.******* *************************************************
(Signature of the OC Unit with office seal )
eT Place :Mumbas
TIRTE Date
u-V
Section-V
* **************sssa*********"*******
(To be filled in by the NCC unit)
Date of despatch ofthe Nomination Form to Group HQ.. **********************************************reeeroo*****-doaaos
Note:- The Nomination Form will be printed on both sides of a single lead.
