Appondlx

FORM
NATIONAL CADET CORPS SENIoR I
DIVISIONLWINQ ENROLMENIFORM
(See Rules 7 and 11)
APPLICATION FOR ENROLMENT
What is your name ?
ARYAN.GADPAYLE
AM GAD PAYLE
1
(in Block Capitals)
What is your parent/guardian's name &address? 2. CHOPR
yoJANA.NAGAR.BELA
Address
6H ANDARA..MAH 441906
3. Are you a citizen of India or a subject of Nepal? 3..NDIA
4
What is your Village, Tehsil or Taluka and 4. Awaka.
Village........
District?
Tehsil of Taluka... ................

Distict,Soucke
. wast Delhienloo 8 .
What is your Post Ofice ? 5.NSIT Po
6 What is your Ratway Station ?

Whal is your education qualification ? 7.

Neo Delli Jn..
ERME9TATE (BTecu Puusng)
What are your age & Date of Birth?

Have yOu ever been convicted by a criminal court

8..8.2611l2004).
and if so in what circumstances and what was the 9...o
sentence?

10. In which Colege are you now studying?

10..NETAJI SUBH ASH UN VERSI7Y ot TECH NOLC
11 Are you willing to be enrolled under the
National Cadet Corps Act. 1948 ? 11. ...eA
12 In which unit do you desire to be enrolled? 12..BN ARHV
13. Are you willing to undergo service training as
specified in the Act and the rules made there under? 13.. . .
14. Are you willing to serve in the National Cadet
Corps untill discharged as provided in the Act? 14. .e.
15. Have you ever previously applied for enrolment 15. ...No
under the Act. and if so, with What result?
16. Have you been dismissed from the National Cadet
Corps. the Territorial Amy or the Indian Amed Forces ? 16. ... N.o.
17. Next of kin with address
(With relationship) 17,,CHORRAM..GARPAYLECLATHER)
8600838643
Telephone No. (0) (R) (as applicable)
YoTANA.NAGARAt.Po..BELA
BHANDARA.MAH 44l4OG.
Place : NSUT AELHI Ce
Date 25 |10/2023 (Signature of the applicant)

DECLARATION ON ACCEPTANCE FOR ENROLMENT

1. Isolemnly declare that the
answers Ihave glven tothe questions in this form
is false,and that I am willing to fulfil the engagement made. are true and that no part of them
2. 1ARYAN
hy the
GADPAYLE .promise thatI will honestly and
Rules Regulations of the
&
camps as may be required by the National Cadet Corps that will , the bestfaithfully serve my country and abide
CommandingOñicer from time tototime. of my abilty, attend all parades and
ARVAN GAPAJLE.Further promisethat after
.7.!........
foranycompensation in the event of injury or
oendue to enrolment.
I wil have no claim on
authorities
while on YEP or any other such NCCevents like RDÇand accident
IDc durlng training camps, courses, travelling and
Place: NSUT DELHI (Slgnaturfof theappllcant)
 FOR
MEMBERSHIP OF THE
(To bo retalned at CADETS WELFARE SOCIETY
NCC Group H)
1
I, Cadet (
biock letters Sectlon-1
CHOPR gi nbl
ANock )ARyAN GAPPAYLE
lejtePAyLE..
School.
On my NETAJI
(rarro of llesje/

apply forenrolment with the SVGH.

..a student of clas.
NCC on
ASH. UNIVERS ITY of TECHNoLDGry BN ARMV
(name ofthe uni) 6
membership of the
(date)25/o|2023with
NCC Cadets
.only) towards its Welfare Society and | hereby subscribe a sum
Ra.
2
My membership fee.
my family
3
father/msource
from all other/GuarRs..00,00...Per
is dian's occupation annum.
TEACHER.
is . . . .
.and the annUal incormo tf

Iunderstand
Committee that Ishall
of the above societybe inentitled
the event of partial
to financial relieforaspermanent
determineddisablement sustained
by the Governing by Managing
Body/ me whle:
participating in an organized NCCactivity. Ihereby
eewith regard
will be final to the accept that the decision of the Governing Body/Manag1riy
and binding onme.quantum of relief to be paid to min theevent of my partiall/permanent os
4.
Iherebyy nominate the
Inaicated and as determined byfollowing person/persons who will receive financial assistance a
and binding on the following the Goveming Bodv/ManainoC i t ofthe above Society, which will beofnal
person(s) in the event of my death while ita
Ser. Name of the
nomingslnomiees Agg participating in an organizeON
No. in block letter) Rglationship with the
Cades
Psrmanent address of the Permanent of flnansja!
n9mineg istncA RAYnble
1.CHOPRAM GA9PAyLE 50 fATHER YDJANANAGAR BEA
2.StALINI GAPAYlE
3 2
BHANPARA MAH 441406
MotHER YoJANA NACAe BEFA
BHANAR9 ul406
(To be filled by the cadet in own hand
writing)
Section |
5 My membership inthe Welfare SOciety and this
Nomination Form will be valid only till such t1me I rear 3
Cadet in the Division or wing of the NCCto which Ihave been enrolled.
Place N5UT DELE)I (Full Signature of the Cadet)
Date
25/10|20 23
Place
(Signature of PTO/Head of Institution)
Date

Section ||
lam willing to allow my
Sonidaughter/ward name.RYAN GADPAYLE
member of the NCC Cadets Welfare Society under the terms 7 condition and rules in force of ..to became a
approve of the nomination made in Section 1(4). the Society laiso
Place: NUTOElHI (Full signature of
Date: 25 /10|2o 23 Father/Mother/Guardlan)
Complete Address.QJANA.NAGAR
Witness ATPo.BELA. BHANDARA MA HAR ASHTeA
1. Signature Witness 41906
2. Signature
Dr. Swapnil L Songvane
Assistant Professor
bepartment of Chemisty
Netajj Subhas University of Tecd
Govt ofNeT oDelthi
Soctor-3. Dwarka, NewtalhwOgünd address or office
Note: The witnessess should be either gazetted onio,nead of sealof the witness)
Head Institution/NCC
Part time Oficer/Sarpanch/Village
 solemnly declare that tthe DECLARATION
1. I BY PARENT/GUARDIAN
sonvdaughterwand is willng totulll tho
2. 1CHOPRAM GADPAy: ngupemontudo promis that anor tho uolbont of my onduglhtor/wr,lrnin)Iwll iv
claim on authonties for anyyCompensaton n the ovent of donthh duo to ncclont durlng
'
Oy ojy or
0usesS, travelingand while on YEPuv other suah NCC 0vunt lko RDC AMl IDG
Tinderstand my aon/daughterwant has no neIvlce llatblitly
Place. N5UT Dllu (8ignaturo of Parenta/Gurduy
Date .0/2023
25
CERTIEICATE
1 Certiñed that the applicant understands and agreos to the conditlons of enrolment.
2. Certified that the applcant and his parenUguardlan understand and agree to the conditlons of enrolrment
Place

Date of Enrolment. (Slgnature of Enroling Offcer)

(Unit Seal)
For Minors Only. Score out in applicable portion.
TO BE COMPLETED BY MEDICAL OFEICER BEEORE ENROLEMENI
Ihave examined (Name) . .ARAN
..... GADPALE .on..

Naional Cadet CorpS

...(date )and consider him/her fir /unfit for enrolment as a Cadet In the

Signature
mar Bhatnagar
Place:
Date..26I0d3 Designation Dr, Rajeev M.R B.S.
(Medical Officer) DMC No. 1241

TO BE USED FOR EXTENSION OF ENROLMENT

SEE RULE 13

lagree extend the enrolment for one year and

am willing to fulfil the engagement made.
A.
Place: N5UT Dei
(Signature of the appllcant)
Date.2.5iO.2023
Place
(Slgnature of Commanding Officer)
Date
my'son/dauahter/ward for one year and am wiling to fulfil tha
I agree to extend the enrolment of
engagement made.

Place: NSUT Dei

25|10)9023 (Slgnature of Parent / Guardian)
Date

Place :
(8ignature of Headmaster)
Date

Date from which extensions starts

Headquarterg
Note :Thls form wll be retained in the unit

(Slgnature of 0c unlt)
 enrollel
Section IV subscription and
time
Received a sum of Rs. (Rupees. Only) as one Division Wing
as a member of.the NCC Cadets Welfare Sociey during the cadetship Inhe Junior/Senlor
Bn
LtColoel
Qaitwith bfiaefeal)
(Signature Gtm
Plata 6 Delhi Bn
Dale
Sectlon V
Vew
(to be filled In by the NCC Unit)
.
Ha
Date of dispatch of the Nomination Fom to GrOup Appendix 'B
Annexure to Form I
(Appllcation for enrolment)

IDEMNITY BOND

To.
The President of India as participant iri
nominated either by the NCCauthorities or at my own request Course, Adventure
being
In consideration of my Republic Day camp and independence. Day camp in travelling (in domestic Delhi),
includes the case my be) and while
any NCC Camp (which & Air Wing activities, as Youth Exchange Programmes abroad, Iundertake
and
Training (including Amy, Navy attending claim against
transport) and will make any
intermational surface, air and water of administrators or other legal representativeseguivalents from Navy and Air
nor my executors JCO's/NCO's or their
agree that neither I, including officers, respect of any loSS Or
Govemmentor against NCC authorities other such person in the service of the Govt. in whatsoever which|my
ne Drivers or against any reasons
Force / Civilians, MT resulting in death, due to any no compensation will
Property or person, including injury
activities and I understand that Navy and
the in the above from
Injury to of mny participation
in consequenceNCCauthorities JCO's/NCO's or their eguivalents executors and
Suter, while or Gaovernment including officers. as to bind myself, my
or loss or injury and I agreeNCC authoities including Officers
be paid by the Drivers in respect of any such or
Air Force or Civilian MT representative indemnify the Govt. any person in the service of Goverment
administrators and other legal Force Civilians or act of default or
from Nayy and Air them arising out of any
JCO's/NCOS of their equivalents any third partv against them or any of and while on Youth
be from Adventure Training, travelling
against any claim which may camps. courses, within or outside the
during or in connection with the said activities as may be organized from time to time
my part NCC
EXCNange Programme or anyother such
Union of India.
Signature of Applicant...
No.860O838.64.3
Witness Koishay
ARYAN GA PPAYE
(1) Signature. Name
Name. KRISHAN. Uni/Group.....
Address.VLLDHAKLA
DISTRICT-JHAIJAR (HR-124109)
Guardian....
Signature of Parent /
(2) Signature.. ... ........ CHOPBAM..GAPPAYLE
Name. Glshe...anA. YaTANA..AJAGAR BELA
Name...
Address.
Address..esah..dsng MH 44 |406
..5Ss..4.S..eidA....loo14. BHAN ARA..
Place: SUTPelw
Date: 25710/2023
appliable to Minor will be used)
case of SD Applicants being a minor. Indemnity Bond
(Note : in
ENTERPRISES Ph.: 28722691, 9971452842
GARG