APPENDIX FORM “A” [See Regulation 4(1)] Application for enrolment as a member of the Civil Defence Service 1. Name in full (in Block letters) 2. Father’s/ husband’s name. 3. Date of birth 4. Nationality 5. Permanent address 6. Occupation and present address 7. Name and address of present employer 8. Educational qualifications 9. Languages known (to read/ write/ speak) 10. Are you a member of the following? (i) Defence Forces (Army/Navy/Air Force) or any of their reserves; (ii) Territorial Army or any other auxiliary force of Defence services; (iii) Civilian cadre of Armed Forces of the Union, subject to Naval, Army or Air Force law, other than “Casual employees”; (iv) Police Service; (v) Fire Services. 11. Are you an ex-service person? If so, give particulars. 12. Do you belong to the National Volunteers Force? If so give particulars. 13. Have you any previous experience in Civil Defence Corps? If so, give particulars, including date. 14. Have you any preference for any particular section of Civil Defence Corps? If so, state the section. 15. Have you any special qualifications for enrolment in the section chosen by you? If so, give details. 16. In case of preference for service in Mobile Columns or ambulance trains, are you prepared to serve anywhere in India, should an emergency arise? 17. For how many hours and so what days of the week will you be available for Civil Defence duty (for part-time volunteers only). 18. Do you have any conveyance (bicycle, motor car, motor cycle) etc? 19. Are you suffering from any communicable diseases? If so, give particulars. 20. Did you have small pox? If so, when 21. Have you been vaccinated? If so, when 22. Have you been inoculated for cholera/ typhoid/ T.B etc? If so, when 23. Do you know First Aid/ motor driving? 24. Signature of applicant. 22 CIVIL DEFENCE LEGISLATION IN INDIA DECLARATION 1. I have read the “Civil Defence Regulations, 1968”. 2. As far as I know. I am physically fit to render efficient service as a member of the Corps. 3. If my application is accepted, I am prepared to service as a whole-time/ part- time member of the Corps, i.e., to undergo the appropriate training and, in the event of any emergency occurring whilst I remain a member of the Corps, to carry out my obligations a a member thereof. 4. I undertake:- (i) to carry out my duties in the Civil Defence Corps in accordance with the instructions and orders issued by the authorities concerned; (ii) to return, when I cease to be a member of the Corps, any articles of uniforms, badge or other personal equipment issued to me; and (iii) to abide by the regulations of the Corps. Signature of the applicant Place: Date: This form duly completed should be submitted to:- Name and address of Enrolling Authority-------------------------------------------------------- FOR OFFICIAL USE Recommendations of the Head of Corps/ Staff officer concerned Admitted to (Corps, etc.) and Allotted to (post No. etc.)----- Signature--------------------------------------------- Signature--------------------------------------- Designation----------------------------------------- Designation------------------------------------- Date------------------------------------------------- Date--------------------------------------------- FORM –B Form of Oath [ See Regulation 5 ] I,-----------------------------* son/ daughter/ wife of ----------------------------- swear/ solemnly affirm that I will be faithful and bear, true allegiance to India and to the Constitution of India as by law established, and that I will loyally carry out the duties entrusted to me ( so help me God*) (* To be deleted as necessary) CIVIL DEFENCE LEGISLATION IN INDIA 23 FORM-C Serial No.-------------------- [ See Regulation 7 ] Membership Certificate Government of ---------------------------( name of States ) CIVIL DEFENCE CORPS 1. Name in full. 2. Nationality 3. Age 4. Father’s/ husband’s name 5. Identification marks 6. Permanent address 7. Name of Civil Defence Corps in which employed 8. Assignment 9 Name and address of next of kin 10 Signature / thumb (left Hand) impression of the worker. Date of issue Office Stamp of Signature and designation of Issuing Authority Issuing Authority FORM –D Government Civil Defence RECORD OF [ See Regulation 13 ] 1. Name 2. Father’s/ husband’s name 3. Nationality 4. Date of birth/ age 5. Identification marks Signature of Civil Defence Controller Or of any officer on his behalf 24 CIVIL DEFENCE LEGISLATION IN INDIA Particulars of C.D. Corps/ Training etc. Name of Assignment Identity From To Scale Pay Allow- Total Reason for Service Card No ances termination of assignment e.g. transfer etc. 1 2 3 4 5 6 7 8 9 10 N.B.- (a) A record in the proforma should be maintained in respect of all C.D. personnel. (b) Particulars in col.(1) to (18) should be filled in as and when they occur, and attested. (c) This record should be kept in the custody of a responsible officer, not below the rank of head of Corps. of__________________________________( name of State ) Corps SERVICE 6. Permanent address 7. Particulars of post held under Government, etc. 8. Name and address of employer 9. Name and address of next of kin. 10. Signature / thumb impression Leave taken Personal equipment, Signature Signature of Remarks _________________ uniform and of C.D. head of C.D. Nature Period accoutrement workers Corps of __________ __________________ leave From To Items Items issued returned and date and date of issue of return 11 12 13 14 15 16 17 18 Items 1 to 10 at the top should be filled in at the time of enrolment. [No. 10/2/66-DGCD (ii) (1)] J.C. AGARWAL, Jt. Secy. REGISTERED NO. D.221 THE GAZETTE OF INDIA EXTRAORDINARY PART II- Section 3 – sub- Section (1) PUBLISHED BY AUTHORITY No.68. NEW DELHI, WEDNESDAY, APRIL.7, 1971/ CHATRA 17, 1893 Separate paging in given to this Part in order that it may be filed as a separate compilation MINISTRY OF HOME AFFAIRS NOTIFICATION New Delhi, the 6th April, 1971 G.S.R.520.- In exercise of the powers conferred by section 9 of the Civil Defence Act, 1968 (27 of 1968), the Central Government hereby makes the following regulations to amend the Civil Defence Regulations, 1968, namely:- 1. (1) These regulations may be called the Civil Defence (Amendment) Regulations, 1971. (2) They shall come into force on the date of their publication in the official Gazette. 2. In the Civil Defence Regulations, 1968.- (a) for regulation 7, the following regulation shall be substituted, namely :- “ 7, Mmebership Certificate. (1) Every person appointed to be a member of the Corps shall be issued a certificate of membership in Form C. (2) A person losing the certificate issued to him under sub- regulation (1), shall report its loss forthwith to his immediate superior officer, who shall make necessary enquiries, and shall after satisfying himself, and arrange the issue of a duplicate certificate of the same. (3) The cost of the aforesaid duplicate certificate as determined by the issuing authority shall be borne by the person to whom the certificate of membership was issued under sub- regulation (1)”. (b) in the appendix, for the existing Form C, the following Form shall be substituted, namely:- “ As on reverse” 25 26 CIVIL DEFENCE LEGISLATION IN INDIA FORM C NO. [See Regulation 7] Membership Certificate Government of -------------------------------------( name of the State) CIVIL DEFENCE CORPS 1. Name in full 2. Nationality 3. Date of birth 4. Father’s/ Husband’s name 5. Identification marks 6. Permanent Address 7. Name of Civil Defence Corps In which employed. 8. Assignment 9. Name and address of next of kin 10. Signature/ thumb impression of the PHOTOGRAPH person Date of issue Office stamp of Issuing Authority. Signature and designation of Issuing Authority [ No. 5/33/69-DGCD (CD)] J.C.AGARWAL, Jt. Secy.
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