Certificate No - 1: (By OC Unit/Army Personnel Branch/DSS & A Board/Record .Office)

CERTIFICATE NO - 1
CHILDREN OF SERVING ARMY PERSONNEL HAVING 10 YEARS CONTINUOUS SERVICE

IN THE ARMY, RETIRED/ RELEASED/ DISCHARGED AFTER 10 YEARS OF
SERVICE/KILLED IN ACTION/DIED DURING SERVICE/DISABLED IN
ACTION/MEDICALLY BOARDED OUT WITH PENSION
(By OC Unit/Army Personnel Branch/DSS & A Board/Record .Office)
1. Certified that Mr/Ms………………………………………………………………………………………..is Son/ Daughter of

No_________________Rank________________________________________Name_________________________
______ Unit__________who has 10 years of continuous service in the Army from_____________________to
_______________-_
2. Certified that Mr/Ms_________________________________________________________________ is

Son/Daughter of No __________________ Rank _______________________ Name
_________________________________________________ who has been released/ discharged from Army after
10 years continuous service from_________________ to ___________
3. Certified that Mr/Ms ________________________________________________________________ is

Son/Daughter of No________________ Rank______________________Name
______________________________________________________ who has been granted/awarded regular
pension, liberalised family pension, family pension or disability pension at the time of his superannuation, demise
discharge, release medical board/invalided medical board.
4. Certified that Mr/Ms _________________________________________________________________

is son/daughter of No____________ Name________________________________________________________ ex
recruit No _______________ Name __________________________________________ who was medically
boarded out and granted disability pension.
Place: OC Unit/Head of Department/Records Office/DSS & A Board

Date : Name
Designation
Office Seal
Name of the Candidate ____________________________ Signature ___________

Name of Parent _________________________________ Signature ___________
Notes :
1. Strike out the portion which is not applicable.
2. If retired/released with pensionary benefits, attach Certificate from pension paying authority.
3. If retired/released on medical grounds with disability pension, attach copy of medical board proceedings.
4. If released/discharged after 10 years of service, attach copy of discharge certificate/ release order.
CERTIFICATE NO - 2
STEP CHILDREN OF ARMY PERSONNEL WHO WERE BORN FROM WEDLOCK

WHERE AT LEAST ONE PARENT BELONGED TO THE ARMY/ADOPTED
CHILDREN OF ARMY PERSONNEL WHO HAVE BEEN ADOPTED
ATLEAST 5 YEARS PRIOR TO COMMENCEMENT OF COURSE
(By Personnel Branch Army HQ/ OC Unit)
1.Certifiedthat Mr/Ms ___________________________________________________is son/ daughter of

No__________Rank_______________Name____________________________________________________
_________ Unit ______________________________ and he/she was born from wedlock where the
father/mother belonged to Army and had served in the Army for 10 years or is serving in the Army and has
minimum 10 years of service.
2. Certified that Mr/Ms_____________________________________________ is son/ daughter of

No_________Rank_____________________Name ___________________________________________,
who has 10 years of service in the Army and he/she was adopted on (5 years prior to commencement of
course).
Name of the Parent _________________________ Signature _____________
Rank ______________________ No, ________________
Place : Signature of the Concerned OC Unit/ Concerned Record Office)
Date : Name
Designation Office Seal
Name of the Candidate ____________________________ Signature ___________

Name of Parent _________________________________ Signature ___________
Notes:
1. Attach copy of legal papers and Part II order of adoption of child.
2. Attach Certificate/ Part II order of birth and copy of kindred roll.
CERTIFICATE NO - 3
CHILDREN OF ARMY MEDICAL CORPS /AD CORPS OFFICERS SERVING-
IN AIR FORCE /NAVY MEDICAL ESTABLISHMENT
/MNS/APS AND TA PERSONNEL
(By Parent, Countersignature by OC Unit)
1. I, No_______ Rank ___________

Name___________________________________________________ Father/Mother
of_______________________________________________________________ certify that:-
(a) I am/was commissioned in Army Medical/Army Dental Corps and have/had not been seconded
to Navy or Air Force and have 10 years of service in the Army.
(b) I am/was commissioned in Army Medical /Army Dental Corps and have been transferred to
Navy or Air Force but I have served in the Army for minimum ten years.
(c) I am an APS personnel on deputation who has put in more, than 10 years of service in the Army
from ________________ to _______________________.
OR
(d) I am an APS personnel directly recruited into APS and who is still serving in Army wef
__________________________________________________________________________________
______
(e) I am a TA personnel who is in receipt of pension/who and has put in more than 10 years of
embodied service in TA from_______________ to
________________________________________________.
(f) I am MNS personnel and who is in receipt of pension/who has put in more than 10 years of
service as member of MNS.
Place : Signature
Date : Name, Designation and Unit
CERTIFICATE
(BY OC UNIT)
The facts in the above mentioned undertaking have been verified from official records and found correct.
OC Unit (for serving personnel) DSS & A Bd(for retired personnel)
Date : Name,
Office Seal Designation and Unit
COUNTERSIGNED
Concerned Staff Officer of Fmn HQs (for serving personnel) DSS&A Board(for retired personnel)
Date : Name
Office Seal Designation
Name the Candidate _________________________ Signature ______________
1. Strike out the portion /Para not applicable.
2. Relevant documents of service records.

CERTIFICATE 4
GALLANTRY AWARD
(By OC Unit/Record Office/DSSA Board)
It is certified that Army No ______________________Rank

__________________________________________ Name
________________________________________________________________________________________
________ of Unit /Regt/Corps
___________________________________________________________________________________ has
been awarded
_____________________________________________________________________________________ on
__________________________________ (Date/Month/Year).
The same has been published vide Part II Order No _________ Date
____________________________________/Gazette Notification __________________ dated
_________________
Signature
Name
Place: Designation
Date: Office Seal
(Name and signature of the Applicant)
● Photocopy of Part II Order/ Gazette Notification is to be attached.

● For Proof of Sena Medal [Gallantry] Candidates must attach a certificate from MS-X that the Sena
Medal has been awarded for Acts of Courage and Bravery.
CERTIFICATE 5
MEDICAL FITNESS
(By PC MH/Auth Medical Attendant)
It is certified that I have carefully examined Mr./Ms. _____________________________________________

age ______________ son/daughter/wife of
_________________________________________________________ and further certify that he/she has
good physical and mental health and free from any disability likely to interfere in his/her undergoing
___________________________________________ Course.
He/she has no abnormality in the heart and lungs and history of mental disease or epileptic fits.
His/her major test results are as under :-

(a) Height: __________________ cms
(b) Weight : _________________ Kgs
(c) Chest: ___________________ cms Expanded _________________ cms
(d) Vision :
Better Eye Worst Eye
(I) Distance Vision (corrected)
(II) Near Vision (corrected)
(e) Hearing: Left Ear Right Ear

(f) Blood Group
Signature of OC MH/Auth Med Attendant

Head of Department
Name
Place: Designation
Date : Office Seal

Certificate No - 1: (By OC Unit/Army Personnel Branch/DSS & A Board/Record .Office)

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CERTIFICATE NO - 1

CHILDREN OF SERVING ARMY PERSONNEL HAVING 10 YEARS CONTINUOUS SERVICE

1. Certified that Mr/Ms………………………………………………………………………………………..is Son/ Daughter of

2. Certified that Mr/Ms_________________________________________________________________ is

3. Certified that Mr/Ms ________________________________________________________________ is

4. Certified that Mr/Ms _________________________________________________________________

Place: OC Unit/Head of Department/Records Office/DSS & A Board

Name of the Candidate ____________________________ Signature ___________

STEP CHILDREN OF ARMY PERSONNEL WHO WERE BORN FROM WEDLOCK

1.Certifiedthat Mr/Ms ___________________________________________________is son/ daughter of

2. Certified that Mr/Ms_____________________________________________ is son/ daughter of

Name of the Parent _________________________ Signature _____________

Rank ______________________ No, ________________

Place : Signature of the Concerned OC Unit/ Concerned Record Office)

Designation Office Seal

Name of the Candidate ____________________________ Signature ___________

(By Parent, Countersignature by OC Unit)

1. I, No_______ Rank ___________

Office Seal Designation and Unit

Office Seal Designation

Name the Candidate _________________________ Signature ______________

1. Strike out the portion /Para not applicable.

2. Relevant documents of service records.

(By OC Unit/Record Office/DSSA Board)

It is certified that Army No ______________________Rank

Date: Office Seal

(Name and signature of the Applicant)

● Photocopy of Part II Order/ Gazette Notification is to be attached.

It is certified that I have carefully examined Mr./Ms. _____________________________________________

His/her major test results are as under :-

(e) Hearing: Left Ear Right Ear

Signature of OC MH/Auth Med Attendant

Date : Office Seal

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Name of the Candidate __________________ Signature _

Name of the Parent _____________ Signature _

Rank ______ No,

Name of the Candidate __________________ Signature _

1. I, No_ Rank _____

Name the Candidate ___________ Signature