Form-2 - Application For Issue of Warrants (S&G)

Form No.
ER-002
EASTERN RAILWAY BHARAT SCOUTS & GUIDES For Office Use
State Headquarters :
NKG ANNEXE BUILDINGS (2nd FL), 3, KOILAGHAT STREET, KOLKATA-700 001 Warrant No……………………
Phone : Rly. : 24154 / 24189 * P&T : 2222 4154 / 2222 4189 # e-mail : bsg_er@yahoo.in
Date…………………………...
APPLICATION FOR ISSUE/RENEWAL OF WARRANT Valid upto…………………….
DISTRICT/LOCAL ASSOCIATION ……………………………………………………… …………………………………

1. Name of the applicant : ……………………………………………………………………………………..
(In block letters)
2. a) Permanent Address : …………………………………………………………………………………….
( Full postal address)
………………………………………………………………………………….…..
b) Present Address : …………………………………………………………………………..…………
( Full postal address) ……………………………………………………PIN………………..……………
Contact No. ………………………E-mail I.D. ………………..…………………...
3. a) Occupation : ……………………………………………………………………….………........
b) If employed, give details : Designation………………………………Working under ………………………
Place of Posting …………………………… Date of Retirement………………..
4. Date of birth & Age
(Attested copy to be attached : ………………………… Age ……………….years……………….month/months.
for issuing of New/Fresh warrant.)
5. Educational qualification
(Attested copy to be attached :………………………………………………………………………………………
for issuing of New/Fresh warrant.)
6. Marital status : ……………………………………………………………………………………..
7. Father’s / Mother’s / Husband’s / Guardians name …………………………………………………………………………
(If Rly. Dependent) Relationship …………………………… Rly designation ……………………….
Deptt…………………………..... Place of posting……………….…….…………
Date of Retirement / Date of Death (If applicable) ……………………………….
8. Details of the course (Attested copy to be attached for issuing of New/Fresh warrant.)
Sl. Course attended Nature Period Place Leader of the Certificate No. &
No. From To course Date
9. Name & Address of the Group attached to : ………………………………………………………………………………

Contact No ……………………………E-mail.……………………….……
10. Whether the Group is Registered……………. Reg.No. …………………… Date…………………Valid upto……………
11. Whether three months probationary service with the Group is completed…………………From………….To……………
(For New/Fresh warrant)
12. Nature of warrant applied for : ………………………………………………………………………………
13. If holding any warrant, Warrant No. ………………………… Date…………………Valid upto………………
(Attached the same in original
with the application) Name of the Group……………………………………………Distt. ………………….
Contd. …..P2
[ 2 ]
I…………………………………………hereby agreed that on receiving a Warrant as …………………., I will

make three fold promise of Scout/Guide and will render services to the Movement and will surrender the same if the
Association called for.
I also declared that all the statements in the application form (page/1) are absolutely true, complete and correct to
the best of my knowledge and belief. In the event of any information being found false or incorrect for eligibility
criteria, then my warrant is liable to be cancelled/withdrawn without showing any reason.
Date…………………… …………………………
Full Signature of the applicant
RECOMMENDED
The statement given by the applicant in the application form along with attachment have been checked and found correct.
…………………………………………. ………………………………………….
Signature of Chairman/Chairperson Group Committee/ Signature of Group Leader (S/G) for Group or Unit Level/
Head of the Institution (For Institutional Group/Unit) Signature of Dist. Secy./DOC(S/G) for District Level
Name…………………………………… Name…………………………………………………..
Rly. Designation …………………………….. Rly. Designation [If dependent;
Date…………………………………….. give relationship with Rly.
Stamp (Scout/Guide Rank) : Employee for GL(G)] ……………………………………
Date with Stamp :
N.B. 1) For issuing of fresh/new warrant of Group Leader, copy of Resolution of Group Council & Group Committee
Meeting to be attached and previous warrant of former Group Leader to be submitted.
2) For issuing of fresh/new warrant of Distt. Office Bearers, copy of Meeting Minutes/Approval of competent
authority to be Attached.
3) If the date of validity of Warrant lapses more than two years or training taken before two years, then event attended
certificate/activity report duly countersigned by District authority to be attached in regard to attachment with the
Group/Movement.
RECOMMENDED
The above statement furnished by Sri/Smt. …………………………………is absolutely true as far as my knowledge goes.
______________________ _______________________
District Commissioner (S/G) Distt.Secretary
Name …………………………………. Name ……………………………
Rly. Designation………………………. Rly. Designation……………………….
Date…………………. Date………………….
Stamp : Stamp :
State Commissioner (S/G) State Secretary
State Chief Commissioner

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Form No.

DISTRICT/LOCAL ASSOCIATION ……………………………………………………… …………………………………

9. Name & Address of the Group attached to : ………………………………………………………………………………

I…………………………………………hereby agreed that on receiving a Warrant as …………………., I will

State Commissioner (S/G) State Secretary

State Chief Commissioner

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