Revised IAF (TA-9A) (i) (2010) APPLICATION FOR COMMISSION IN THE TERRITORIAL ARMYFOR NON DEPT INF TA 1.

Candidate s Name (To be filled in BLOCK CAPITALS in blue ball point pen. In case of variation in Name as given in Metric Certificate attachan affidavit) 2. Father s Name3. PermanentAddress.(Furnishdomicilecertificateissued byDM/DC) House No.Block/Pkt.Village/TownPost OfficeTehsilDistrict StatePin CodeMobile No.Land Line No. 4. PresentAddress.(Furnishdomicilecertificateissued byDM/DC) House No.Block/Pkt.Village/TownPost OfficeTehsilDistrictStatePin CodeMobile No.L and Line No. 5. Date of Birth in per metric certificate6. Gender(Strike out whichever is nota pplicable )7. No. of attempts already made inSSB for:NDACDSETA8. Educational Qua lification *(Attach attested Mark Sheets &Cert from Metric onwards) Code: Graduation- 01, Post Graduation-029.Education StreamCode: Arts -01,Science-02,Commerce-03, Engineering 04,Medical 05, MBA-06 & Anyother - 07 10. Nationality11. Marital Status:Single /Married/ Divorcee(Strike out which ever not applicable) 12. Next to kinCode: Father-01,Mother-02, Wife-03,Son-04, Daughter-05 & Other -0 612(a). Name of Next of kin15.13. Nature of employment: (Write Code) Employment Code :-Central Govt /Union Territory -01 State Govt/ Semi Govt -02Sel f Employed -03Pvt Sector -0414. Details of previous Commissioned Service in theA rmed Forces (Furnish Discharge / Release Certificate) b)Service Code : Army 01, Air Force-02, Navy-03,TA-04c)Category Code : Officer 01, JCO/Equivalent-02, OR-03d) Rank e)Army/Service No 15.Reason for Discharge (Write Code) Code : Med Bd Out -01, Voluntary Discharge -02, Disciplinary Ground-03, On Superannuati on-04 & Any Other-05

16.DECLARATION TO BE SIGNED BY CANDIDATE (i) In the event of my selection for a commission in the Territorial Army, I am will ing to serve anywhere in India for longer duration also, whenever required or as per the rules and orders in force from time to time.(ii)I clearly understand th at if at any time during the period of probation I am not found suitable, I shal l have to resignmy commission in accordance with the rules and orders in force f rom time to time and in case I decline to do so I amliable to be discharged /rem oved from the Territorial Army.(iii) I am fully aware that if it is found at any stage that I have knowingly furnished any particular which is / are falseor hav e suppressed material information or I fail to comply with the above undertaking s, my candidature will berejected summarily and if already commissioned ,I shall be liable to be discharged/removed from the TerritorialArmy.Signature of Witnes s ___________________ Signature of Applicant_________________________ Name ____ ___________________________ Name ______________________________________ Address of Witness ____________________ Address ____________________________________ __

__________________________________ ___________________________________________ _____________Mob /Ph No ____________ ___________________________________________ Date: ____________________________ Date ______________________________ 17. CERTIFICATE TO BE RENDERED BY CANDIDATES EMPLOYED IN CENTRAL GOVT/UNIONTERRI TORY/ STATE GOVT/SEMI GOVT DULY AUTHENTICATED BY HEAD OF OFFICE . (a)I certify that Shri_________________________________ S/O_____________________ ______________ employed under me as___________________________________ for the l ast______________ years and that hischaracter as far as known to me is good. He is /is not recommended for the grant of commission in the TA.(b)It is also certi fied that Shri__________________________________ will be made available for trai ning or embodiment for service in a Provincial/Urban unit (any of the two types of units) of the Territorial Army as andwhen required. (c) It is further certified that Shri_____________________________________ does not hold and /or is not likely tohold in the foreseeable future a key-post in_______ _________________ (Department/ Organization) which couldaffect the minimum essen tial functions of this Department/ Organization. However in the event of this be coming akey man subsequently the Additional Director General Territorial Army Ne w Delhi shall be requested immediatelyto release or discharge him from the Terri torial Army.Place: SignatureDate: Designation______________________________ Stam p/Seal of Office 18.CERTIFICATE TO BE RENDERED BY SELF EMPLOYED PERSONNEL TO BEAUTHENTICATED BYGA ZETTED/ COMMISSIONED OFFICER/DM (a) I certify that Shri _______________________________________ S/O_________________ ________________________ is known to me for the last _______________ years and b ears good moral character to the best my belief and knowledge. Heis /is not reco mmended for the grant of commission in the TA.Place: SignatureDate: Designation_ _____________________________ Stamp/Seal of Office