Application Form for Adventure Sports Programme of Central Government Employees
Scheme for Promotion of Adverture Sports & Similar Activities amongst Central Government Employees
Application Form
Name of Programme/Institute*
1. Name of Applicant* :
2. Designation* :
3. Ministry/Department* :
4. Group of Services with level/Grade Pay(revised)* :
5. Father’s Name* :
6. Date of Birth* :
7. Address* :
8. Telephone No. (Mobile)*:1. 2.
9. Landline no.* :
10. Duration of Programme/Date* :
11. Amount Claimed* :
12. Bank Detail:
a) Applicant Name in Bank* :
b) Bank Name* :
c) Bank Account Number* :
d) IFSC Code* :
13. Next of kin to be informed in case of emergency*:
*Mandatory field:
I Understand that the____________________________________________________
programme may involve serous risk to me. I am undertaking the programme at my own violation cost, risk and consequence
14. I hereby undertake that I will not hold responsible Central Civil Services Culture & Sports Board/ Governmen: of India for any untoward incident/ mis happening.
Date:
Place:
(Signature of Applicant)
Name in Block Letters :
Ministry/Department :
This is to certify that the applicant is a Central Government Employees working in the main Ministry/ Department and information given above is correct. The applicant is medically fit for the adventure activities opted by him/her.
(Welfare Officer)
REQUIRED DOCUMENTS FOR ADVENTURE SPORTS REIMBURSEMENT:
1. Application form forward by Welfare Officer
2. Special Casual leave order
3. Programme fee Receipt
4. Travel Ticket
5. YHAI Admit Card
6. Compilations Certificate
7. Your Programme Circular Copy
8. Copy of Aadhar Card
9. Copy of Office Identity Card
10. Bank Details (Cancel Cheque/Photocopy of passbook)