Form Of Territorial Army – Fill Out and Use This PDF

APPLICATION FORM FOR COMMISSION IN THE TERRITORIAL ARMY

FOR NON DEPT (INF) TA

1.

Attested

Candidate’s

photograph of

Name

the candidate

(To be filled in BLOCK CAPITALS in blue ball point pen. In case of variation in Name as given to Matric

size l 4.5x 3.5

Certificate attach an affidavit.)

Cms (To be

pasted)

2.

Father’s

Name

3.

House No

Block/Pkt

Permanent

Village/Town

Post Office

Address

Tehsil

District

State

Pin Code

Mobile No

Land Line No.

4.

Present

House No

Block/Pkt

Address

Village/Town

Post Office

Tehsil

District

State

Pin Code

Mobile No

Land Line No.

4 (A) Choice of written exam centre

Zone - I (Chandigarh - 01), Zone - II (Lucknow - 02, Patna - 03),

Zone - III (Kolkata – 04, Shillong- 05), Zone - IV (Pune - 06, Bangalore - 07, Jaipur – 08,

Hyderabad - 09) Zone - V (Udhampur – 10, Sri Nagar -11)

Note :- Candidates are required to fill up their choice of centre as per their respective Zone only.

Note :- Domicile Certificate issued by DM/DC as applicable or certified copy of passport/driving license/ration card/voter ID card or any other residential proof issued by State/Central Govt. as applicable.

5. Date of Birth as Matric

6.

Gender

7. No. of attempts already made in SSB for :-

Certificate

(Strike out which ever is not applicable)

NDA

CDSE

Day

Month

Year

M

F

TA

8. Educational Qualification

9. Educational Stream

10. Nationality

Code : Arts – 01, Science – 02,

Code : Graduation

-

01

Post Graduation - 02

Commerce – 03, Engineering – 04

Medical – 05, MBA – 06 &

Any other – 07

11. Marital Status :-

12.

Next of Kin

12 (a). Name of next of kin

Single/Married/Divorced

(Strike out whichever not

Code : Father – 01, Mother – 02, Wife- 03,

applicable).

Son – 04, Daughter – 05 & Other - 06

13. Nature of employment :

14.

Details of previous Commissioned Service in the Armed Forces (Furnish Discharge/Release

Write code

Certificate) (write code wherever applicable).

(a)

Service

Employment Code

Central Govt/Union Territory

-01

State Govt/Semi Govt

-02

Self Employed

-03

Code : Army-01, Air Force-02, Navy-03, TA-04

Pvt Sector

-04

(b)

Category

Code : Officer-01, JCO/Equivalent-02, OR-03

(c)

Rank

(d)

Army/Service

Number

(e)

Arms/Service

15. Reason for Discharge

(write code)

Code : Med Bd Out-01, Voluntary Discharge-02, Disciplinary Ground-03, On Superannuation-04, & Any Other-05

16.	DECLARATION TO BE SIGNED BY CANDIDATE

(a)In the event of my selection for commission in the Territorial Army, I am willing to serve anywhere in India for longer duration also, whenever required, or as per the rules and orders in force from time to time.

(b)I clearly understand that if at any time during the period of probation I am not found suitable, I shall have to resign my commission in accordance with the rules and orders in force from time to time and in case I decline to do so I am liable to be discharged/removed from the Territorial Army.

(c)I am fully aware that if it is found at any stage that I have knowingly furnished any details which is/are false or have suppressed material information or I fail to comply with the above undertakings, my candidature will be rejected summarily and if already commissioned, I shall be liable to be discharged/removed from the Territorial Army.

Signature of Witness__________________	Signature of Applicant _______________
Name__________________________	Name ____________________________
Address of Witness___________________	Address ___________________________
___________________________________	__________________________________
Mobile/Phone No_____________________	Mobile/Phone No____________________
Date ______________________________	Date ______________________________

17.CERTIFICATE TO BE RENDERED BY CANDIDATES EMPLOYED IN

CENTRAL GOVT/UNION TERRITORY/STATE GOVT/SEMI GOVT DULY AUTHENTICATED BY HEAD OF OFFICE

(a)I certify that Shri_____________ S/o _______________________employed under me as ______________for the last ________________yrs and that his character as far as known to me is good. He is/is not recommended for the grant of commission in TA.

(b)It is also certified that Shri ____________________will be made available for Trg/embodiment for service of the Territorial Army as and when required.

(c)It is further certified that Shri ____________________does not hold and/or is not likely to hold in the foreseeable future a key – post in______________

(Department/Organisation which could affect the minimum essential functions of this Department/Organisation. However, in the event of this becoming a key man subsequently the Additional Director General Territorial Army, New Delhi shall be requested immediately to release or discharge him from the Territorial Army.

Place __________________	Signature ___________________________
Date ___________________	Designation _________________________
	Stamp/Seal of Office __________________

18.CERTIFICATE TO BE RENDERED BY SELF EMPLOYED PERSONNEL TO BE AUTHENTICATED BY GAZETTED/COMMISSIONED OFFICER/DM

I certify that Shri ___________________________S/o________________________ is

known to me for the last __________yrs and bears good moral character to the best

of knowledge and belief. He is/is not recommended for the grant of commission in the TA.

Place_______________	Signature_________________________
Date_______________	Designation_______________________
	Stamp/Seal of Office________________

19.CETIFICATE TO BE RENDERED BY CANDIDATES EMPLOYED IN PRIVATE SECTOR (TO BE AUTHENTICATED BY HEAD OF OFFICE)

Certified that :-

(a)Any difference between the civil and military pay and allowances of the applicant Name _________________S/o _____________________ an employee of this organization will be paid by us for the period of his military duties in the Territorial Army.

(b)On return from military duty in the Territorial Army Shri__________________ will be absorbed in the same or equivalent post which he would have held if his service in the civil had not been so interrupted and the such military service would count for all benefits in his civil job, like seniority for promotion, increment of pay, bonus and provident fund etc. To which he would have other wise been entitled.

Place_______________	Signature_________________________
Date_______________	Designation_______________________
	Stamp/Seal of Office________________

20.RECOMMENDATION OF INTERVIEW BOARD AT COMMAND

(To be completed by Presiding Officer Preliminary Interview Board)

RECOMMENDED/NOT RECOMMENDED FOR COMMISSION IN THE TERRITORIAL ARMY

Place :	Signature________________________
Date _______________	President PIB(With Rubber Stamp)
	Stamp/Seal of Office