ServicePlus- Civil Defence Volunteer Enrollment Service

GOVERNMENT OF PUDUCHERRY

DEPARTMENT OF REVENUE AND DISASTER MANAGEMENT

OFFICE OF THE DISTRICT COLLECTOR-CUM-CONTROLLER OF CIVIL DEFENCE PUDUCHERRY DISTRICT

APPLICATION FOR ENROLMENT AS A CIVIL DEFENCE VOLUNTEER

Personal Details

Name *

Mobile Number *

Father Name *

E-Mail *

Blood Group *

Ration Card No. *

Gender *

Male

Female

Transgender

Govt. Issued ID Card No. *

DOB *

Present Address line 1 *

Educational Qualification *

Address line 2

Course or Degree Name *

State *

Board or University or Institution Name *

District *

Year of Passing *

Taluk *

Skills and Extracurricular Activity

Revenue Village *

Marital Status *

Postal Code *

Spouse Name *

Contact No. of Family Member *

Additional Details

Please specify: *

Are you currently suffering from any communicable disease? *

Yes

No

Do you have any conveyance?

Bicycle

Motorcycle

Other

Name of the disease *

Is it currently under treatment? *

Yes

No

Declaration

I Agree *

.

1. I have read the “Civil Defence Regulations, 1968”.

2. As far as I know, I am physically fit to render efficient service as a member of the Volunteers.

3. If any application is accepted, I am prepared to service as a whole-time/part-time member of the Volunteers, ie, to undergo the appropriate Training and, in the event of any emergency occurring whilst I remain a member of the Volunteers, to carry out may obligations as a member thereof.

4. I undertake -

(i) to carry out my duties in the Civil Defence Volunteers in accordance with the instructions and orders issued by the authorities concerned;

(ii) to return, when I cease to be a member of the Volunteers, any articles of uniform, badge or other personal equipment issued to me, and

(iii) to abide by the regulations of the Volunteers.

Additional Details

Applied to the Office*

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