National Rock Climbing Camp National Rock Climbing Camp

Download as pdf or txt
Download as pdf or txt
You are on page 1of 2

SVIM

Swami Vivekanand Institute of Mountaineering


" Sadhana Bhavan" , Gaumukh Road, Mount Abu, Rajasthan - 307501 ( India ) Government of Gujarat
Phone : + 91 ( 2974 ) 237103 Fax : +91 ( 2974 ) 235 228 web : https://commi-synca.gujarat.gov.in/
synca.gujarat.gov.in/

Pandit Deendayal Upadhyay Mountaineering Center


Radhanagar Society, Girnar Darwaja, Junagadh Gujarat - 362001 ( India ), email id : inst-sports
[email protected]
Phone : + 91 ( 0285 ) 2627228 we
web : https://commi-synca.gujarat.gov.in/
synca.gujarat.gov.in/
………………………………………………………………………………………………………
…………………………………………………………………………
… Affix
Attach APPLICATION FOR TEMPORARY/DAILY WAGED VISITING SUBJECT EXPERT Photograph
Photogra Here (2)
ph Here
National Rock Climbing Camp at inaccessible mountains of Girnar
(1) ( TO BE FILLED OR TYPED IN BLOCK LETTERS )

1. Name of Visiting
Subject Expert

2. Father’s Name

3. Permanent Address

4. Correspondence
Address

5. Date of Birth

6. Contact Number Mobile No. Landline

7. E-mail Address:

8. Contact Number Next Mobile Number:


of
kin in case of Land Line Number:
emergency Home/Office: if any
9. Bank Account no of
Applicant & Name of
Bank
10. IFSC Code:

11. Adhar Card Number


/PAN Card
12. Educational Matric Yes / No ( Attached )
Qualification
(Attach attested Xerox 10+2 Yes / No ( Attached )
Copy)
Graduate Yes / No ( Attached )

Post Graduate Yes / No ( Attached )


13. Subject Qualification Service in gov. of Gujarat /India Government ID Card Yes / No ( Attached )
in Courses
(Attach attested Xerox Represative International & 1.Authority letter Yes / No ( Attached )
Copy ) National Mountaineering 2.circular/order/
association recognized by Resolution for recognized
Government by Government
Winner of International/National Certificate by Yes / No ( Attached )
Medal/Award/Achievement from Government/
Government/ Mountaineering Mountaineering
association recognized by association recognized
Government by Government
14. Mountain Climbing/ Sr. No. Name of Year Height
Expeditions/Achieveme the
nt Mountain
(Attach attested Xerox
Copy)

15. Experiences if any

16. DECLARATION:-
I hereby declare that all the statements/informations furnished in the application are true and complete to the best of my
knowledge and belief.
I have read and understood the instructions. I understand that action can be taken against me if I breach any condition
or instruction of the SVIM,Mount Abu/PDUMC JUNAGADH.
I will be held responsible for any wrong information given in the application form.
I agree to abide by /adhere to the discipline of the SVIM,Mount Abu/PDUMC JUNAGADH. during the duty failing I am
liable to expulsion. In case of accident/injury I will not hold SVIM,Mount Abu/PDUMC Junagadh partially or wholly
responsible. I have read all the terms and conditions of the Institute and have fully understood the meaning and
significance of the same.
17. PLACE :-
18. Date:

D D M M Y Y Y Y
Signature of Applicant:…………………………….

Name:………………………………

You might also like