DHQ Serial No. . . . . . . . . . . . . . . SHQ Serial No . . . . . . . . . . . . . .

THE BHARAT SCOUTS AND GUIDES

___________________________________STATE HEADQUARTERS

Registration Form for State Level Testing Camp for

President Scout Certificate
(To be filled by the candidate in his own handwriting in capital letters.
Overwriting/use of fluid will not be accepted)

District __________________________

1. Name of the Scout______________________________________________________

2. (A) Father’s Name ______________________________________________________
(B) Mother’s Name______________________________________________________
3. Date of Birth _____________________________________ Age __________________
(Supported by Admit Card/Mark Sheet/Certificate of class X/Secondary Board Examination, attested copy of certificate should be attached)

4. Home Address_______________________________________________________________________
P.O. ___________________________District _____________________State ___________________
E-mail ID ____________________________________________________________________________
Aadhaar No.__________________________________________________________________________
(Attach photocopy of Aadhaar Card)

5. BSG UID No. _________________________________________________________________________

6. Name and address of Unit ______________________________________________________________
______________________________________________ District_______________________________
Charter No._________________ Date of Issue_________________ Date of Validity________________

Signature of Scout Master Signature of Scout

7. Name of the Scout Master _______________________________________________________________
Scouting Qualification:______________________ Certificate No:__________________ Date:__________
Warrant No. __________________ Date of Issue _________________Date of Validity________________
(Attach photocopy of Certificate/Parchment and Warrant of SM)

Certified that the information given above is correct as per the District records.

Seal & Signature of District Secretary Seal & Signature of DOC (Scout)
Date: Date:
NB: Information Sheet attached.

For State Headquarters use

Date of Receipt of Application at SHQ ______________________________Remarks ____________________
Checked by (Name & Designation) ______________________________ Signature______________________

Signature of State Secretary Signature of SOC (S)

He is qualified in the State Level Testing Camp for President Scout Certificate held at
__________________________ from _____________ to_______________
The form is recommended for the National Level Examination for President Scout Certificate.

SIGNATURE of SOC(S)
For Regional Headquarters use
Date of Receipt of Application at RHQ __________________________ Remarks ____________________
Checked by (Name & Designation) __________________________ Signature_______________________
RHQ Enrolment No . . . . . . . . . . . . . . . .
Signature of ROC/Assistant Director
 Date of Birth Certificate

This is to certify that Mr. ___________________________________________

S/o____________________________ is a student of ______________________

______________________________ School/College studying in class _____

in the year______________________ His date of Birth is_____________________(in

figures)_______________________________________________________(in words)

as per his School/College record.

Signature
Date................. (Office Seal) Head of the Institution
 THE BHARAT SCOUTS AND GUIDES . . . . . . . . . . . . . . . . . . . . . . . . . STATE
INFORMATION SHEET FOR SCOUT
(to be attached with Registration Form)
NB: To be filled by the Candidate in his own handwriting in capital letters. Overwriting / use of fluid will not be accepted.

1. Name of the District:…………………................................................................................................................................

2. Name of the Scout:
…………………………………………………………………………………………………………………..
3. (A) Father’s Name: ……………………………………………………………………………………………………………..
(B) Mother’s Name:…………………............................................................................................................................
4. Date of Birth:……………………….....................................................................................................................................
5. Date of (I) Joining the Troop………………………………………………………………………………………………………
(II) Completion of Pravesh..................................................................................................................................
(III) Date of Investiture……………………………………………………………………………………………………..
(IV) Completion of Pratham Sopan......................................................................................................................
(V) Completion of Dwitiya Sopan........................................................................................................................
(VI) Completion of Tritiya Sopan..........................................................................................................................
(VII) Completion of Rajya Puraskar......................................................................................................................
Rajya Puraskar Testing Camp held at .........................................................................................
from............................. to........................... Certificate No.....................................................................Date of Issue
..........................................
11(10) of APRO II (Detail of Proficiency Badges earned for Dwitiya Sopan)
Name of Badge Date of Passing Name of the Examiner

12(10) of APRO II (Detail of Proficiency Badges earned for Tritiya Sopan)

Group Name of Badge Date of Passing Name of the Examiner
A.
B.

13(3) of APRO II (Detail of Ambulance Man Badge earned for Rajya Puraskar)
Date of Passing Name of the Examiner

13(8) of APRO II (Detail of Proficiency Badges earned for Rajya Puraskar)

Name of Badge Date of Passing Name of the Examiner

13(9) of APRO II (Detail of Proficiency Badges earned for Rajya Puraskar)

Name of Badge Date of Passing Name of the Examiner

Details of the work done for President Scout Badge

14-B (2.a) of APRO II (Details of Camping)
Camping Place Date Name of the Leader of the camp
s
From To

14-B (3.a) of APRO II (Details of Disaster Management Badge)

Date of Passing Name of the Examiner

14-B (3.b) of APRO II (Details of Re-pass Ambulance Man Badge)

Date of Passing Name of the Examiner
14-B (4) of APRO II (Details of Proficiency Badge earned for President Scout Award)
Name of Badge Date of Passing Name of the Examiner

14-B (5) of APRO II (Details of Sustained Community Development Project)

Date
Name of the Project undertaken From To Service Hrs.

14-B (6) of APRO II (Details of working as Badge Instructor)

Name of Badge Name of Group Date
From To

Note: A copy of appointment letter from Group Leader/ADC/DOC and list of Scouts who earned the Proficiency Badge to be produced.
OR
Alternate to the above (Teaching Games)
Name of Locality Date No of Children
From To

Note: List of names of Children with their age and Father’s name and a copy of appreciation letter from Parent / Head of
Institution to be produced with details.

14-B(7) Knowledge of Kandersteg Adventure centre of WOSM and prepare log book
Date of Submission of Log Book in
COH

Note: All relevant records, Log Books& Certificates should be produced in the testing camp as and when demanded.

Signature of Scout
Date: …………………..

Certify that the above information is correct and verified by me.

Signature of Scout Master Seal & Signature of District Org. Commissioner (S)
Date: Date:

Information Sheet Checked & Verified

Seal & Signature of ASOC/SOC(Scout)

Date:

Note: 01. All relevant records, Progress Card, Log Books and certificates is to be produced at the time of State
Level Testing Camp for National level Examination for President Scout Certificate.
02. Incomplete / Contradictory information is liable to be rejected.
Photocopy of documents to be attached:-
1. Date of Birth Certificate.
2. Aadhaar Card.