Form – A
Home Guard Application
(Each applicant is required to fill this form in duplicate)
To
The Superintendent of Police,
Tiruppur District.
Declaration to be signed by the Applicant:
I declare that I am a citizen of India and that I desire to be enrolled as a member of the
Home Guard for three years in and have no intension of permanently leaving the
limits of the State of Tamil Nadu for at least three years after enrolment and that I am not
under any obligation to serve in any other force.
I understand that :-
1) In any emergency I shall be liable to be called out on duty at any time and for any period
and in any part of the state of Tamil Nadu.
2) I shall be liable to undergo training and attend parades in accordance with the orders of my
superior officers.
3) I shall be required to take the following pledge namely:-
“I , Son of residing at
do solemnly and sincerely declare and affirm that I will well and truly serve the Government of
Tamil Nadu as a Member of the Home Guard in without favour or affection,
malice or ill-will or communal or political bias; and that I will, to the best of my ability cause
peace to be kept and preserved and prevent all offences against person and property and that
I will, to the best of my skill and knowledge, discharge all the duties as such member, faithfully
according to law and will not allow any communal or political bias to interfere with the duties
assigned to me by the State Government or my superior officers.
4) I shall be required to serve in the Home guard for such period as may be required under
Rule.6 of the Tamil Nadu Home Guard Rules, 1963.
Place :
1. Name in Block Letters:
2. Address :
(Residence)
3. Telephone Number/Mobile Number:
4. Date of Birth :
5. Place of Birth :
6. Occupation or profession :
7. Educational or special qualification such as
knowledge of foreign language or stenography
or typing :
8. Particulars of was service or military or naval
training or training with any First-Aid or Ambulance Corps:
9. Father/Husband Name :
10. Father’s Occupation or profession:
11. If originally a resident of Pakistan, the address in the
country and the date of migration to the Indian Union :
12. Particulars of places where you have resided for more
than one year during the preceding five years :
(Residential address in full
(i.e.) house No/Lane/Street
and Road.Village, and
District, State or)
Police station:
13. Do you hold an arms license?
If so, give description of the weapon :
14. Have you received any
training in the use of fire arms?:
15. Do you own a motor vehicle ?
If so, give the description :
16. Have you ever been
convicted by a court of any
offence? If the answer is
‘Yes” the full particulars of the
conviction and sentence
should be given :
I , hereby declare that the particulars furnished in the application are to
the best of my knowledge and belief, true and correct.
Place :
Date :
Signature of the Applicant
Certificates of character signed by two gentlemen of position who have known you
personally for at least three years:
1.) Certified that
Date:
Designation :
Address :
Telephone/Mobile No.: (Signature of person who gives the certificate)
2.) Certified that
Date:
Designation :
Address :
Telephone/Mobile No.: (Signature of person who gives the certificate)
Certificate to be signed by the employer or superior officer.
I certify that I shall have no objection to attending the duty / the training on week days
and that I shall release him for duty in an emergency at any time, and for such period as may
be required under Rule. 6 of the Tamil Nadu Home Guard Rules, 1963.
Full Address :
Designation :
Telephone/Mobile No: (Signature of employer or Superior Officer)
Notes:
a) If you are a Government or any employee in a local authority, a fir, or any other office,you should send this form
through your superior officer, with his certificate that he has no objection to you for attending the training and the
training and that he will release you for duty in an emergency at any time and for any period.
