xUizj FHij ts gf l

mftho Kjik gahsf gfhd zg

l :

ifgl
ifbahgJl
Passport size

01

kDjhu bga

02

jfgdh / fzt bga

03
04

khefuh/thL v myJ bga

khefuh bga

05

mftho gahs akd

nfhU ika bga kW
yhr
f jF (SSLC) nj bgw
gu rhW efYl
wj nj kW ailj
taJl
tF ( tUth Jiw bgw
rh rhWl)
kDjhu Ul Kft
(rhWl)
thfhs milahs mil ef
(m) FLg mil ef (m) t uJ

06
07
08
09

10

kDjhu
tF
lF
akd
nfhU
mftho
ikaF cs u

jh.t/jh.g./..t/.t/.t

11

kDjhu FLgntW ahnuD

muR/csh Wtd /jah
Jiw Wtdf g
cshuh? iyba mjfhd
rhW izfgl ntL
12
kDjhu w jFf (rhj
izfgl ntL)
13
Ukz iy
14
ju jFf
14(a) kDjhu cl CdKwtuh?
M v vjifa Cd?
Cd rjj
(rhWl rkf)
15
kDjhu FLg tUkhd
16

Ukzkhdt/jit/fztuh iflglt
M/iy

w Ff

l :
eh :

kDjhu ifbahg
gjidf: gjh tF (SSLC) nj bgUf ntL,
mW taJ 25 Kj 35-F Uf ntL (jit / fztdh iflglt /
kiy gF 40 taJ tiu js).
nj bragL ika mikJs lnyna tf ntL.
jit/fztuh iflglt cl CdKwtfSF ca tif rhW
rkfgl ntL.
FLg cWd muR g iy vgjfhd rhW njitahd df
rkf ntL.
jht/jhg/t/t vgjfhd rhW tlhalUJ bgW rkf
ntL.

mYtyf cgnahfF kL (For Office Use Only)

fl rhWf izfgLsjh?

taJ (g khW rhj )

f jF(SSLC)kbg goa
FLgdmuR ntiyf iy vgjfhd rhW
jit/fztuh iflglt CdKwt rhW
w Ff VnjD U
Ul rhj

: M / iy
: M / iy
: M / iy
: M / iy

FHij ts l mYty.