KjpNahh; cjtpj;jpl;lk;

tpz;zg;g gbtk;
KjpNahh; /tpjit/ khw;Wj;jpwdhsp
,ju cjtp :
khtl;lk;
tl;lk;
fpuhkk;
FLk;g ml;il vz;
1) kDjhh; ngah;
2) je;ij /fzth; ngah;
3) Kfthp

:
:
:
:
:
:
:

4) taJ Fwpj;j rhd;W

5) kjk; /rhjp
6) mq;f kr;r milahsk;

:
:
:

7) gps;isfs; tpguk;

8) gps;isfspd; epiy kw;Wk;

njhopy;

9) tPL epyk; nrhj;Jf;fs;

10) vd;dhy; g+h;j;jp
nra;ag;gl;l tpguq;fs; midj;Jk;
cz;ik vd njhptpf;fpd;Nwd;

:
:

kDjhh; ifnahg;gk;
(my;yJ) ,lJ if ngUtpuy; Nuif

kDjhh; thf;F%yk;

Gifg;glk;

Nfhtpy;gl;b tl;lk;________________________________

fpuhkk;

________________________________________________________ vd;w
Kfthpapy; trpj;J tUk; ______________________________________ j.ng./
f.ng____________________________________vd;gth; nfhLj;j thf;F%yk;
ehd;____________________________ cjtpj;njhif toq;ff; Nfhhp
kDr;

nra;Js;sJ

njhlh;ghf

vdJ

kDtpd;

kPJ

tprhuiz

nra;jjpy;

fPo;f;fz;lthW vdJ thf;F%yj;ijj; njhptpf;fpd;Nwd;.

vdf;F taJ ___________ MfpwJ. ehd; __________________ rhjpiar;
Nrh;e;jth;. vdf;F __________ gps;isfs; cs;sdh;.
vdJ FLk;gj;jpy; _________________ Ntiy nra;tjd; %yk; Rkhh;
&._____________(&gha;___________________________________) MFk;.
ehd; kpFe;j twpa epiyapy; tho;e;J tUfpNwd;. vdf;Nfh my;yJ vdJ
fztUf;Nfh ehd; trpf;Fk; fpuhkk; kw;Wk; NtW ve;j fpuhkj;jpYk;
epyq;fs; kjpg;Gs;s tPL nrhj;Jf;fs; VJkpy;iy. ehd; jw;NghJ thlif
tPl;by; khj thlif Rkhh; &.___________ nfhLj;J FbapUe;J tUfpNwd;.
ehd; cz;ikf;F khwhf ngha;ahd jfty; jw;NghJs;s tprhuizapy; nfhLj;J
gpd;G mJ jtW vdj; njhpate;jhy; mjd; njhlh;ghf vd; kPJ muR
vLf;Fk; eltbf;iff;F fl;Lg;gLNtd; vd;gijj; njhptpj;Jf; nfhs;fpNwd;.
Mifahy; vdf;F

________________________ cjtpj; njhif toq;FkhW

jho;ikAld; Nfl;Lf; nfhs;fpNwd;.

gbf;f Nfl;Nld;
ehd; nrhd;dgb rhpahf vOjg;gl;Ls;sJ

fpuhkeph;thf mYtyh;

tUtha; Ma;thsh;

fpuhkeph;thf mYtyh; thf;F%yk;

Jhj;Jf;Fb khtl;lk;> Nfhtpy;gl;b tl;lk;______________________ FWtl;lk;
_______________________________________fpuhkj;jpy;

fpuhkeph;thf

mYtyuhfg; gzpGhpe;J tUk; jpU._________________ vd;gth; nfhLj;j

thf;F%yk;
ehd;

Nfhtpy;gl;b

tl;lk;

_________________________________

FWtl;lk; _____________________________________ fpuhkj;jpy; fpuhk

eph;thf

mYtyuhfg;

gzpGhpe;J

tUfpNwd;.

jpU./jpUkjp.

_______________________________ vd;gth; _______________________

cjtpj;njhif Nfl;L kDr; nra;Js;sJ njhlh;ghf kDjhiu tprhuiz nra;J vdJ
tprhuiz mwpf;ifapid fPo;;f;fz;lthW rkh;g;gpf;fpd;Nwd;.

kDjhh; kDtpy; Fwpg;gpl;Ls;s Kfthpapy; trpj;J tUfpwhh;.

mtUf;F taJ ________ MfpwJ. mtUf;F Nkw;gb fpuhkj;jpy; epyk;>
kjpg;Gs;s nrhe;j tPL kw;Wk; nrhj;Jf;fs; VJkpy;iy. kDjhh; kpfTk;
twpa

epiyapy; cs;shh;.

vdNt kDjhUf;F

____________________

cjtpj;njhif toq;fyhnkd ghpe;Jiu nra;fpNwd;.

Nkw;$wpaitfs;

midj;Jk;

cz;ik

vdj;njhptpf;fpd;Nwd;.

gpd;

tprhuizapy; VNjDk; jtWfs; fz;Lgpbj;jhy; muR vLf;Fk; eltbf;iff;F

fl;Lg;gLNtd; vd;gijg; gzpTld; njhptpj;Jf; nfhs;fpNwd;.

fpuhkeph;thf mYtyh;

tUtha; Ma;thsh;

_____________________tUtha; Ma;thsh;
tprhuizg;gbtk;
1)

kDjhh; ngah; kw;Wk; Kfthp :

2)
3)
4)
5)
6)

FLk;g ml;il vz;

kjk; /rhjp
taJ
njhopy; / tUl tUkhdk;
epyk; / kjpg;Gs;s tPL

:
:
:
:
:

7)

nrhj;Jf;fs;
kfd; / cwtpdh;fs; MjuT

8)

cs;sjh?
kDjhh; twpa epiyapy;

9)

cs;stuh?
kDjhh; cjtpj;njhif ngwj;

10

jFjpAilatuh?
,ju tpguq;fs;

fpuhkeph;thf mYtyh;tUtha; Ma;thsh;

jdptl;lhl;rpah;
(rghjp)
Nfhtpy;gl;b

AGE CERTIFICATE
Certified

that

Thiru./Tmt._____________________________________

Son / Wife of ________________________________ of _______________________

village appeared before me and her / his age is according to
her / his

own

statement

and

her / his

appearance

about

___________________ years.

1)
2)

Place :
Date :

Medical Officer