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th¡fhs® gÂÎ mYty®,

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th¡fhs® g£oaèš v‹Dila bga® gÂÎbrŒa¥gl nt©Lbk‹W nf£L¡bfhŸ»nw‹.
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bga® (KGikahf) _________________________________________________ghèd«__________

jªij/jhŒ/fzt® bga®(KGikahf) _________________________________________________

Å£L Kftç (rhjhuzkhf tÁ¡F« Ïl«)

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fhtš ãiya« / t£l« ________________________________________________________

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fšé ãWtd¤Â‹ bga® Kjš tiu fhy msÎ
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2.
3.
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mšyJ
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bfhL¡f¥g£LŸs étu§fŸ mid¤J« c©ik v‹W« cWÂTW»nw‹.

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bga® __________ tçir v©âš __________ghf¤Âš gÂÎ brŒa¥g£LŸsJ

(M) ______________________________________________________________________________

______________________________________________v‹w fhuz¤Â‰fhf jŸSgo brŒa¥g£lJ.

ehŸ th¡fhs® gÂÎ mÂfhç

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