Rvnv½xibMi wek¦we`¨vjq

mvfvi, XvKv - 1342|

wk¶K/Awdmvi c‡`i Rb¨ Av‡e`bcÎ (AcÖ‡qvRbxq kã/evK¨ KvwUqv

w`‡Z nB‡e)

1| c‡`i bvg:...............................wefvM/Bbw÷wUDU/Awdm:.............................

2| ¯úó¶‡i cÖv_x©i c~Y© bvg:..........................................................................

3| †ckv I wVKvbvmn wcZv/¯^vgxi bvg:............................................................

4| R¤§ ZvwiL:........................................eZ©gvb eqm:..................................

(gva¨wgK/mggv‡bi cix¶vi mb`cÎ Abyhvqx)

5| K) R¤§¯’vb:.....................................................................................

L) ¯’vqx wVKvbv:................................................................................

M) eZ©gvb wVKvbv;.............................................................................

N) weevwnZ/AweevwnZ:.......................................................................

6| RvZxqZv:............................................................................................

7| ag©:....................................................................................................

8| wk¶vMZ †hvM¨Zv: (gva¨wgK/mggv‡bi cix¶v nB‡Z m‡e©v”P wWMÖx ch©š—)

¯‹zj/K‡jR/†evW©/wek¦we`¨vj‡qi wk¶v DËxb© cÖvß mb`cÎ

bvg ermi cix¶vi wefvM/†kªbx A_ev
bvg Ges ¯’vb wWMÖx
cÖvwßi
ermi
9| K) we‡kl †Kvb cÖwZôv‡b wk¶v/cÖwk¶b MÖnb A_ev †Kvb †Kv‡m© Ask MÖnb Kwiqv
_vwK‡j Zvnvi weeiY:...............................................................................

L) øvZK Ges øvZ‡KvËi ch©v‡q cwVZ welqmg~n D‡j−L Kwi‡Z nB‡e (ïaygvÎ wk¶K
c‡`i Rb¨ cÖ‡hvR¨
):................................................................................................

10| cÖKvwkZ eB/MwelYvi

ZvwjKv:......................................................................

11| Rbv fvlvi bvg Ges Zvnvi Dci `¶Zv:

K) fvlvi bvg:........................`¶Zv

L) fvlvi bvg:........................`¶Zv

M) fvlvi bvg:........................`¶Zv

N) fvlvi bvg:........................`¶Zv

12| AwfÁZv:

K‡jR/wek¦we`¨vjq c`ex PvKzix/M‡elYvi cy‡e©i wk¶K c‡`i

cÖwZôv‡bi bvg mgqKvj PvKzix‡Z †¶‡Î †h
ZvwiLmn me©‡kl mKj †kªbx‡Z
cÖvß gyj I Ges †h mKj
†gvU †eZb wel‡q
covb/M‡elYv
Kiv nBqv‡Q
13| eZ©gvb PvKzix K) c`ex...........................L) †hvM`v‡bi
ZvwiL:......................

M) †eZb †¯‹j:.............................................N) gyj

†eZb:................................

14| †Kvb wek¦we`¨vjq A_ev Ab¨ †Kvb cÖwZôv‡b †Kvb wbw`©ó mg‡qi Rb¨ PvKzix
Kwievi †Kvb eva¨evaKZv Av‡Q wKbv? _vwK‡j Zvnvi
weeiY:.............................................

15| b~¨bZg †h g~j †eZ‡b( wba©vwiZ †eZb †¯‹‡ji g‡a¨) †hvM`vb Kwi‡Z B”QyK:

...............................................................................................................
....

16| AvZœxq bb Ggb `yBRb e¨w³i bvg 1)

I wVKvbv D‡j−L Kwi‡Z nB‡e hvnv‡`i
wbKU nB‡Z cÖv_x©i †hvM¨Zv, AwfÁZv
I Dchy³Zv m¤ú‡K© cÖ‡qvRbxq Z_¨ cvIqv
hvB‡Z cv‡i(PvKzixiZ cÖv_x©i †¶‡Î GKRb
†idvix‡K Av‡e`bKvixi †kl Kg©¯’j PvKzixi
†kl Kg©¯’j PvKzixiZ nB‡Z nB‡e| 2)

17| AvevwmK wek¦we`¨vj‡q PvKzixi AwfÁZv (hw` _v‡K) Ges QvÎ-QvÎx‡`i ‡hŠ_
Kvh©µg Dbœq‡bi e¨vcv‡i Ask MÖn‡bi
weeiY.............................................................

......................
ZvwiL: ........................ cÖv_x©i ¯^v¶i

‡hvMv‡hv‡Mi c~Y© wVKvbv:....................................

..................................................................

..................................................................