Form 4

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jehL ntiythgnwh

cjbjhif

(muR Miz (iy) v.72, bjhyhs kW ntiyth(M2)Jiw, eh 25 .8.2006)

cjbjhif tu
gjh tF njbgwtfSF

khj %.150/-

+2 tF nj/mjF rkkhd
jFbgwtfSF

khj %.200/-

gljhf/KJfiy gljhfSF

khj

%.300/-

zg v
ntiythgf Kiu (njl)
cjbjhif bgWtjFa jFf

1. fjF:
m)

gjh tF (v.v.v.) go nj bgwtf

M) +2 tF nj/mjF rkkhd jFd


(gla go, iliy Ma g Konjh nghwtf)
) gljhf / KJfiy gljhf
(bgha, kUJt, fheil kUJt, trha, rl
nghw bjh glgof fyhf).
2. g brJ fhU fhy:
200.... - ML . f..M eh IjhLfSF FiwahJ ntiyth mYtyff
g brJ ntiyF fhUUf ntL.
3. tUkhd:
zgjhuuJ FLg bkhj tUkhd khjbkhWF %.2000/-F myJ MblhWF %.24,000/-F
nkglTlhJ.
4. taJ tu:
zgjhuUF 200....- ML..fM njaW 40 taJ milUf TlhJ.
M uhl/gHFod zgjhuf 45 taJ milUfTlhJ.
5. Ul:
zgjhu jKila g f myJ f fia KGikahf jehonyna goUf
ntL. myJ mtUila bgnwhf xUt myJ mtuJ fhghs 15 MLfSF Fiwahk jHf
tJ tUf ntL.
6. ntiythik:
zgjhu muRJiw / jah Jiw vjjkhd Ca bgW gnyh myJ
Ra ntiyth <Lgltuhfnth Uj TlhJ. nkY zgjhu, jahlUnjh, myJ mulUnjh
ntW vj tifY vjjkhd cjbjhif bgWgtuhf Uj TlhJ.
7. g, ffSF mwhl brW gY khzt khzaf:
zgjhu mwhl f WtdfSF brW gY khzt khzauhf (Regular students) Uj
TlhJ. j gjid bjhiyJhu f myJ mrt f fF zgjhufSF bghUjhJ.
8. Vfdnt ga bgwtf: Vfdnt eilKiwgLjgL 1993 - Wj bragl ntiythgnwh
thuz l gabgw kDjhufS a ntiythgnwh cjbjhif l za
bragLw taJ tufSFgL ntiythgnwh cjbjhif bgw jFiltf Mt.

2
zj kW bjhlJ gabgWj ga tu:
1.
ntiythgnwh cjbjhif bgWtjF nH bfhLfgLsthW tUthJiwduh tHfgL
rhW bgW kDl rkfntL.
2.
ntiythgfUJ cjbjhif bgw zg got ilj 30 ehfSF jdJ khtlF
cs njakakhfgl VnjD xU t is nr fzif (Savings Bank Account) bjhl, fzF
v (Account Number) is KG Kft cl tufis zg got mikJsthW bjf
ntL.
3.
ntiythgnwh cjbjhif fhyhL fzL bragL mjj fhyhL Kow d
zgjhuUila t fz brYjgL.
4.
ntiythgnwh cjbjhif _W MLfSF myJ Vidnahfis bghWjtiu 40 taJ
KoW tiuY, M uhl kW gHFodiu bghWjtiu 45 taJ KoW tiuY tHfgL.
5.
ntiythgnwh cjbjhif bgW tU fhy muRJiwnyh myJ jah Jiwnyh g
akd bgwhnyh myJ Ra ntiyth <Lglhnyh mJ bjhlghd tufis cldoahf ca ntiyth
mYtyfF bjf ntoaJ zgjhu bghWghF. muRJiwnyh myJ jah Jiwnyh
g akd bgwhnyh myJ Ra ntiyth <Lglhnyh ntiythgnwh cjbjhif tHFtJ Wj
bragL.
6.

ntiythgnwh cjbjhif bgW fhy git bjhlJ JJ tu ntL.

7.

cikF khwhd tuf mJ cjbjhif bgWgt g uJ bragL.

8.
l cjbjhif bgWnth xbthU aho bjhlfY zg got
FLsthW Ra cW Mtzij (Self Affidavit) ca ntiyth mYtyf Vu / nk khjfSF ne
rkf ntL. mtka tfzF jf, Jj mil kW ju rhjfis bfhL tu
ntL.

tUthJiw rhW
ntiythgnwh cjbjhif l ga bgw kDjhuf rkf ntoa rhj (tUkhd,
ntiyik, jehonyna f fUj myJ bgnwh myJ ghJfhty, fzt myJ kid
jeho FoUj Matiw cslaJ)
rhj fl got tUthJiw
mYtylUJ bgW zgJl mfgl ntL.

tUth

Mths

myJ

mjF

nkgl

1. U/Uk/br ................................................................. vw ntiythgnwh cjbjhif l


gabgw cs kDjhu jh/jij/fzt/kid Ma U/Uk ................................... ........................... ...................... ...
.................................................................................................................................................................................................. Kft tJ tUgt khj
tUkhd %. 2000/- F fhkY ML tUkhd %. 24,000/- F fhkY csJ vdrhW mfgLwJ.
2. U/Uk/br ................................................................. vw ntiythgnwh cjbjhif l
gabgw cs kDjhu muR myJ jah Jiw vjjkhd Ca bgW gY iy vW, t
Rantiyth <Lgliy vW
t KGtJkhf ntiyyhknyna UJ tUwh vW rhW
mfgLwJ.
3. U/Uk/br ................................................................. vw ntiythgnwh cjbjhif l
gabgw cs kDjhu muR myJ jahJiw myJ ju Mjhuf t vjjkhd cjbjhif bgW
tUgt my vW rhW mfgLwJ.
4. U/Uk/br ................................................................. vw ntiythgw kDjhu jehonyna jdJ g
myJ fYh fid Kojt myJ kDjhu bgnwh jh/jij myJ ghJfhty myJ fzt
myJ kid jehonyna 15 MLfSF nkyhf FoUJ tUgt vW rhW mfgLwJ.
5. U/Uk/br ................................................................. vw ntiythgnwh cjbjhif l
gabgw cs kDjhu mwhl g myJ fYhF brW tU khzt myJ khza my vW rhW
mfgLwJ.
l:
eh:

mYtyf Kiu

tUthJiw mYty
(tUth Mths iyF Fiwahj mYty)

ntiythgnwh cj bjhif l cjbjhif bgWtjfhd


zg got
( muR Miz (iy) v ..72,. bjhyhs kW ntiyth (M.2) Jiw, eh...25..08.2006 )
zg v:

ntiythgnwh cjbjhif

zgjhu ifgl
ghngh ms F
xlglntL

( * ) zgjhu tir v:

(ifgl nk zgjhu
ifbahglntL)
1. zgjhu bga
2. jij /jhah/ fzt / ghJfhty bgaU
Kft

3. zgjhu wj nj

taJ

4. zgjhu Kft

5 (*)

5.*ntiythgnwh
cjbjhif bgWtjfhd
fjF

v.v.v.. nj

nkiy tF (+2) /
rkkhd
fjF

sfiygl/
KJfiygl

ntiyth mYtyf
g brj nj

zgjhu t fzF ga tuf


6 (*)

t bga

is KG Kft

t fzF v

7. kDjhu rhj d: (vj tFig nrjtnuh mj tFfhd fl xU D nghl)


Muhl

gHFod

f
tFd

F :- (* ) Fl df mYtyfduh bragL

gl

gl
tFd

ju tFd

4
8. f/bjhKiw f jFf

( jF bgw fD nghl)

m) v.v.v.. nj bgwtf

M) nkiy tF (+2) / mjF rkkhd jFd

) gla gof

<) iliy Ma g bgwtf

c) gljhf

C) KJfiy gljhf

9. ntiythgf g tu
khtl ntiyth mYtyf
m) g brj ntiyth mYtyf bga
........................... ...
M) g v . . . . . . . . . . .. . . . . . . . . . .
) g brj nj . . . . . . . . . . . . . . . . . . . .
<) nja bjh FpL v . . . . . . . . . . . . . . . . . . . ..
(gtil csgo)

10) mf milahsf
(f rhj csgo)

1)

2)

11. jij, jh, kid, fzt kW


FLg cWd ga tuf
bga
(1)

zgjhuUF
cw Kiw
(2)

bjh kW g
Wtd Kft
(3)

khj tUkhd.
(4)

zgjhu ifbahg

5
mYtyf gaDF kL

rghj rhj
I.

zgjhu d 1- UJ 11-tiu bfhLJs tufis, ntiythgf cs


gntLf cs tuf mogil rghj mit rahf csd vd eh
rhwnw.
tUthJiw rhW ca got jFj mYty nkbyhgJl
bgwgLsJ.

siy ntiyth mYty xg


II.

ntiythgnwh cjbjhif mDkfglJ/kWfglJ ga tuf

(m) mDkj

ntiythgnwh cj bjhif mDkfgL


tHfgl Miz vQ nj

khjbkhWF mDkfgl cjbjhif

mDk bjhlfgl fhyhL

mDkfglJ g zgjhuUF jft


mDa nj

t bga kW is
(KG Kftl)

nr t fzF v

(M) kWj
ntLnfh kWfgljfhd fhuz :

l:

nj:

cj aFe / khtl ntiyth mYty

fhyhL thahf cj bjhif xg tu


fhyhL

braKiw Miz
v.

eh

goa
tir v

bjhif
%.

. . . . . . . . . . . . Kj
. . . . . . . . . .. . tiu
. . . . . . . . . . . . Kj
. . . . . . . . . .. . tiu
. . . . . . . . . . . . Kj
. . . . . . . . . .. . tiu
. . . . . . . . . . . . Kj
. . . . . . . . . .. . tiu
. . . . . . . . . . . . Kj
. . . . . . . . . .. . tiu
. . . . . . . . . . . . Kj
. . . . . . . . . .. . tiu
. . . . . . . . . . . . Kj
. . . . . . . . . .. . tiu
. . . . . . . . . . . . Kj
. . . . . . . . . .. . tiu
. . . . . . . . . . . . Kj
. . . . . . . . . .. . tiu
. . . . . . . . . . . . Kj
. . . . . . . . . .. . tiu
. . . . . . . . . . . . Kj
. . . . . . . . . .. . tiu
. . . . . . . . . . . . Kj
. . . . . . . . . .. . tiu

g khw / gakj / cjbjhif Wj ga F

mYty
rhbwhg

ntiythgnwh cjbjhifahf khj xWF %.150 / 200 / 300 mDk


mfglJ ga jft

zg v:

khtl ntiyth mYtyf:

( * ) zgjhu tir v:
eh

ntiythgnwh cjbjhif khj xWF %gh 150 /200 / 300 t x


_ykhf fhyhL njhW tHF tif mDkfgLsJ.

200....... ML

............................ khj............................ -M eh Kotilj fhyhLF nru ntoa bjhif


.khj Kj 15 ehfSF jf t fz brYjgL.

mLJ

tHfgLw bjhiff, mit tHfgLtjF jF bgU ca fhyhoid


mLJ tU khj 15-M njF Kd fz tu itfgL.

vfhy cjbjhif bjhlghf jhf foj vjid tYtyfF


mDnghJ nkfl zg v, t fzF v, tis tufis jtwhJ
FL vG mDg ntL.

cj aFe / khtl ntiyth


mYty ifbahg
bgWe
U/Uk/br.

Ra cW bkh Mtz
cjbjhif bgWgt bjhlJ gabgw cjbjhif bgW fhy xbthU aho
JtfY Vu/nk khj ne tJ ntiyth mYtyf Ra cWbkh mf ntL. ne
tUnghJ t fzF jf, ju rhjf kW Jj MjhuJl tu ntL.
Ra cWbkh Mtzfhd got
..

.j/bg

..

bjU . . . . . . . . . . .

. . . . . . . . . . . . . . .mr . . . . . . . . . . . . . tl . . . . . . . . khtl vw
Kft tF eh tU tufis cWahf bjnw.
1.

eh ntiythgnwh cjbjhif bgW tUnw.

2.

jnghJ vdJ bgnwh FLg tUkhd / FLg cWdf midJ tUkhd / khjF
%.2,000/-F, ML tUkhd %.24,000/-F mfkhf iy.

3.

eh jnghJ vj xU WtdY Ca bgW ntiy iy.


nkbfhsiy.

4.

eh jnghJ vj xU WtdY vj jkhd cjbjhif bgwiy.

5.

eh jnghJ vj xU f WtdY dr (regular Student) khztuhf gW tuiy.

6.

vj xU fhyY eh muRJiw / muR rh Wtdf / csh WtdfUJ g f


(dismissal) bragliy.

7.

vdF vj xU fhyY tH _y jlid mfgliy.

8.

cjbjhif bgw eh jF H cl ntiyth mYtyfF bjf cW mnw.

9.

eh cikF khwhf jftf mJ cjbjhif bgWtjhf maglh vdF tHfgL


cjbjhif WjgL vd, Vfdnt tHfgl bjhif jehL tUth tN rlgo
(Revenue Recovery Act) tNfgL vd, ntiyth mYtyf g uJ bragL
vgij eh mJns.

10.

nkbrhd tuf eh mj tif cikahdit vW, nkfl vj xU jftY


cikF khwhf iy vW, eh cjbjhif bgWtjfhf vj xU jftiy kiwfiy
vd cWahf bjJbfhnw.

l:
nj:

g v

ifbahg
bga
Kft

rh ifbahg

(bgnwh myJ ghJfhty)

vj xU Ra bjhiy

zg got bgWbfhlikfhd xif L


zg v

ntiythgnwh cj bjhiffhd zg gotid .................................


njaW bgW bfhnl. zgid brJ mJl tUthJiw rhW,
vdJ t nr fzF v Matiw izJ mtiw ---------M njf
ntiyth mYtyf rkf ntL vW, mthW Fj njF rkf
jtdh d vdF ntiythgnwh cj bjhif tHFt lghLf VgL
kWfgl neuyh vd vdF ne ntiyth mYtyf bjfglJ.
g v:

l:

zgjhuifbahg

nj:

bga:

mYtyf gaDF kL
uL Jj tuf
t.v.

Jj eh

gnto
v

tir

mr

ne

Jj tu rghjgahs bgaU xgK

bragl zg got bgWbfhlikfhd ntiyth


mYtyf xif L
zg v

ntiythgnwh

cj

bjhiffhd

bragl

zg

U/Uk/br .............................................................. mtflUJ........................................ njaW bgW


bfhsglJ.
mYtyf Kiu

cj aFe/
khtl ntiyth mYty

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