bjhlf f aff

2017-2018 M fahLfhd Cuh xa / efuh / khefuh /

muR bjhlf kW eLiy g jiyik Ma / gljh / iliy / cl
f Maf bghJ khWj nfhU zg

Xa L xa
xaF khtl L khtl
(khtlF)
(bghUjkhdjF FLfhLf)
Ma bga
1.
(jiybgGij fil Fl)

NAME IN ENGLISH
(Write in Block Letters) (Initials at End)

2. ghd

3. ifng v

4. wj nj

jnghJ g gj
5.
(gljh Ma v ghl Fl)

jnghija gj Kj Kj g
6.
nrj eh
jnghJ g g g
7.
nrj eh
bghJ khWj
kdbkhj khWj
gF khWj bgw Kiw
8. neuo akd
(bghUjkhd xF kL
Fl) gj ca
thf khWj

jnghJ g g bga :

9.
xa :

khtl :

1
 1. 01.06.2016 - F fzt /
01.06.2
01-06-2014
10 w KDik mogil khWj 013kid gnyh myJ
. nfhdh mj tu (ca rhjf) nehthgnlh wUjh
izfglntL. rhj Ujh (wj eh
kLnk w KDikF )
gfgL
2. KY fghitanwh
(bghUjkhd xF kL 3. Uja khW mWit ir (Heart
Fl) Transplantation Surgery), Wuf kh
W mWit ir brjtf
5. 01.06.2011-F
(Kidney Transplantation Surgery), k
W ilah ir (Dialysis)
nkbfhLtUgtf
(mWit ir bragl eh
_______________
4. fLikahf ghfgl ) W
nehah
5. uhQt g gahs
kid
6. jit / 40 taij flj Ukz
9. brJbfhshj K fa
10
7. 40 % kW mjF nkY
.
Cd cs khW wdh
8. 40 % kW mjF nkY
11.06.2
011kdts Fa kW kh
11 W wdh FHij bg
nwh
9. jnghJ g g
01.06.2014F K g V
wtf
1 fzt / kid ika / khy muR
0. mYtyf / muR rhj mYtyf /
muR / cj bgW g
gtf

1 2016-17faho gut k
1. W gj ca bgwtf
flj 2016-2017 M ML bghJ
M
khWj fyjh fzt / kid UtU
11. /
ggtf vw mogil khWj
iy
bgwt

zgjhu g lUJ fzt khtl :

12. / kid g khtl kW
l u (..) .. :

2
 Ma cW bkh

nkny FlgLs tuf midJ cikbad cW TWnw. eh

Fl tuf jtW vd flaglh v J Jiw rhJ nkbfhsgL
xGF eltoifF cgLnt vd bjJbfhnw. nkY, eh nfhU lF
khWj tHFgr vj khWj gazgo nfhukhnl vd cW
mnw.

l : Ma
ifbahg
eh :

nkfl tuf midJ rhj Ma KjKj g nrj eh, j

nghJ g g g nrj eh, kW neuo akd / bghJ
khWj / kdbkhj khWj / gj ca _y khWj / thf khWj Mat
iw g gntL kW ju MtzfnshL xL rahf csJ
vW rhwfgLwJ.

eh : jiyikaha ifbahg

nkfl tuf midJ rhj Ma KjKj g nrj eh, j

nghJ g g g nrj eh, kW neuo akd / bghJ
khWj / kdbkhj khWj / gj ca _y khWj / gut / thf khWj
Matiw ggntL kW ju MtzfnshL xL rahf csJ
vW mdh J jehL FoKiwg (xGFKiw kW nkKiwpL) f
17(a) kW 17(b)- go vj xGF eltoif Yit iy vW
rhwfgLwJ.

nkY w KDikfhd rhjf rghfglJ vd rhW

mfgLwJ.

eh :
cj / TLj cj bjhlf f mYty