mvkÖqx M„n FY

m¤¢ve¨ MÖvn‡Ki Z_¨ msMÖn dig (wmI-cÖMwZ KZ©„K c~iYxq)

ZvwiL: / /

kvLv: .................................................... GjvKv: .................................................... AÂj: ................................

1. e¨w³MZ Z_¨
bvg:
wcZvi/¯^vgxi bvg:
Rb¥ ZvwiL: / / †gvevBj b ^i:
RvZxq cwi qcÎ b ^i:
eZ©gvb wVKvbv:

¯’vqx wVKvbv:

g~j †ckv: miKvix/AvavmiKvix vKzwi †emiKvix vKzwi we‡`‡k vKzwi Ab¨vb¨: ----------
(wUK w ý w`b) evwoi gvwjK e¨emv we‡kl †ckvRxwe -------------------
cÖwZôv‡bi bvg: c`ex:
cÖwZôv‡bi wVKvbv:
ˆeevwnK Ae¯’v: e¨emv/ vKywi/we‡`‡k Ae¯’vbKvj: eQi

2.FY Pvwn`vi aiY

D‡Ïk¨: evwo evbv‡bv †hŠ_ M„nwbg©vY evwo/d¨¬vU Dbœqb †jvb †UKIfvi
(wUK w ý w`b) evwo m úªmviY Aa©wbwg©Z evwo‡Z A_©vqb G¨vcvU©‡g›U µq Ab¨vb¨

cÖ‡qvRbxq F‡bi cwigvY ------------------------------------------------------UvKv †gqv` ------------- gvm

3. e¨w³i Avq-e¨qmsµvšÍ Z_¨vewj

gvwmK Avq UvKv gvwmK e¨q UvKv
†eZb ( vKywiRxex) Lvevi, wkÿv I †cvkvK
e¨emvwqK Avq evwofvov I wej
fvov eve` Avq cwienb
Ab¨vb¨ Avq (hw` _v‡K) jgvb F‡Yi gvwmK wKw¯Í
Drm: ......................
Ab¨vb¨ (. ................ )

†gvU Avq †gvU e¨q

gvwmK nv‡Z bM` (†gvU Avq - †gvU e¨q) =

†hvM¨ZvkZ© hvPvB c~e©K gšÍe¨ wjLyb Ges mycvwik Kiæb-
1. AšÍZ 5 eQi †gqvw` I Kgc‡ÿ 10 jÿ UvKv FY wb‡Z AvMÖnx|
2. Kgc‡ÿ 1.75 KvVvRwg Av‡Q|
3. evwo †mwgcvKv/cvKv (B‡Ui ˆZwi) wbg©vY Ki‡e|
4. Av‡e`bKvix Ab¨ †Kv_vI FY †Ljvcx bb|
FY cÖ`v‡bi ¯^c‡ÿ hyw³:
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M„n FY wjW mycvwikKvwi ¯^vÿi

bvg: wcb:
 m ¢ve¨ MÖvn‡Ki Z_¨ msMÖn dig (GjvKv e¨e¯’vcK KZ…K c~ibxq)

wcI KZ…©K hvPvB m‡šÍvlRbK n‡j GjvKv e¨e¯’vcK wb‡¤œi Ask hvPvB c~e©K PzovšÍ mycvwik Ki‡eb-
cwi`k©‡bi ZvwiL: / /

1. M„nwbg©vY/d¬¨vU µ‡qi †ÿ‡Î hvPvB msµvšÍ

wbRevwo wbg©vY/ ewa©ZKi‡Yi †ÿ‡Î cÖ‡hvR¨ d¬¨vU µ‡qi †ÿ‡Î cÖ‡hvR¨

Rwgi cwigvY (KvVv) †W‡fjcv‡ii bvg

Rwgi AbygvwbK g~j¨ (UvKv) cÖ‡R‡±i bvg

Zjvi msL¨v wbg©vYvwab GjvKv

cÖwZ Zjvi AvqZb (eM©dzU) n¯ÍvšÍ‡ii m ¢ve¨ ZvwiL
evwo wbg©vY/ewa©ZKi‡bi m ¢ve¨ Li m ¢ve¨ µq g~j¨
†nvwìs Gi aiY (wUK w ý w`b) wjR‡nvì wd«‡nvì wbg©vY KvR mgv‡ßi
cÖZ¨vwkZ ZvwiL

2. M„nwbg©vY/d¬¨vU Gi eZ©gvb Ae¯’v hvPvB

Pjgvb Kv‡Ri wPÎ wbg©vY KvR ïiæ nqwb dvD‡Ûk‡bi KvR B‡Ui KvR Qv` XvjvB
(wUK wPý w`b) ˆe`y¨wZK ms‡hvM I m¨vwbUvwi †`qvj cøv÷vi UvBj‡mi KvR m c~b© cÖ¯‘Z

wewb‡qvMK…Z GjvKvi wVKvbv evox bs: --------------- moK/MÖvg: ---------------------------------------------------------------------

†cvó Awdm: -------------------- _vbv/Dc‡Rjv: --------------------- †Rjv: ---------------------------

†hvM¨ZvkZ© hvPvB c~e©K gšÍe¨ wjLyb Ges mycvwik Kiæb
1. eÜK ivLvi Dc‡hvMx evwo/Rwg Av‡e`b Kvwii Av‡Q|
2. m úwËi gvwjKvbv wb®‹›UK|
3. ¯’vei m úwË AvBwcwWwm-i Kv‡Q eÜK ivL‡Z ivwR Av‡Qb|
4. evwoi bKkv h_vh_ KZ©„cÿ KZ©„K Aby‡gvw`Z Av‡Q|
5. FY Av‡e`bKvix GjvKvq mycwiw Z|
6. Av‡e`bKvwi ivR‰bwZKfv‡e cÖfvekvjx e¨w³ bb|
7. e¨w³ wn‡m‡e Zvi m‡½ Avw_©K †jb‡`b Kiv hv‡e|
8. FY wewb‡qvM ïay D‡jøwLZ D‡Ï‡k¨B Ki‡e|
9. Av‡e`bKvix Ab¨ †Kv_vI FY †Ljvcx bb|
cÖKíwU hvPvB evQvB K‡i Avgvi g‡b n‡q‡Q FYwU nIqv DwPZ-
¯^í †gqv`x `xN© †gqv`x
gšÍe¨:
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M„n FY wjWwU AvBwcwWwm KZ©„c‡ÿi Kv‡Q mycvwik Kiv nj|

GjvKv e¨e¯’vcK (cÖMwZ)-i ¯^vÿi I wmj wcb:

AvBwcwWwm cÖwZwbwai gšÍe¨:

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AvBwW: bvg ¯^vÿi I ZvwiL