cPn \¼À :

tIcf kmaqly kpc£m anj³

kvt\l]qÀÆw ]²Xn
(\n_Ô\IÄ ]qÀ®ambpw hmbn¨tijw At]£ ]qcn¸n¡pI)
1. hnZymÀ°nbpsS t]cv (aebmf¯nð) :
Cw¥ojnð (henb A£c¯nð) :
taðhnemkw ]n³tImUv klnXw :

samss_ð \¼À :

Xt±ikzbw`cW Øm]\¯nsâ t]cpw :

dh\yq Pnñbpw

2. AÑsâ t]cv :
Pohn¨ncp¸pïv/acWs¸«p
(Bhiyanñm¯Xv sh«nIfbpI)----
-----------------------------------------
3. A½bpsS t]cv :
Pohn¨ncp¸pïv/acWs¸«p
(Bhiyanñm¯Xv sh«nIfbpI)

4. Aѳ /A½ acWs¸« XobXn :----------------------

5. Ct¸mgs¯ c£IÀ¯mhnsâ t]cpw :

taðhnemkhpw

6. hnZymÀ°nbpambpÅ _Ôw :

7. hnZymÀ°nbpsS P\\XobXnbpw hbÊpw :

B¬/s]¬ (Bhiyanñm¯Xv sh«nIfbpI)

8.
(F). ]Tn¡p¶ kvIqfnsâ ]qÀ®amb t]cv :

(_n). kvIqfnsâ kz`mhw :

(Kh/FbvUUv/A¬ FbvUUv)

(kn). ]Tn¡p¶ ¢mÊv :

(Un). kvIqÄ GXv Pnñbnðs]Sp¶p. :

9. 5 hbÊn\p XmsgbpÅ Ip«nbmsW¦nð : Dïv/Cñ (Bhiyanñm¯Xv sh«nIfbpI)
ssNðUv shð^bÀ I½nän sNbÀamsâ
kÀ«n^n¡äv lmPcm¡nbn«ptïm).

10. IpSpw_¯nsâ hmÀjnI hcpam\w :

_n.]n.Fð IpSpw_mwKamsW¦nð
Xt±ikzbw`cW Øm]\ sk{I«dnbpsS
km£y]{Xhpw Añm¯hÀ hntñPv
B^okdnð \n¶pÅ hcpam\ kÀ«n^n¡äpw
lmPcmt¡ïXmWv.

11. (F). hnZymÀ°nbpsSbpw c£IÀ¯mhnsâbpw :þ

t]cnð tZikmðIrX_m¦nð Bcw`n¨n«pÅ
tkhnwKvkv _m¦v A¡uïv \¼À
(tPmbnâv A¡uïv)
(]mÊv_p¡nsâ H¶mwt]Pnsâ t^mt«mtIm¸n
tNÀ¡Ww)

(_n). A¡uïv Bcw`n¨n«pÅ hyànIfpsS t]cv :þ (1).

(2).

(kn). _m¦nsâ t]cv :þ

(Un). {_m©v :þ

(C). sF.F^v.Fkv.kn \¼À :þ

(F^v). B[mÀ ImÀUv \¼À :þ

hnZymÀ°nbpsS t]cv :

hnceSbmfw /H¸v

kXy{]kvXmh\

.......................................................... F¶ Ip«n ]qÀ®ambpw Fsâ kwc£WbnemsW¶pw Ip«n

Ct¸mÄ ................................................ ¢mÊnð ]Tn¡pIbmsW¶pw tað {]kvXmhn¨ hnhc§Ä
kXyamsW¶pw CXn\mð km£ys¸Sp¯nsImÅp¶p. Ip«n A\mYmeb¯nsetbm aäv
Øm]\¯nsetbm At´hmknbsñ¶pw Fsâ ho«nð\n¶pXs¶ hnZym`ymkØm]\¯nð
t]mIp¶sX¶pw km£ys¸Sp¯p¶p.
H¸v :-

t]cv :

_Ôw :

(Aѳ/A½/c£IÀ¯mhv)
 hnZym`ymk Øm]\¯nsâ tae[nImcn \ðIp¶ km£y]{Xw

............................................................F¶ hnZymÀ°n ......................................................................................

kvIqfnð .......................... ¢mÊnð ]Tn¡pIbmWv. Snbm³/SnbmÄ A\mYmeb¯nsetbm aäv
Øm]\¯nsetbm At´hmknbsñ¶pw kvt\l]qÀÆw ]²Xn {]Imcapff B\pIqey
¯n\v AÀlXbpsï¶pw Cu hnZym`ymk Øm]\w kÀ¡mÀ/ FbvUUv/kzImcy
hnZym`ymk Øm]\amsW¶v CXn\mð km£ys¸Sp¯p¶p.

H¸v :

t]cv :

slUvamÌÀ/slUvankv{Skv/{]n³kn¸ð

Øew : kvIqÄap{Z kvIqfnsâ t]cv

XobXn :

km£y]{Xw

........................................... Ip«nbpsS amXmhv/]nXmhv acWs¸«n«psï¶pw Snbm³/SnbmÄ Ct¸mÄ

..................................... kwc£WbnemsW¶pw Snbmsâ/ SnbmfpsS hnZym`ymk sNehpIÄ
hln¡p¶Xn\p amXmhmb/]nXmhmb/c£IÀ¯mhmb ......................................................... \v
km¼¯nIambn ]cm[o\X A\p`hn¡p¶psh¶pw kvt\l]qÀÆw ]²Xn {]ImcapÅ
[\klmb¯n\v AÀl\msW¶pw Ip«n A\mYmeb¯nsetbm aäv Øm]\¯nsetbm
At´hmknbsñ¶pw km£ys¸Sp¯p¶p.

H¸v :

t]cv :

Øm\t]cv :

Øew :

XobXn :

(NB :þ kÀ«n^n¡äv Xt±i kzbw`cW Øm]\§fnse tabÀ/sNbÀam³/{]knUâv/

Iu¬kneÀ/ sa¼À/ Fw.]n / Fw.Fð.F F¶nhcnð BcpsSsb¦nepw Bbncn¡Ww.)
 km£y]{Xw

(5 hbÊn\p XmsgbpÅ Ip«nIÄ¡v am{Xw)

.................................... Ip«nbpsS amXmhv/]nXmhv acWs¸«n«psï¶pw Snbm³/SnbmÄ Ct¸mÄ
................................. kwc£WbnemsW¶pw Snbms\ hfÀ¯n hnZym`ymkw sN¿p¶Xn\v
amXmhmb/]nXmhmb/c£IÀ¯mhmb ....................................................... \v km¼¯nIambn
]cm[o\X A\p`hn¡p¶psh¶pw kvt\l]qÀÆw ]²Xn {]ImcapÅ [\klmbw
............................................ Ip«n¡v A\phZn¡Wsa¶pw ip]mÀi sNbvXpsImÅp¶p. Ip«n
A\mYmeb¯nsetbm aäv Øm]\¯nsetbm At´hmknbsñ¶pw km£ys¸Sp¯p¶p.

H¸v :

t]cv :

sNbÀam³ :

ssNðUvshð^bÀ I½nän :
Øew :
XobXn :

At]£bn³taepÅ Xocpam\w

....................................................................... sâ At]£bpw A\p_ÔtcJIfpw ]cntim[n¨Xnð

................................................ ¢mÊnð ]Tn¡p¶ Ip«n¡v Cu A²ymb\ hÀjw {]Xnamkw
..................................... cq]bpsS [\klmb¯n\v AÀlXbpïv. hcpw hÀj§fnð ]T\w
XpScp¶psï¦nð ]Tn¡p¶ ¢mÊv A\pkcn¨pÅ XpIbv¡pw AÀl\mWv. {]kvXpX XpI
A\phZn¡p¶p.

FIvknIyq«ohv UbdIvSÀ
tIcf kmaqly kpc£m anj³
 tIcf kmaqly kpc£m anj³
kvt\l]qÀÆw ]²Xn
amÀ¤ \nÀt±i§Ä :

1. At]£ ]qÀ®ambpw ]qcn¸n¨ncn¡Ww. At]£bnse Hcp tImfhpw

]qcn¸n¡mXncn¡m³ ]mSpÅXñ.
2. At]£bnð kvIqfnsâ t]cpw kz`mhhpw ]qÀ®ambpw \ðInbncn¡Ww. Npcp¡t¸À
\ðInb At]£IÄ ]cnKWn¡p¶Xñ.
3. AÑt\m A½tbm acn¨pt]mb s{]m^jWð tImgvkS¡apÅ Un{KnXe tImgvkpIÄ
hsc ]Tn¡p¶ Ip«nIÄ¡mWv ]²XnbpsS {]tbmP\w e`yamIpI. Aѳ \jvSs¸«
Ip«nIÄ c£IÀ¯mhnsâ tImf¯nð A½bpsS t]cpw, A½ \jvSs¸« Ip«nIÄ
AÑsâ t]cpamWv FgptXïXv. AÑ\pw A½bpw \jvSs¸« Ip«nIÄ am{Xta
c£IÀ¯mhnsâ tImf¯nð Ip«nsb kwc£n¡p¶ ASp¯ _Ôphnsâ t]cv
FgpXphm³ ]mSpÅq. acWs¸«pt]mb AÑsâtbm A½bpsStbm t]cpw At]£bnð
_Ôs¸« tImf¯nð FgptXïXmWv.
4. tIcf kmaqly kpc£m anj³ ku¯v C´y³ _m¦nsâ Xncph\´]pcw tImÀ¸tdäv
{_m©nð Bcw`n¨n«pÅ A¡uïneqsS tImÀ_m¦nwKv hgnbmWv [\klmbw hnXcWw
sN¿p¶Xv. AXn\mð kao]¯pÅ ku¯v C´y³ _m¦nsâ {_m©pIfntem Asñ¦nð
tImÀ_m¦nwKv kwhn[m\apÅ aäv _m¦pIfntem Ip«nbpsSbpw c£nXmhnsâbpw t]cnð
tPmbnâv A¡uïv XpS§n _m¦v ]mÊv _p¡nsâ H¶mw t]Pnsâ t^mt«m tIm¸n
At]£tbmsSm¸w DffS¡w sNt¿ïXmWv. Cu A¡uïnð F än Fw ImÀUv
hm§m³ ]mSpÅXñ. Ip«nbpw c£nXmhpw sN¡nð H¸n«p \ðIn XpI ]n³hen¡p¶
coXnbnepÅ _m¦v A¡uïmWv XpSt§ïXv. _m¦v A¡uïv XpS§pt¼mÄ Cu amÀ¤
\nÀt±i¯nsâ tIm¸n _m¦nð \ðtIïXmWv.
5. At]£IÄ Ab¡p¶ Ihdnð “ kvt\l]qÀÆw ]²Xn¡pÅ At]£” F¶pw Pnñbpw
hyàambn FgpXWw. IqSmsX At]£Isâ t]cpw taðhnemkhpw hyàambn
Ihdnsâ ]pd¯v FgpXWw.
6. At]£tbmsSm¸w tNÀt¡ï tcJIfpsS ]IÀ¸v KkäUv Hm^okÀ
km£ys¸Spt¯ïXmWv.
7. ]qcn¸n¨ At]£IÄ Xmsg ]dbp¶Xp {]Imcw Abbvt¡ïXmWv. ImkÀtKmUv,
I®qÀ, ae¸pdw, hb\mSv, tImgnt¡mSv PnñIfnse At]£IÄ doPnbWð UbdIvSÀ,
tIcf kmaqly kpc£m anj³ doPnbWð B^okv, knhnð tÌj³, tImgnt¡mSv F¶
hnemk¯nepw aäp PnñIfnepÅ At]£IÄ FIvknIyq«ohv UbdIvSÀ, tIcf kmaqly
kpc£m anj³, cïmw\ne, htbmP\ ]Ið ]cn]me\ tI{µw, ]qP¸pc, Xncph\´]pcw
þ 12 F¶ hnemk¯nepw Abbvt¡ïXmWv.
8. B[mÀ ImÀUnsâ cPnkvt{Sj³ \¼À DÅS¡w sNbvXncn¡Ww. B[mÀ
e`n¨n«nsñ¦nð cPnkvt{Sj³ sNbvXXnsâ ]IÀ¸v km£ns¸Sp¯n DÅS¡w sN¿pI.
9. kvt\l]qÀÆw ]²Xn B\pIqeyw hcpw hÀj§fnepw XpSÀ¶v e`nt¡ïXn\v Hmtcm
A²ymb\ hÀj¯nsâbpw Bcw`¯nð Cu t]Pnsâ adphi¯pÅ kÀ«n^n¡äv
]qcn¸n¨v ]Tn¡p¶ hnZym`ymk Øm]\¯nsâ ta[mhnsbs¡mïv km£ys¸Sp¯n
anjsâ Xncph\´]pcs¯ BØm\ Hm^oknte¡v Abt¡ïXmWv.
Xmsg ]dbp¶ tcJIfpsS KkäUv Hm^okÀ/ Øm]\ ta[mhn km£ns¸Sp¯nb ]IÀ¸v
At]£tbmsSm¸w DÅS¡w sNbvXncn¡Ww.

1. acn¨pt]mb c£nXmhnsâ acW kÀ«n^n¡änsâ ]IÀ¸v.

2. _m¦v ]mkv_p¡nð Ip«nbpsS t]cpw taðhnemkhpw, _m¦nsâ taðhnemkhpw, IFSC
tImUpw AS§nb t]PpIfpsS ]IÀ¸v.
3. B[mÀ ImÀUnsâ ]IÀ¸v. (B[mÀ ImÀUv e`n¨n«nñm¯hÀ B[mÀ cPnkvt{Sj³
sNbvXXnsâ Én¸nsâ tIm¸n)
4. hcpam\ kÀ«n^n¡äv (HdnPn\ð) Asñ¦nð _n.]n.Fð kÀ«n^n¡änsâ/_n.]n.Fð tdj³
ImÀUnsâ km£ys¸Sp¯nb ]IÀ¸v.

XpSÀ¶pÅ Hmtcm A²ymb\ hÀj¯nsâbpw {]mcw`¯nð Ab¨p Xtcï

kÀ«n^n¡äv

cPnÌÀ \w :
t]cv :
hnZym`ymk Øm]\¯nsâ t]cv :
hnZym`ymk Øm]\¯nsâ kz`mhw :
]Tn¡p¶ ¢mÊv :
Ignª A²ymb\ hÀj¯nð :
]Tn¨ hnZym`ymk Øm]\w

]Tn¨ncp¶ ¢mÊv :

Ip«nbpsS H¸v / hnceSbmfw

c£nXmhnsâ H¸v/ hnceSbmfw

Cu Øm]\¯nð e`yamb tcJIÄ h¨v tað tcJs¸Sp¯nb hnhc§Ä hmkvXhamsW¶v

km£ys¸Sp¯p¶p. Cu Øm]\w Kh¬saâv/ FbvUUv/A¬FbvUUv hn`mK¯nðs]Sp¶p.

Øm]\ta[mhnbpsS t]cpw H¸pw