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òif¥gl«
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Passport size

01 kDjhu® bga®

02 jf¥gdh® / fzt® bga®

03 kDjhuç‹ ÏU¥Ãl Kftç

04 khefuh£Á/efuh£Á/ng%uh£Á
k©ly« nfh£l« /th®L/ t£lhu«/
Cuh£Á v©

05 khefuh£Á/ efuh£Á/ ng%uh£Á/

t£lhu« / Cuh£Áæ‹ bga®

06 cjéahs® ãakd« nfhU«

ika¤Â‹ v©, bga®/ éyhr«

07 fšé¤ jFÂ

08 Ãwªj nj k‰W« ó®¤Âailªj

taJl‹

09 tF¥ò ( tUthŒ Jiwæš bg‰w *jh.t/jh.g./ä.Ã.t/Ã.t/Ï.t

rh rh‹Wl‹)
10 kDjhuç‹ ÏU¥Ãl Kftç
(rh‹Wl‹) th¡fhs® milahs
m£il efš (m) FL«g m£il efš
(m) tç uÓJ (m) Mjh® m£il efš

11 kDjhu® tÁ¡F« Ïl¤Â‰F«

ãakd« nfhU« m§f‹tho
ika¤Â‰F« cŸs öu«
12 kDjhuç‹ Ãw fšé jFÂfŸ
(rh‹¿jœ Ïiz¡f¥gl nt©L«)

13 ÂUkz ãiy ÂUkzkhdt®/éjit/Mjut‰w éjit/

fztuhš ifél¥g£lt®

14 Ïju jFÂfŸ(Extra Curricular

activities)

14( kDjhu® Loco Motor Disability i.e., M«/Ïšiy

a) partially orthopaedically differently
abled persons
M« våš mj‹ étu« / rjÅj«
(rh‹Wl‹ rk®¥Ã¡fΫ)

15 kDjhuç‹ FL«g tUkhd«

16 Ãw F¿¥òfŸ

Ïl« :

ehŸ :

kDjhu® ifbah¥g«
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 vGj go¡f bjçªÂU¡f nt©L«.

 é©z¥gjhu® é©z¥Ã¡F« m‹W taJ 20 Kjš 40-¡FŸ ÏU¡f
nt©L« (éjit / Mjut‰w éjit/ fztdhš ifél¥g£lt® /
kiythœgFÂæd® 5 taJ js®Î / Loco Motor Disability i.e., partially
orthopaedically differently abled persons r«gªj¥g£lt® våš 3 taJ
js®Î).
 é©z¥gjhu® é©z¥Ã¡F« ika¤Â‹ mU»š tÁ¡f nt©L«.
 éjit/fztuhš ifél¥g£lt® /Loco Motor Disability i.e., partially
orthopaedically differently abled persons r«kªj¥g£lt® våš cça
tifæš rh‹W rk®¥Ã¡f¥gl nt©L«.
 * jhœ¤j¥g£l tF¥Ãd® /jhœ¤j¥g£l gH§Foæd®/äfΫ ÉgL¤j¥g£l
tF¥Ãd® / ÉgL¤j¥g£l tF¥Ãd® v‹gj‰fhd rh‹W
t£lh£ÁaçläUªJ bg‰W rk®¥Ã¡f nt©L«

mYtyf cgnahf¤Â‰F k£L« (For Office Use Only)

Ñœf©l rh‹WfŸ Ïiz¡f¥g£LŸsjh?

 taJ (gŸë kh‰W¢ rh‹¿jœ ) : M« / Ïšiy

 éjit/fztuhš ifél¥g£lt®, Loco Motor Disability i.e., partially
orthopaedically differently abled persons v‹gj‰fhd rh‹W : M« / Ïšiy
 ÏU¥Ãl rh‹¿jœ
 Ãw F¿¥òfŸ VnjD« ÏU¥Ã‹

FHªij ts®¢Á¤ £l mYty®.

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• é©z¥gjhu®fŸ ÏU¥Ãl¤Â‰F mU»š cŸs FHªij

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