e¨vswKs cÖwewa I bxwZ wefvM Website: www.bb.org.

bd
evsjv‡`k e¨vsK
cÖavb Kvh©vjq
XvKv|
10 dvêyb 1426
weAviwcwW mvKz©jvi bs-02 ZvwiL:
23 ‡deªæqvwi 2020

e¨e¯’vcbv cwiPvjK/cÖavb wbe©vnx

evsjv‡`‡k Kvh©iZ mKj Zdwmwj e¨vsK|

wcÖq g‡nv`q,
e¨vsKmg~‡n wnmve †Lvjvi dig I †KIqvBwm †cÖvdvBj cÖm‡½
e¨vsKmg~‡n wnmve †Lvjvi wel‡q evsjv‡`k e¨vs‡Ki 30 Ryb 2008 Zvwi‡Li cÎ bs-GGgGjwW-1(cwjwm)/2008-
2324 I 28 wW‡m¤^i 2014 Zvwi‡Li weGdAvBBD mvK©yjvi bs-10 Ges evsjv‡`k dvBb¨vwÝqvj B‡›Uwj‡RÝ BDwbU Gi
16 Rvbyqvwi 2017 Zvwi‡Li weGdAvBBD mvK©yjvi ‡jUvi bs-01 Gi cÖwZ Avcbv‡`i `„wó AvKl©Y Kiv hv‡”Q|
2| DwjøwLZ cÎ, mvK©yjvi I mvK©yjvi †jUv‡ii gva¨‡g Zdwmwj e¨vsKmg~‡ni Rb¨ wnmve †Lvjvi dig I †KIqvBwm
†cÖvdvBj msμvšÍ wewfbœ wb‡`©kbv Rvwi Kiv nq| †`‡k Z_¨ cÖhyw³i weKvk, Avw_©K Bbd«v÷ªvKPvi Dbœqb I cÖhyw³i mnvqZvq
Z_¨ cÖvwßi my‡hvM e„w×i avivevwnKZvq wnmve †Lvjvi digmg~n‡K AwaKZi MÖvnK-evÜe Kivi j‡ÿ¨ Zv nvjbvMv`Ki‡Yi
wm×všÍ M„nxZ n‡q‡Q| nvjbvMv`K…Z wb‡¤œv³ digmg~n Avcbv‡`i AeMwZ I cÖ‡qvRbxq e¨e¯’v MÖn‡Yi Rb¨ GZ`&m‡½ †cÖiY
Kiv n‡jv:
K) wnmve †Lvjvi dig: e¨w³K wnmve
L) wnmve †Lvjvi dig:  cÖvwZôvwbK wnmve
M) wnmve †Lvjvi dig:  miKvwi/Avav miKvwi/¯^vqËkvwmZ cÖwZôv‡bi wnmve
N) wnmve †Lvjvi dig:  ¯’vqx AvgvbZ/mÂqx w¯‹g/we‡kl w¯‹g wnmve
3| wnmveavixi †ckv I A‡_©i Drm we‡ePbvq e¨vsK wnmveavixi †KIqvBwm Kivi cvkvcvwk Uªvb‡RKkb †cÖvdvBjI
c~iY Ki‡e Ges wnmve †Lvjvi 6(Qq) gvm ci cÖK…Z †jb‡`b we‡ePbvq Zv nvjbvMv` Ki‡e| G †ÿ‡Î, we`¨gvb Uªvb‡RKkb
†cÖvdvBj di‡gi MÖvnK/wnmve cwiPvjbvKvixi †Nvlbv I ¯^vÿi cÖ`v‡bi Ask ev` hv‡e| GZبZxZ, Uªvb‡RKkb †cÖvdvBj I
†KIqvBwm †cÖvdvBj msμvšÍ we`¨gvb wb‡`©kbv AcwiewZ©Z _vK‡e|
4| GZ`&mshy³ wnmve †Lvjvi di‡g D‡jøwLZ Z_¨vw` e¨vs‡Ki wnmve †Lvjvi di‡g Aek¨B _vK‡Z n‡e; Z‡e †Kvb
e¨vsK cÖ‡qvR‡b AwZwi³ Z_¨vw` ms‡hvRb Ki‡Z cvi‡e| e¨vsKmg~n Zv‡`i wnmve mswkøó kZ©vejx di‡gi mv‡_ mshy³
Ki‡e| dig evsjvq ev Bs‡iRx‡Z ev Dfq fvlvq gy`ªY Kiv hv‡e; Z‡e di‡g D‡jøwLZ evsjv I Bs‡iRx gva¨‡g Z_¨ msMÖ‡ni
mswkøó wb‡`©kbv Z`vbyhvqx cwicvjb Ki‡Z n‡e|
5| Bmjvgx kwiqvn& wfwËK e¨vsKmg~n DwjøwLZ di‡g e¨eüZ kã/k㸇”Qi cwie‡Z© cÖPwjZ I mvgÄm¨c~Y© Bmjvgx
kixqvn& wfwËK kã/k㸔Q e¨envi Ki‡Z cvi‡e|
6| dig gy`ªY I e¨env‡ii †ÿ‡Î cwi‡ek evÜeZvi welqwU we‡klfv‡e jÿ¨ ivL‡Z n‡e|
7| wnmve †Lvjvi nvjbvMv`K…Z digmg~n AvMvgx 30 Ryb 2020 Zvwi‡Li g‡a¨ Avewk¨Kfv‡e cÖPjb Ki‡Z n‡e|
8| e¨vsK-‡Kv¤úvbx AvBb, 1991 Gi 45 avivi AvIZvq G wb‡`©kbv Rvwi Kiv n‡jv|

mshyw³: eY©bv Abyqvqx| Avcbv‡`i wek¦¯Í,

(‡gv: †iRvDj Bmjvg)

gnve¨e¯’vcK
†dvbt 9530252|
 ......................... e¨vsK/e¨vsK wjwg‡UW
....................kvLv
wnmve †Lvjvi dig
e¨w³K wnmve
ZvwiL:............................... wnmve b¤^i: ............................
BDwbK MÖvnK AvBwW †KvW: .............................
(e¨vs‡Ki e¨env‡ii Rb¨)
e¨e¯’vcK
--------------e¨vsK/e¨vsK wjwg‡UW
------------- kvLv|
wcÖq g‡nv`q,
Avwg/Avgiv Avcbvi kvLvq GKwU wnmve †Lvjvi Rb¨ Av‡e`b KiwQ| Avgvi/Avgv‡`i wnmve msμvšÍ I e¨w³MZ
we¯ÍvwiZ Z_¨ wb‡gœ cÖ`vb KiwQ:
| cÖ_g Ask: wnmve msμvšÍ Z_¨vw` |
1| wnmv‡ei wk‡ivbvg : (evsjvq).....................................................................................
In English (Block Letter) .......................................................
2| wnmv‡ei cÖK…wZ (wUK w`b) : mÂqx PjwZ GmGbwW Gdwm
AviGdwmwW GbGdwmwW Ab¨vb¨..................................
3| gy`ªv (wUK w`b) : UvKv Wjvi BD‡iv cvDÛ Ab¨vb¨...................
4| wnmve cwiPvjbv c×wZ (wUK w`b): GKKfv‡e †hŠ_fv‡e ‡h †Kvb GKRb
‡h †Kvb GKRb A_ev RxweZRb Ab¨vb¨ .............................
5| cÖv_wgK Rgvi cwigvb: (As‡K) ......................................(K_vq) ..........................................................
| wØZxq Ask: e¨w³ msμvšÍ Z_¨vw`1 |
1| wnmveavixi bvg (evsjvq):............................................................................ wnmve b¤^i:....................
In English (Block Letter) .................................................. (e¨vs‡Ki e¨env‡ii Rb¨)
2| Rb¥ ZvwiL :.......................................................................................
3| wcZvi bvg :.......................................................................................
4| gvZvi bvg :....................................................................................... wnmveavixi
5| ¯^vgx/¯¿xi bvg :....................................................................................... Qwe
6| RvZxqZv :................................................. 7| wj½:..........................
(wnmveavix we‡`kx bvMwiK n‡j wfmvmn cvm‡cv‡U©i Kwc Avewk¨Kfv‡e MÖnY Ki‡Z n‡e)
8| ‡iwm‡W›U ÷¨vUvm (wUK w`b): ‡iwm‡W›U bb-‡iwm‡W›U
(cÖ‡qvRbxq †ÿ‡Î e¨vsK KZ©…K MvBWjvBÝ di d‡ib G·‡PÄ Uªvb‡RKkbm& Gi wb‡`©kbv AbymiY Ki‡Z n‡e)
9| †ckv (we¯ÍvwiZ):.....................................................................................................................
10| gvwmK Avq :.....................................................................................................................
11| A‡_©i Drm (we¯ÍvwiZ): ...........................................................................................................
12| U¨v· AvBwW b¤^i (TIN) (hw` _v‡K) ........................................................................................
13| (K) eZ©gvb wVKvbv : moK/MÖvg:.........................†cv:.........................._vbv:.............................
‡Rjv:...................‡dvb/‡gvevBj b¤^i:. ....................... B‡gBj:......................
(L)¯’vqx wVKvbv: moK /MÖvg:......................†cv:..........................._vbv:...................................
‡Rjv:..............‡dvb/‡gvevBj b¤^i:. ........................B‡gBj:......................................

1 wnmveavix GKvwaK n‡j cÖ‡Z¨‡Ki Ges wnmveavix bvevjK n‡j wnmveavixi AwffveK (evev A_ev gv A_ev Ab¨ †Kv‡bv AvBbMZ AwffveK) Gi
e¨w³ msμvšÍ Z_¨vw` c„_Kfv‡e wØZxq As‡k ev wØZxq As‡ki msjMœx wn‡m‡e hy³ Ki‡Z n‡e|
‡gvU ---- c„ôvi g‡a¨---bs c„ôv
14| cwiwPwZ cÎ: (K) RvZxq cwiPqcÎ b¤^i.....................................................................................
A_ev, (L) cvm‡cvU© b¤^i/ Rb¥ wbeÜb bg¦i/ Ab¨vb¨2 (wbw`©ófv‡e D‡jøL Ki‡Z n‡e):.......................
(M) cwiPq`vbKvixi Z_¨ (RvZxq cwiPqcÎ e¨ZxZ Ab¨vb¨ cwiwPwZcÎ cÖ`v‡bi †ÿ‡Î):
bvg :......................... wnmve/RvZxq cwiPqcÎ b¤^i (Rb¥ ZvwiLmn) :.............................
¯^vÿi(ZvwiLmn):..................................................................................................

| Z…Zxq Ask: bwgwb msμvšÍ Z_¨vw`3 |

wnmve b¤^i:................................
1| bwgwb msμvšÍ Z_¨vejx : (e¨vs‡Ki e¨env‡ii Rb¨)
Avwg/Avgiv G wnmv‡ei A_© Avgvi/Avgv‡`i g„Zy¨i ci wb‡gœ ewY©Z e¨w³/e¨w³MY‡K cÖ`v‡bi Rb¨ g‡bvbxZ
Kijvg| Avwg/Avgiv DwjøwLZ g‡bvbqb †h †Kvb mgq evwZj ev cwieZ©‡bi AwaKvi msiÿY Kwi| Avwg/Avgiv
GB g‡g© Av‡iv m¤§wZ Ávcb KiwQ †h, Avgvi/Avgv‡`i G wb‡`©kbv †gvZv‡eK e¨vsK A_© cÖ`vb Ki‡e Ges A_©
cwi‡kva Kiv n‡j mswkøó AvgvbZ m¤úwK©Z hveZxq `vq cwi‡kva n‡q‡Q e‡j MY¨ n‡e|
K) bwgwbi bvg I Rb¥ ZvwiL : .................................................................. wnmveavix KZ©„K
mZ¨vwqZ
L) wVKvbv : .................................................................................. bwgwbi
M) kZKiv nvi : ................................................................................. Qwe
N) wnmveavixi mv‡_ m¤úK© : ....................................................................
O) RvZxq cwiPqcÎ b¤^i/cvm‡cvU© b¤^i/ Rb¥ wbeÜb bg¦i/ Ab¨vb¨ (wbw`©ófv‡e D‡jøL Ki‡Z n‡e):................
2| bwgwb bvevjK n‡j Zvi/Zv‡`i bvevjK _vKv Ae¯’vq wnmveavix/wnmveavixM‡Yi g„Zy¨i †ÿ‡Î e¨vsK-‡Kv¤úvbx
AvBb, 1991 Gi 103(2) aviv Abyhvqx bwgwbi c‡ÿ Avgvb‡Zi A_© MÖnYKvixi Z_¨:
K) bvg : ..............................................................................................................
L) ¯’vqx wVKvbv : .....................................................................................................
M) RvZxq cwiPqcÎ b¤^i/cvm‡cvU© b¤^i/ Rb¥ wbeÜb bg¦i/ Ab¨vb¨ (wbw`©ófv‡e D‡jøL Ki‡Z n‡e)t.......
N) bwgwbi mv‡_ m¤úK©:.....................................................................................................

| †NvlYv I ¯^vÿi |
Avwg/Avgiv mÁv‡b †NvlYv KiwQ †h, DwjøwLZ Z_¨vw` mZ¨| Avwg/Avgiv e¨vs‡Ki Pvwn`v †gvZv‡eK cÖ‡qvRbxq
Z_¨/`wjjvw` mieivn Kie|
Av‡e`bKvix(MY)4 Gi bvg, ¯^vÿi I ZvwiL

1|.......................................2|...............................3|..........................*| ...............................

| e¨vs‡Ki e¨env‡ii Rb¨ |

gšÍe¨:........................................................................................................................................
......................... .........................
......................... .........................
wnmve †Lvjvi mv‡_ mswkøó Kg©KZ©vi Aby‡gv`bKvix Kg©KZ©vi
bvghy³ mxjmn ¯^vÿi I ZvwiL bvghy³ mxjmn ¯^vÿi I ZvwiL

2 ïaygvÎ dvBb¨vwÝqvj BbK¬zkb ‡cÖvWv‡±i †ÿ‡Î e¨vs‡Ki wbKU MÖnY‡hvM¨ ‡Kv‡bv cwiwPwZcÎ|
3 bwgwb GKvwaK n‡j cÖ‡Z¨‡Ki bwgwb msμvšÍ Z_¨vw` c„_Kfv‡e Z…Zxq As‡k ev Z…Zxq As‡ki msjMœx wn‡m‡e hy³ Ki‡Z n‡e|
4 wnmveavix bvevjK n‡j Av‡e`bKvixi ¯^vÿ‡ii ¯’‡j wnmveavixi AwffveK ¯^vÿi Ki‡eb|
‡gvU ---- c„ôvi g‡a¨---bs c„ôv
 ......................... e¨vsK/e¨vsK wjwg‡UW
....................kvLv
wnmve †Lvjvi dig
cÖvwZôvwbK wnmve
ZvwiL:............................... wnmve b¤^i: ............................
BDwbK AvBwW †KvW: .........................
(e¨vs‡Ki e¨env‡ii Rb¨)
e¨e¯’vcK
--------------e¨vsK/e¨vsK wjwg‡UW
------------- kvLv|
wcÖq g‡nv`q,
Avwg/Avgiv Avcbvi kvLvq GKwU wnmve †Lvjvi Rb¨ Av‡e`b KiwQ| Avgvi/Avgv‡`i, cÖwZôv‡bi Ges wnmv‡ei
we¯ÍvwiZ Z_¨ wb‡gœ cÖ`vb KiwQ:
| cÖ_g Ask: wnmve msμvšÍ Z_¨vw` |
1| wnmv‡ei wk‡ivbvg : (evsjvq).....................................................................................
In English (Block Letter) .......................................................
2| wnmv‡ei cÖK…wZ (wUK w`b) : mÂqx PjwZ GmGbwW Gdwm
BAviwKD Ab¨vb¨.......................................................
3| gy`ªv (wUK w`b) : UvKv Wjvi BD‡iv cvDÛ Ab¨vb¨...................
4| wnmve cwiPvjbv c×wZ (wUK w`b): GKKfv‡e †hŠ_fv‡e Ab¨vb¨ .......................................
5| cÖv_wgK Rgvi cwigvb: (As‡K) ......................................(K_vq) ...............................................

| wØZxq Ask: cÖwZôvb msμvšÍ Z_¨vw` |

1| cÖwZôv‡bi bvg (evsjvq):......................................................................................................

In English (Block Letter) ............................................................................
2| †UªW jvB‡mÝ b¤^i : ....................... ZvwiL: ................... Bmy¨Kvix KZ©„cÿ :...........................
3| wbeÜb b¤^i :.........................ZvwiL: .................... wbeÜb KZ©…cÿ I †`k :...................
wbeÜbK…Z wVKvbv :...........................................................................................................
4| f¨vU †iwR‡÷ªkb b¤^i/BIN :...............................................................................................
5| U¨v· AvBwW b¤^i (TIN) (hw` _v‡K):.......................................................................................
6| e¨emv¯’j/Awd‡mi wVKvbv:....................................................................................................
7| cÖwZôv‡bi aiY (wUK w`b): GKK gvwjKvbv Askx`vix †hŠ_ D‡`¨vM cÖvB‡fU wj: †Kv¤úvbx
cvewjK wj: †Kv¤úvbx Uªv÷ GbwRI/GbwcI K¬ve/†mvmvBwU
wkÿv cÖwZôvb agx©q cÖwZôvb Ab¨vb¨ (wbw`©ófv‡e D‡jøL Kiæb)............
8| e¨emvi aiY t ‡UªwWs †mev Drcv`b Ab¨vb¨
9| e¨emv‡qi cÖK…wZ (we¯ÍvwiZ) t ................................................................................................
10| evwl©K Uvb©Ifvi t...............................................................................................................

‡gvU ---- c„ôvi g‡a¨---bs c„ôv

 | Z…Zxq Ask: e¨w³ msμvšÍ Z_¨vw`1 |
wnmve b¤^i:....................
1| wnmve cwiPvjbvKvixi bvg (evsjvq):...........................................................................
(e¨vs‡Ki e¨env‡ii Rb¨)
In English (Block Letter) ..................................................
2| Rb¥ ZvwiL :.......................................................................................
3| wcZvi bvg :....................................................................................... wnmve
4| gvZvi bvg :....................................................................................... cwiPvjbvKvixi
5| ¯^vgx/¯¿xi bvg :....................................................................................... Qwe
6| RvZxqZv :................................................. 7| wj½:..........................
(wnmve cwiPvjbvKvix we‡`kx bvMwiK n‡j wfmvmn cvm‡cv‡U©i Kwc Avewk¨Kfv‡e MÖnY Ki‡Z n‡e)
8| ‡iwm‡W›U ÷¨vUvm (wUK w`b): ‡iwm‡W›U bb-‡iwm‡W›U
(cÖ‡qvRbxq †ÿ‡Î e¨vsK KZ©…K MvBWjvBÝ di d‡ib G·‡PÄ Uªvb‡RKkbm& Gi wb‡`©kbv AbymiY Ki‡Z n‡e)
9| †ckv (we¯ÍvwiZ):.................................................... cÖwZôv‡bi mv‡_ m¤úK©: ................................
12| U¨v· AvBwW b¤^i (TIN) (hw` _v‡K) ........................................................................................
13| (K) eZ©gvb wVKvbv : moK/MÖvg:.........................†cv:.........................._vbv:............................
‡Rjv:...................‡dvb/‡gvevBj b¤^i:. ....................... B‡gBj:.....................
(L)¯’vqx wVKvbv: moK /MÖvg:......................†cv:..........................._vbv:...................................
‡Rjv:..............‡dvb/‡gvevBj b¤^i:. ........................B‡gBj:......................................
14| cwiwPwZ cÎ: RvZxq cwiPqcÎ b¤^i/cvm‡cvU© b¤^i/ Rb¥ wbeÜb bg¦i:.................................................

| †NvlYv I ¯^vÿi |
Avwg/Avgiv mÁv‡b †NvlYv KiwQ †h, DwjøwLZ Z_¨vw` mZ¨| Avwg/Avgiv e¨vs‡Ki Pvwn`v †gvZv‡eK cÖ‡qvRbxq
Z_¨/`wjjvw` mieivn Kie|
Av‡e`bKvix(MY) Gi bvg, c`ex, ¯^vÿi I ZvwiL

1|.......................................2|...............................3|..........................*| ..............................

| e¨vs‡Ki e¨env‡ii Rb¨ |

gšÍe¨ :.....................................................................................................................................
......................... .........................
......................... .........................
wnmve †Lvjvi mv‡_ mswkøó Kg©KZ©vi Aby‡gv`bKvix Kg©KZ©vi
bvghy³ mxjmn ¯^vÿi I ZvwiL bvghy³ mxjmn ¯^vÿi I ZvwiL

1 wnmve cwiPvjbvKvix GKvwaK n‡j cÖ‡Z¨‡Ki e¨w³ msμvšÍ Z_¨vw` c„_Kfv‡e Z…Zxq As‡k ev Z…Zxq As‡ki msjMœx wn‡m‡e hy³ Ki‡Z n‡e|
‡gvU ---- c„ôvi g‡a¨---bs c„ôv
 ......................... e¨vsK/e¨vsK wjwg‡UW
....................kvLv
wnmve †Lvjvi dig
miKvwi/Avav miKvwi/¯^vqËkvwmZ cÖwZôv‡bi wnmve
ZvwiL:............................... wnmve b¤^i: ............................
BDwbK AvBwW †KvW: ...........................
(e¨vs‡Ki e¨env‡ii Rb¨)
e¨e¯’vcK
--------------e¨vsK/e¨vsK wjwg‡UW
------------- kvLv|
wcÖq g‡nv`q,
Avwg/Avgiv Avcbvi kvLvq GKwU wnmve †Lvjvi Rb¨ Av‡e`b KiwQ| Avgvi/Avgv‡`i, cÖwZôv‡bi Ges wnmv‡ei
we¯ÍvwiZ Z_¨ wb‡gœ cÖ`vb KiwQ:
| cÖ_g Ask: wnmve msμvšÍ Z_¨vw` |
1| wnmv‡ei wk‡ivbvg : (evsjvq).....................................................................................
In English (Block Letter) .......................................................
2| wnmv‡ei cÖK…wZ (wUK w`b) : mÂqx PjwZ GmGbwW Gdwm
Ab¨vb¨..................................
3| gy`ªv (wUK w`b) : UvKv Wjvi BD‡iv cvDÛ Ab¨vb¨....................
4| wnmve cwiPvjbv c×wZ (wUK w`b) GKKfv‡e †hŠ_fv‡e Ab¨vb¨
................................
5| cÖv_wgK Rgvi cwigvb: (As‡K) ......................................(K_vq) ...............................................
| wØZxq Ask: cÖwZôvb msμvšÍ Z_¨vw` |
wnmve b¤^i:....................
1| cÖwZôv‡bi bvg (evsjvq):........................................................................... (e¨vs‡Ki e¨env‡ii Rb¨)
In English (Block Letter) .............................................. ........................
2| cÖwZôv‡bi aiY : ............................................................................................................
3| cÖwZôv‡bi wVKvbv :.............................................................................................................
4| ‡hvMv‡hv‡Mi wVKvbv : ............................................................................................................

| Z…Zxq Ask: e¨w³ msμvšÍ Z_¨vw`1 |

1| wnmve cwiPvjbvKvixi bvg (evsjvq):........................................................................... wnmve b¤^i:....................
In English (Block Letter) .................................................. (e¨vs‡Ki e¨env‡ii Rb¨)
2| Rb¥ ZvwiL :.......................................................................................
3| RvZxqZv :....................................................................................... wnmve
(wnmveavix we‡`kx bvMwiK n‡j wfmvmn cvm‡cv‡U©i Kwc Avewk¨Kfv‡e MÖnY Ki‡Z n‡e)
cwiPvjbvKvixi
4| ‡iwm‡W›U ÷¨vUvm (wUK w`b): ‡iwm‡W›U bb-‡iwm‡W›U
(cÖ‡qvRbxq †ÿ‡Î e¨vsK KZ©…K MvBWjvBÝ di d‡ib G·‡PÄ Uªvb‡RKkbm& Gi wb‡`©kbv AbymiY Ki‡Z n‡e) Qwe
5| †ckv (we¯ÍvwiZ):.....................................................................................
cÖwZôv‡bi mv‡_ m¤úK©: ........................................................

1 wnmve cwiPvjbvKvix GKvwaK n‡j cÖ‡Z¨‡Ki e¨w³ msμvšÍ Z_¨vw` c„_Kfv‡e Z…Zxq As‡k ev Z…Zxq As‡ki msjMœx wn‡m‡e hy³ Ki‡Z n‡e|
‡gvU ---- c„ôvi g‡a¨---bs c„ôv
6| cwiwPwZ cÎ: RvZxq cwiPqcÎ b¤^i/cvm‡cvU© b¤^i/ Rb¥ wbeÜb bg¦i/ Ab¨vb¨ (wbw`©ófv‡e D‡jøL Ki‡Z
n‡e):...........................

7| wVKvbv :..............................................................................................................................
‡dvb/‡gvevBj b¤^i:. ...........................................B‡gBj:..............................................

| †NvlYv I ¯^vÿi |
Avwg/Avgiv mÁv‡b †NvlYv KiwQ †h, DwjøwLZ Z_¨vw` mZ¨| Avwg/Avgiv e¨vs‡Ki Pvwn`v †gvZv‡eK cÖ‡qvRbxq
Z_¨/`wjjvw` mieivn Kie|
Av‡e`bKvix(MY) Gi bvg, c`ex, ¯^vÿi I ZvwiL

1|.......................................2|...............................3|..........................*| ...............................

| e¨vs‡Ki e¨env‡ii Rb¨ |

gšÍe¨ :.......................................................................................................................................
......................... .........................
......................... .........................
wnmve †Lvjvi mv‡_ mswkøó Kg©KZ©vi Aby‡gv`bKvix Kg©KZ©vi
bvghy³ mxjmn ¯^vÿi I ZvwiL bvghy³ mxjmn ¯^vÿi I ZvwiL

‡gvU ---- c„ôvi g‡a¨---bs c„ôv

 ......................... e¨vsK/e¨vsK wjwg‡UW
....................kvLv
wnmve †Lvjvi dig
¯’vqx AvgvbZ/mÂqx w¯‹g/we‡kl w¯‹g wnmve
ZvwiL:............................... wnmve b¤^i: ............................
BDwbK MÖvnK AvBwW †KvW: .....................,,........
(e¨vs‡Ki e¨env‡ii Rb¨)
e¨e¯’vcK
--------------e¨vsK/e¨vsK wjwg‡UW
------------- kvLv|
wcÖq g‡nv`q,
Avwg/Avgiv Avcbvi kvLvq GKwU wnmve †Lvjvi Rb¨ Av‡e`b KiwQ| Avgvi/Avgv‡`i wnmve msμvšÍ I e¨w³MZ we¯ÍvwiZ
Z_¨ wb‡gœ cÖ`vb KiwQ:
| cÖ_g Ask: wnmve msμvšÍ Z_¨vw` |
1| wnmv‡ei wk‡ivbvg : (evsjvq)..........................................................................................................
In English (Block Letter) ......................................................................................................
2| K) ¯’vqx AvgvbZ Gi ‡ÿ‡Î cÖ‡hvR¨:
cwigvb: (As‡K) ......................(K_vq) ..................................................... my`/gybvdvi nvi:..............
†gqv`Kvj: eQi gvm w`b | ‡gqv` c~wZ©i ZvwiL:......................................................................
bevq‡bi †ÿ‡Î: Avmj Ges my` bevqb Kiæb
ïaygvÎ Avmj bevqb Kiæb, my` ...............................b¤^i wnmv‡e Rgv Kiæb
cÖ‡hvR¨ b‡n|
L) mÂqx w¯‹g/we‡kl w¯‹g Gi ‡ÿ‡Î cÖ‡hvR¨:
w¯‹‡gi bvg:............................................................................ w¯‹‡gi †gqv`:.....................................

MÖvnK KZ…©K cÖ‡`q wKw¯Íi wd«‡Kv‡qwÝ:.......................wKw¯Íi msL¨v:............................................................

wKw¯Íi cwigvY: (As‡K) ......................(K_vq) ...................................................................................
†gqv`v‡šÍ e¨vsK KZ…©K cÖ‡`q: (As‡K) ......................(K_vq) ..................................................................

GKKvjxb Rgv: (As‡K) ......................(K_vq) ...................................................................................

cwi‡kv‡ai wd«‡Kv‡qwÝ:....................... cwi‡kva¨ wKw¯Íi msL¨v:....................... .........................................
e¨vsK KZ…©K cÖwZ wKw¯Í‡Z cÖ‡`q: (As‡K) ......................(K_vq) ..............................................................
3| wnmve cwiPvjbv c×wZ (wUK w`b): GKKfv‡e †hŠ_fv‡e ‡h †Kvb GKRb
‡h †Kvb GKRb A_ev RxweZRb Ab¨vb¨ ...............................

| wØZxq Ask: cÖwZôvb msμvšÍ Z_¨vw` |

1| cÖwZôv‡bi bvg (evsjvq):...............................................................................................................

In English (Block Letter) ...................................................................................
2| †UªW jvB‡mÝ b¤^i : ....................... ZvwiL: ................... Bmy¨Kvix KZ©„cÿ :...........................
3| wbeÜb b¤^i :.........................ZvwiL: .................... wbeÜb KZ©…cÿ I †`k :.............................
wbeÜbK…Z wVKvbv :....................................................................................................................
4| f¨vU †iwR‡÷ªkb b¤^i/BIN :.........................................................................................................
5| U¨v· AvBwW b¤^i (TIN) (hw` _v‡K):...............................................................................................
6| e¨emv¯’j/Awd‡mi wVKvbv:..............................................................................................................
‡gvU ---- c„ôvi g‡a¨---bs c„ôv
7| cÖwZôv‡bi aiY (wUK w`b): GKK gvwjKvbv Askx`vix †hŠ_ D‡`¨vM cÖvB‡fU wj: †Kv¤úvbx
cvewjK wj: †Kv¤úvbx Uªv÷ GbwRI/GbwcI K¬ve/†mvmvBwU
wkÿv cÖwZôvb agx©q cÖwZôvb Ab¨vb¨ (wbw`©ófv‡e D‡jøL Kiæb)..........
8| e¨emvi aiY t ‡UªwWs †mev Drcv`b Ab¨vb¨ (wbw`©ófv‡e D‡jøL Kiæb).........................
9| e¨emv‡qi cÖK…wZ (we¯ÍvwiZ) t ...........................................................................................................
10| evwl©K Uvb©Ifvi t.........................................................................................................................

| Z…Zxq Ask: e¨w³ msμvšÍ Z_¨vw`1 |

1| wnmveavixi /cwiPvjbvKvixi bvg (evsjvq):....................................................... wnmve b¤^i:....................
In English (Block Letter) .................................................. (e¨vs‡Ki e¨env‡ii Rb¨)
2| Rb¥ ZvwiL :.......................................................................................
3| wcZvi bvg :.......................................................................................
4| gvZvi bvg :....................................................................................... wnmveavixi
5| ¯^vgx/¯¿xi bvg :........................................................................................ Qwe
6| RvZxqZv :.........................................7| wj½:....................................
(wnmveavix we‡`kx bvMwiK n‡j wfmvmn cvm‡cv‡U©i Kwc Avewk¨Kfv‡e MÖnY Ki‡Z n‡e)
8| ‡iwm‡W›U ÷¨vUvm (wUK w`b): ‡iwm‡W›U bb-‡iwm‡W›U
(cÖ‡qvRbxq †ÿ‡Î e¨vsK KZ©…K MvBWjvBÝ di d‡ib G·‡PÄ Uªvb‡RKkbm& Gi wb‡`©kbv AbymiY Ki‡Z n‡e)
9| †ckv (we¯ÍvwiZ):.....................................................................................................................
10| gvwmK Avq :......................................................................................................................
11| A‡_©i Drm (we¯ÍvwiZ): ...........................................................................................................
12| U¨v· AvBwW b¤^i (TIN) (hw` _v‡K) .........................................................................................
13| (K) eZ©gvb wVKvbv : moK/MÖvg:.......................†cv:......................._vbv:...................................
‡Rjv:.......................‡dvb/‡gvevBj b¤^i:. ......................... B‡gBj:........................................
(L) ¯’vqx wVKvbv: moK /MÖvg:...........................†cv:......................_vbv:....................................
‡Rjv:......................‡dvb/‡gvevBj b¤^i:. ........................B‡gBj:.................................
14| cwiwPwZ cÎ:(K) RvZxq cwiPqcÎ b¤^i/ cvm‡cvU© b¤^i/ Rb¥ wbeÜb bg¦i/:.....................................
15| cwiPq`vbKvixi Z_¨ (RvZxq cwiPqcÎ e¨ZxZ Ab¨vb¨ cwiwPwZcÎ cÖ`v‡bi †ÿ‡Î):
(K) bvg:........................(L) wnmve/RvZxqcwiPqcÎ b¤^i(Rb¥ ZvwiLmn):............................................
¯^vÿi (ZvwiLmn):.......................................................................................................................
16| wnmveavix bvevjK n‡j :
Avwg wbgœewY©Z wnmveavixi ˆea AwffveK wn‡m‡e GB g‡g© †NvlYv KiwQ †h, wnmveavix bvevjK| Zvi cÖ‡qvRbxq
Z_¨ mshy³ di‡g cÖ`vb Kiv n‡jv| wnmveavix mvevjK bv nIqv ch©šÍ wKsev Avgvi cieZx© †NvlYv bv †`qv ch©šÍ
AwffveK wnmv‡e wnmvewU Avgvi ¯^vÿ‡i cwiPvwjZ n‡e|(AwffveK ej‡Z evev A_ev gv A_ev Df‡qi AeZ©gv‡b Ab¨
†Kvb AvBbMZ AwffveK‡K eySv‡e)
(K) Awffve‡Ki bvg :......................................................bvevj‡Ki mv‡_ m¤úK© :..................................

1 wnmveavix GKvwaK n‡j cÖ‡Z¨‡Ki Ges wnmveavix bvevjK n‡j wnmveavixi AwffveK (evev A_ev gv A_ev Ab¨ †Kv‡bv AvBbMZ AwffveK) Gi
e¨w³ msμvšÍ Z_¨vw` c„_Kfv‡e Z…Zxq As‡k ev Z…Zxq As‡ki msjMœx wn‡m‡e hy³ Ki‡Z n‡e|
‡gvU ---- c„ôvi g‡a¨---bs c„ôv
 | PZz_© Ask: bwgwb msμvšÍ Z_¨vw`2 |
wnmve b¤^i:................................
1| bwgwb msμvšÍ Z_¨vejx: (e¨vs‡Ki e¨env‡ii Rb¨)
Avwg/Avgiv G wnmv‡ei A_© Avgvi/Avgv‡`i g„Zy¨i ci wb‡gœ ewY©Z e¨w³/e¨w³MY‡K cÖ`v‡bi wnmveavix KZ©„K
Rb¨ g‡bvbxZ Kijvg| Avwg/Avgiv DwjøwLZ g‡bvbqb †h †Kvb mgq evwZj ev cwieZ©‡bi AwaKvi mZ¨vwqZ
msiÿY Kwi| Avwg/Avgiv GB g‡g© Av‡iv m¤§wZ Ávcb KiwQ †h, Avgvi/Avgv‡`i G wb‡`©kbv †gvZv‡eK bwgwbi
e¨vsK A_© cÖ`vb Ki‡e Ges A_© cwi‡kva Kiv n‡j mswkøó AvgvbZ m¤úwK©Z hveZxq `vq cwi‡kva n‡q‡Q Qwe
e‡j MY¨ n‡e|
K) bwgwbi bvg I Rb¥ ZvwiL : .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ....... .. .
L) wVKvbv : .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..........
M) kZKiv nvi : .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. . .. .........
N) wnmveavixi mv‡_ m¤úK© : .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ...... ..
O) RvZxq cwiPqcÎ b¤^i/cvm‡cvU© b¤^i/ Rb¥ wbeÜb bg¦i/ Ab¨vb¨ (wbw`©ófv‡e D‡jøL Ki‡Z n‡e):.................
2| bwgwb bvevjK n‡j Zvi/Zv‡`i bvevjK _vKv Ae¯’vq wnmveavix/wnmveavixM‡Yi g„Zy¨i †ÿ‡Î e¨vsK-‡Kv¤úvbx AvBb,
1991 Gi 103(2) aviv Abyhvqx bwgwbi c‡ÿ Avgvb‡Zi A_© MÖnYKvixi Z_¨:
K) bvg : .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .................... ..
L) ¯’vqx wVKvbv : .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ........... ..
M) RvZxq cwiPqcÎ b¤^i/cvm‡cvU© b¤^i/ Rb¥ wbeÜb bg¦i/ Ab¨vb¨ (wbw`©ófv‡e D‡jøL Ki‡Z n‡e):...........
N) bwgwbi mv‡_ m¤úK©:..........................................................................................................
| †NvlYv I ¯^vÿi |
Avwg/Avgiv mÁv‡b †NvlYv KiwQ †h, DwjøwLZ Z_¨vw` mZ¨| Avwg/Avgiv e¨vs‡Ki Pvwn`v †gvZv‡eK cÖ‡qvRbxq Z_¨/`wjjvw`
mieivn Kie|
Av‡e`bKvix(MY)3 Gi bvg, ¯^vÿi I ZvwiL

1|.......................................2|...............................3|..........................*| ............................

| e¨vs‡Ki e¨env‡ii Rb¨ |

gšÍe¨ :.....................................................................................................................................
......................... .........................
......................... .........................
wnmve †Lvjvi mv‡_ mswkøó Kg©KZ©vi Aby‡gv`bKvix Kg©KZ©vi
bvghy³ mxjmn ¯^vÿi I ZvwiL bvghy³ mxjmn ¯^vÿi I ZvwiL

2 bwgwb GKvwaK n‡j cÖ‡Z¨‡Ki bwgwb msμvšÍ Z_¨vw` PZz_© As‡k ev PZz_© As‡ki msjMœx wn‡m‡e hy³ Ki‡Z n‡e|
3 wnmveavix bvevjK n‡j Av‡e`bKvixi ¯^vÿ‡ii ¯’‡j wnmveavixi AwffveK ¯^vÿi Ki‡eb|
‡gvU ---- c„ôvi g‡a¨---bs c„ôv
 e¨vsKmg~‡n wnmve †Lvjvi dig I †KIqvBwm †cÖvdvBj Gi wel‡q mvaviY wb‡`©kbv
1. Ôe¨w³Õ ej‡Z cÖvK…wZK e¨w³ eySv‡e|
2. di‡gi cÖwZ c„ôvq e¨vs‡Ki mswkøó Kg©KZ©vM‡Yi ¯^vÿi/Aby¯^vÿi _vK‡Z n‡e|
3. di‡gi cÖwZwU Ask c~iY Ki‡Z n‡e| †Kvb As‡ki Z_¨ bv _vK‡j ev cÖ‡hvR¨ bv n‡j Zv D‡jøL Ki‡Z n‡e|
4. cÖvwZôvwbK wnmv‡ei †ÿ‡Î, wfbœiƒc wb‡`©kbv bv _vK‡j, †UªW jvB‡mÝ MÖnY Ki‡Z n‡e|
5. cvU©bviwkc cÖwZôv‡bi wnmv‡ei †ÿ‡Î cvU©bviwkc wWW MÖnY Ki‡Z n‡e|
6. †Kv¤úvwbi wnmv‡ei †ÿ‡Î mvwU©wd‡KU Ae BbK‡c©v‡ikb, AvwU©‡Kjm Ae G‡mvwm‡qkb, †g‡gv‡iÛvg Ae
G‡mvwm‡qkb, †ev‡W©i mfvq M„nxZ AvbyôvwbK wm×všÍ (resolution), cwiPvjK m¤úwK©Z †NvlYv MÖnY Ki‡Z
n‡e| GQvov, †Kv¤úvwbi m‡e©v”P †kqviavix by¨bZg 5 Rb cwiPvjK ev †hme †ÿ‡Î 5 R‡bi Kg †m‡ÿ‡Î
mK‡ji/Ab¨vb¨ cÖ‡hvR¨ †ÿ‡Î wbe©vnx KwgwUi m`m¨M‡Yi e¨w³ msμvšÍ Z_¨ msMÖn Ki‡Z n‡e| (†Kv¤úvwb ev
Zvi cwiPvjKM‡Yi wel‡q cÖ‡qvR‡b Z_¨vw`i mwVKZv hvPvB‡qi j‡ÿ¨ †iwR÷ªvi Ae R‡q›U ÷K †Kv¤úvwbR
GÛ dvg©m& Gi mvnvh¨ MÖnY Kiv †h‡Z cv‡i| evsjv‡`‡ki evB‡i wbewÜZ †Kv¤úvwbi †ÿ‡Î wbeÜb `wjjvw`
†h ¯’vb n‡Z Bmy¨K…Z n‡q‡Q, cÖ‡qvR‡b ‡mLv‡b †hvMv‡hvM K‡i `wjjvw`i h_v_©Zv m¤ú‡K© wbwðZ nIqv ‡h‡Z
cv‡i)|
7. miKvwi/Avav miKvwi/¯^vqËkvwmZ cÖwZôv‡bi ev Zv‡`i Aax‡b cwiPvwjZ cÖK‡íi wnmve †Lvjv I cwiPvjbvi
Rb¨ mswkøó Dchy³ KZ©„cÿ KZ©„K cÖ`Ë AbygwZcÎmn wnmve cwiPvjbvKvixi Òe¨w³ msμvšÍ Z_¨vw`Ó
h_vh_fv‡e c~iY Ki‡Z n‡e|
8. K¬ve/†mvmvBwUi wnmv‡ei †ÿ‡Î cwiPvjbv cl©`, evB-jR ev msweavb, wnmve †Lvjvi †iRjy¨kb, †iwR÷vW©
n‡j miKvix Aby‡gv`bcÎ BZ¨vw`mn mswkøó mfvcwZ, m¤úv`K, †Kvlva¨ÿ I Ab¨vb¨ wnmve cwiPvjbvKvixi
Òe¨w³ msμvšÍ Z_¨vw`Ó h_vh_fv‡e c~iY Ki‡Z n‡e|
9. mgevq mwgwZ/wjwg‡UW †mvmvBwUi wnmv‡ei †ÿ‡Î †Kv-Acv‡iwUf Kg©KZ©v KZ©„K mZ¨vwqZ evB-jR, Awdm
Kg©KZ©v‡`i (office  bearers) weeiY, wnmve ‡Lvjvi wel‡q wm×všÍ (resolution), mvwU©wd‡KU Ae
†iwR‡÷ªkb BZ¨vw`mn mswkøó wnmve cwiPvjbvKvixi wel‡q Òe¨w³ msμvšÍ Z_¨vw`Ó h_vh_fv‡e c~iY Ki‡Z
n‡e|
10. ‡emiKvix ¯‹zj, K‡jR, gv`ªvmvi wnmv‡ei †ÿ‡Î Mfwb©s ewW ev g¨v‡bwRs KwgwUi m`m¨M‡Yi c~Y© cwiwPwZ,
wnmve ‡Lvjvi wel‡q wm×všÍ (resolution) BZ¨vw`mn mswkøó wnmve cwiPvjbvKvixi wel‡q Òe¨w³ msμvšÍ
Z_¨vw`Ó h_vh_fv‡e c~iY Ki‡Z n‡e|
11. Uªv÷ wnmv‡ei †ÿ‡Î wWW Ae Uªv÷ Gi mvwU©dvBW Kwc, Uªvw÷ †evW© Gi m`m¨M‡Yi c~Y© cwiwPwZ, wnmve
‡Lvjvi wel‡q wm×všÍ (resolution) BZ¨vw`mn mswkøó wnmve cwiPvjbvKvixi wel‡q Òe¨w³ msμvšÍ
Z_¨vejxÓ h_vh_fv‡e c~iY Ki‡Z n‡e|