Rb¥ Z_¨ ms‡kva‡bi Av‡e`b

cÖKí cwiPvjK
Rb¥ I g„Zz¨ wbeÜb cÖKí
¯’vbxq miKvi wefvM
cwienb cyj feb (K¶ bs 908-9)
mwPevjq wjsK †ivW, XvKv-1000|

welq: cvm‡cvU©/wkÿvMZ mb`/RvZxq cwiPqcÎ Gi wfwˇZ Rb¥ wbeÜb Z_¨ ms‡kva‡bi Av‡e`b |
Rbve,
Avgvi cvm‡cvU©/wkÿvMZ mb`/RvZxq cwiPqcÎ Gi mv‡_ Rb¥ wbeÜb mb‡`i Rb¥ Zvwi‡L Mowgj n‡q‡Q|
Avgvi fwel¨r Rxeb wbwe©Nœ Kivi Rb¨ Rb¥ wbeÜb mb`wUi ms‡kvab cÖ‡qvRb| GZ`&m‡½ Avgvi Rb¥ wbeÜb mb‡`i g~jKwc I
cvm‡cvU©/wkÿvMZ mb`/RvZxq cwiPqcÎ Gi Abywjwc mshy³ K‡i wb‡¤œ cª‡qvRbxq Z_¨vw` †`qv n‡jv t
Rb¥ wbeÜb b¤^i :
wbe܇bi ZvwiL : .........../............. /................wLªt
mb` cÖ`v‡bi ZvwiL : .........../............. /................wLªt
weeiY †hwU ms‡kvab cÖ‡qvRb †Kej †mB ms‡kvwaZ Z_¨ mshy³ `wjjvw`i weeiY
Z‡_¨i wecix‡Z wjLyb
bvg (evsjv)
(Bs‡iwR)
wcZvi bvg
gvZvi bvg
Rb¥ ZvwiL
Rb¥ ¯’vb

‡NvlYv: Avwg ¯^Áv‡b †NvlYv KiwQ †h Dc‡iv³ Z_¨/Z_¨vejx mZ¨| †Kvb Z_¨ AmZ¨ cÖgvwYZ n‡j Avwg AvBbMZ †h
†Kvb kvw¯Í ‡g‡b wb‡Z eva¨ _vKe|

msjMœx :................... cvZv|

wbeÜK Kvh©vj‡qi gšÍe¨:

Avcbvi wek¦¯Í
1| fzj Z_¨ Gw›Uªi KviY :
¯^vÿi:
bvg:.........................................
A_ivBRW cvim‡bi ¯^vÿi
bvgmn wmj I †dvb b¤^i wVKvbv:.....................................
2| Av‡e`bKvixi Av‡e`‡bi Dci gZvgZ: ..............................................
..............................................
†gvevBj b¤^i:
wbe܇Ki ¯^vÿi
bvgmn wmj I †dvb b¤^i

3| †Rjv cÖkvmK/DccwiPvjK, ¯’vbxq miKvi/ Dc‡Rjv wbe©vnx Awdmv‡ii mycwikt

†Rjv cÖkvmK/DccwiPvjK, ¯’vbxq miKvi/Dc‡Rjv wbe©vnx Awdmv‡ii ¯^vÿi

bvgmn wmj I †dvb b¤^i

wet `ªt g~j Av‡e`bmn 1, 2 I 3 bs Kjvg h_vh_fv‡e c~iY bv Ki‡j Av‡e`bwU we‡ePbv Kiv n‡e bv|