wbe©vnx cÖ‡KŠkjx

‡emvgwiK wegvb PjvPj KZ©…c¶

welqt cÖwZôvb/wkí cÖwZôv‡bi M¨vm ms‡hvM/ M¨vm ms‡hvM m¤§wZ c‡Îi Rb¨
Av‡e`b|

Rbve,

D‡jwLZ wel‡q wbgœ ¯^v¶iKvix ......................................................... cjx we`y¨r

mwgwZ ......................... Gi hveZxq wewae× wbqg cÖwZcvjb I mwgwZi cªwZ wbw`©ó M¨vm
ms‡hvM Pzw³cÎ ¯^v¶i Kwi‡Z m¤§Z nBqv wbgœewY©Z Z_¨vw` AewnZ Kib c~e©K we`y¨r
ms‡hv‡Mi Rb¨ AvMÖnx|
GgZve¯’vq ewY©Z cÖwZôvb/wkí cÖwZôv‡b M¨vm ms‡hvM / M¨vm ms‡hvM cÖvwßi m¤§wZ cÎ
cÖ`vb Kivi Rb¨ Aby‡iva Rvbvw”Q|

cÖ¯—vweZ cÖwZôvb/ wkí m¤úwK©Z Z_¨vw`

01| Av‡e`bKvixi bvg (cÖavb Kg©KZ©v) t

Rb¥ ZvwiL
02| Av‡e`bK…Z cÖwZôv‡bi bvg t

03| wcZv ev ¯^vgxi bvg (cÖ‡hvR¨ nB‡j) t

04| Av‡e`bKvixi wVKvbv (K) ¯’vqx t

(L) eZ©gvb t

05| cÖ¯—vweZ M¨vm ms‡hvM ¯’‡ji eY©bv t

(K) m¤úwËi AvBbMZ gvwj‡Ki bvg t

(L) Dc‡Rjv t ................................................ (M) BDwbqb

t ......................................................

(N) MÖvg t .................................................. (O) †gŠRv t ....................................................

(P)`vM bs t ................................................... (Q) LwZqvb bs t ..............................................

(R) we`y¨r jvB‡bi wbKUeZ©x LyuwU nB‡Z
`~iZ¡ t. .....................................................................................

6| cÖ¯—vweZ ms‡hv‡Mi aib

t ...........................................................................

7| Av‡e`b c‡Îi cÖK…wZ

t .............................................................................

t K) ¯’vqx ms‡hv‡Mi Rb¨/(L) mvgwqK ms‡hv‡Mi

Rb¨/
M) we`y¨r ms‡hvM welqK m¤§wZ c‡Îi Rb¨
8| Pvwn`vK…Z †jvW
(K) ¯’vqx ms‡hvM †jvW Pvwn`v ............................. wKt It/†KwfG ......................
†dR ........................ †fvë
(L) mvgwqK ms‡hvM †jvW ................................wKt It/†KwfG ......................
†dR ........................ †fvë

†h Zvwi‡L ms‡hvM cÖ‡qvRb .......................................... ¯’vwqZ¡ ......................................

gvm|

9| cÖwZôv‡bi AvBbMZ cÖK…wZ t e¨w³ gvwjKvbv/ cÖvB‡fU wjt †Kvs/ cvewjK wjt †Kvs
 mgevq/Avav-miKvix/ miKvix/ ¯^vqZ¡kvwmZ|

10| we`y¨r ms‡hvM RwbZ Pzw³i e¨vcvi

AvBbvbyM fvicÖvß Kg©KZ©vi bvg I c`ext

11| Ab¨ †Kvb Z_¨ cÖ`vb Kwi‡Z Pvwn‡j t

ZvwiLt .................................. Av‡e`bKvixi ¯^v¶i I c`ex

(Aci c„ôvq `ªóe¨)

wb‡gœi Z_¨vw` Awdm KZ©©„K c~iYxq

1| cÖv_wgK wi‡cv©U (m`m¨ †mev wefvM KZ©„K) t

(m‡e©v”P 7 w`‡bi g‡a¨)

2| †ówKs mx‡Ui myÎmn civgk©`vZv cÖ‡KŠkjxi gš—e¨ t

(m‡e©v”P 7 w`‡bi g‡a¨)

3| G, wR, Gg (BwÄwbqvwis/ wbci) cÖKí wefv‡Mi gš—e¨ t

(jvBb wbg©v‡bi ZvwiL)

4| wbe©vnx cÖ‡KŠkjx (wmwfj wWwfkb) t

.........................................
wbe©vnx cÖ‡KŠkjx
‡emvgwiK wegvb PjvPj
KZ©…c¶