Awqm prgws soSl vYl&yAr kONsl

qoN sihXog pRwpq krn leI sihmqI p`qr

qsdIk kIqw jWdw hY ik swfy pirvwr dy mYNbr ……………………………… spu`qr/spu`qrI
…………………………………, jnm imqI………………… (Poto n`QI) BwrqI ikswn AMdoln
dOrwn dySvwsIAW dy h`kW dI rwKI leI SWqmeI sMGrS iv`c syvwvW inBwauNdy hoey imqI ……………
ƒ ……………………… sQwn au~pr ……………………………… kwrn ShIdI pRwpq kr
gey sn[AsIN Akwl purK vwihgurU jI dw Sukrwnw krdy hW ijnHW ny ies smyN Awqm prgws soSl
vYl&yAr kONsl dI tIm ƒ swfy pirvwr dIAW muFlIAW loVW pUrIAW krn leI XQwSkq sihXog
krn dI pRyrnw dy ky swfy kol ByijAw hY[swƒ smJ hY ik Awqm prgws koeI srkwrI jW isAwsI
sMsQw nhIN hY Aqy isr& mnu`Kqw dI syvw dI Bwvnw nwl swfw du`K vMfwaux dI koiSS kr rhI
hY[Awqm prgws soSl vYl&yAr kONsl v`loN swfy pirvwr dIAW m`uFlIAW zrUrqW pUrIAW krn leI
loVINdw sihXog pRwpq krn leI AsIN sihmqI idMdy hW[AsIN Brosw idvwauNdy hW ik swfy pirvwr ƒ
iksy vI hor s`jx/ srkwr/ sMsQw v`loN iml cu`ky jW Biv`K iv`c imlx vwly sihXog Aqy swfy pirvwr
dIAW bwkI loVW dI TIk jwxkwrI pRdwn krWgy[swfy pirvwr dIAW loVW sMbMDI sMgqW ƒ jwxU
krvwaux leI swfy nwl hoeI g`lbwq dI vIfIE jW ^br pRkwiSq/pRswirq krn leI AsIN Awqm
prgws soSl vYl&yAr kONsl ƒ AwigAw idMdy hW[swfy pirvwr dI Awmdn Aqy hor loVW dI
jwxkwrI nwl n`QI hY jI[

hsqw^r……………………

nwm…………………… spu`qr/spu`qrI………………… ShId nwl irSqw…………………

mkwn nMbr/glI……………………………… ipMf/ksbw/Sihr………………………………
fwkKwnw……………………………… izlHw…………………………………………………
styt……………………… ipMn kof…………………………………………………………
Pon nMbr:…………………… eI myl:…………………… vtsAYp nMbr:…………………
tYlIgrwm nMbr:…………………… ADwr kwrf nMbr:……………………(Poto kwpI n`QI hY)
qsdIk kIqw jWdw hY ik n`QI jwxkwrI dru`sq hY

1. srpMc/ kONslr dw nwm:………………………hsqw^r (mohr smyq)…………………

Pon nMbr:…………………………………… pqw:……………………………………
2. koeI vI hor ngr invwsI dw nwm: ………………………hsqw^r…………………
Pon nMbr:…………………… pqw:……………………………………………………
3. koAwrfInytr dw nwm:……………………………………………………………………
hsqw^r……………… Pon nMbr:………………………………………………………
 pirvwr dI jwxkwrI Aqy loVW

1. pirvwr dI Awmdn dw vsIlw Aqy KyqI ADIn rkbw:

2. pirvwr dI hor c`l Ac`l zwiedwd (v`fy KyqIbwVI sMdW smyq):

3. ShId hoey pirvwirk mYNbr dw ik`qw (Ahudw Aqy sMsQw) Aqy jIvn bImy sMbMDI jwxkwrI:

4. kI pirvwr ny ‘AwXUSmwn pirvwr ishq bImw Xojnw’ krvw leI hY:

5. pirvwr iv`c p`ky KyqI mzdUrW dI igxqI:
6. pirvwr dI swlwnw Awmdn:

7. pirvwr dIAW mu`FlIAW loVW pUrIAW krn leI loVINdI mwisk mwiek shwieqw:

8. mwisk loVINdI mwiek shwieqw dw ivsQwr:

9. pirvwr dIAW mu`FlIAW loVW pUrIAw krn leI ie`k vwr loVINdI mwiek shwieqw:
10. jy mwiek shwieqw dI loV hovy qW pirvwr v`loN pUMjI invyS dI jwxkwrI:

11. ie`k vwr loVINdI mwiek shwieqw dw ivsQwr:

12. pirvwr dy iksy mYNbr ƒ iksy iBAwnk ibmwrI leI ielwz leI jW koeI hor ivSyS loV:

13. iksy hor s`jx/srkwr/sMsQw v`loN pRwpq hoieAw sihXog jW ies sMbMDI koeI sMprk/pRgqI:

14. KyqIbwVI mwihr dI loV (hW jI/nhIN jI):

auprokq jwxkwrI iblkul drusq hY[auprokq qoN ibnW swƒ jdoN vIN iksy vI s`jx/ srkwr/ sMsQw pwsoN
koeI sihXog pRwpq hoieAw qW AsIN ies sMbMDI TIk jwxkwrI Awqm prgws soSl vYl&yAr kOsl ƒ
qurMq dyx leI pwbMd hovWgy[

hsqw^r…………………… nwm……………………… spu`qr/rI…………………………

hsqw^r srpMc/ kONslr hsqw^r ngr invwsI hsqw^r koAwrfInytr

 pirvwirk mYNbrW dI jwxkwrI
jwxkwrI mYNbr 1 mYNbr 2 mYNbr 3 mYNbr 4

nwm

Pon nMbr
ShId nwl irSqw
ilMg
irhwieS pqw

jnm imqI
jmwq/ik`qw

skUl/d&qr

ishq / jIvn bImw (bImy dw nwm

Aqy rkm)

AiDAwpk dI loV
(ivSy dw nwm ilKo)

ausqwd dI loV (hW jI/nhIN jI)

pwizitv iQMkr rijstrySn (jy

AiDAwpk/ausqwd dI loV hY qW)
srkwr v`loN nOkrI leI sihXog
(ArjI id`qI/nOkrI iml geI, jy
hW qW Ahudw Aqy ivBwg)
(pirvwr dy muKI dw nwm it`k kro jI[ShId ikswn dI Poto, pirvwr dI Poto, Gr dI Poto Aqy pirvwr nwl ieMtrivaU dI vIfIE nwl Byjo jI)

hsqw^r srpMc/kONslr………………………… hsqw^r ngr invwsI………………………………… hsqw^r koAwrfInytr…………………………

 pirvwirk mYNbrW dI jwxkwrI
jwxkwrI mYNbr …… mYNbr …… mYNbr …… mYNbr ……

nwm

Pon nMbr
ShId nwl irSqw
ilMg
irhwieS pqw

jnm imqI
jmwq/ik`qw

skUl/d&qr

AiDAwpk dI loV
(ivSy dw nwm ilKo)

ausqwd dI loV (hW jI/nhIN jI)

pwizitv iQMkr rijstrySn (jy

AiDAwpk/ausqwd dI loV hY qW)
srkwr v`loN nOkrI leI sihXog
(ArjI id`qI/nOkrI iml geI, jy
hW qW Ahudw Aqy ivBwg)
(pirvwr dy muKI dw nwm it`k kro jI[ShId ikswn dI Poto, pirvwr dI Poto, Gr dI Poto Aqy pirvwr nwl ieMtrivaU dI vIfIE nwl Byjo jI)

hsqw^r srpMc/kONslr………………………… hsqw^r ngr invwsI……………………………… hsqw^r koAwrfInytr………………………

 kmytI dI is&wrS
is&wrS: purzor is&wrS / is&wrS / sihXog dI loV nhIN
is&wrS dw sivsQwr kwrn:

Shwdq snmwn icMn dI is&wrS (hW jI/ nhIN jI): …………………………………………

is&wrS dw sivsQwr kwrn:

mwisk iv`qI sihXog dI is&wrS:…………………………………………………………

mwisk iv`qI sihXog dw ivsQwr:

ie`k vwr iv`qI sihXog dI is&wrS:………………………………………………………

ie`k vwr iv`qI sihXog dw ivsQwr:

ivSyS kQn:

koAwrfInytr dw nwm:………………………………………… Pon nMbr:……………………………

pirvwr nwl pihlI imlxI dI imqI:…………………………………………………………………
is&wrS krqw:
nwm ik`qw/Ahudw Aqy d&qr Pon nMbr eImyl hsqw^r
dw nwm Aqy pqw
 bynqI p`qr
syvw ivKy

cyArmYn
Awqm prgws soSl vYl&yAr kONsl
luiDAwxw

ivSw: iv`qI sihXog leI bynqI p`qr

bynqI hY ik mYN AwpxI Awmdn nwl pirvwr dIAW muFlIAW loVW pUrIAW krn qoN Asmr`Q hW[myry
bYNk Kwqy dIAW ipCly Cy mhIny dIAW pws bu`kW dw auqwrw n`QI hY, n`QI vyrvy qoN ibnw myrw hor koeI
bYNk Kwqw nhIN hY[swfy pirvwr dy pwlx poSx leI loVINdy iv`qI sihXog dI ivsQwirq jwxkwrI mYN
drz krvw id`qI hY[swfy pirvwr leI ieh iv`qI sihXog hyT ilKy bYNk Kwqy iv`c jmHW krvwaux dI
ikrpwlqw krnI jI[AsIN ivSvwS idvwauNdy hW ik swfy pirvwr ƒ jy iksy vI hor sMsQw/ivAkqI jW
srkwr v`loN koeI iv`qI sihXog imilAw qW aus dI qurMq jwxkwrI Awqm prgws soSl vYl&yAr
kONsl dy d&qr ƒ dyx leI zMumyvwr hovWgy[

Name of Account Holder: ……………………………………………………………………

Bank Account Number: ………………………………………………………………………

Bank: …………………………………………………………………………………………

Name of Branch: ……………………………………………………………………………...

IFSC: …………………………….……………………………………………………………

hsqw^r …………………… nwm ……………………… spu`qr/rI……………………………

mkwn nMbr/glI…………………………… ipMf/ksbw/Sihr……………………………………

fwkKwnw……………………………… izlHw……………………………………………………

styt……………………… ipMn kof……………………………………………………………

Akwl clwxw kr gey ikswn dw nwm: …………………………………… irSqw………………

pqw………………………………………………………………………………………………

hsqw^r koAwrfInytr……………………………… nwm…………………………………………

&on nMbr………………………………
 rsId
qsdIk kIqw jWdw hY ik mYN AwpxI Awmdn nwl pirvwr dIAW loVW pUrIAW krn qoN Asmr`Q

hW[Awpxy pirvwr dI prvirS/ ielwz/ b`icAW dI pVHweI Awid leI mYN Awqm prgws soSl vYl&yAr

kONsl v`loN imqI _________ ƒ Awpxy bYNk Kwqy nMbr___________________________,

_________________________ bYNk iv`c ______________________________ rupey

DMnvwd sihq pRwpq kr ley hn[

sihXog pRwpq krqw dy hsqw^r………………………… nwm……………………………………

spu`qr/rI……………………………………… &on nMbr…………………………………………

pqw…………………………………………………………………………………………………

Akwl clwxw kr gey ikswn dw nwm………………………………………… irSqw………………

pqw…………………………………………………………………………………………………
 pirvwirk srvyKx – cY~kilst:
1. pirvwirk srvyKx &wrm

2. Akwl clwxw kr gey mYNbr dI Poto

3. smu`cy pirvwr dI nvIN (hwl hI iv`c iK`cI) Poto

4. pirvwr dy Gr dIAW PotoAW

5. Awqm prgws tIm dI pirvwr ƒ imlx smyN dy Poto

6. pirvwr dI BUgoilk siQqI

7. bynqI p`qr

8. pirvwr dy muKI dy ADwr kwrf dI PotokwpI

9. pirvwr dy swry mYNbrW dy bYNk KwiqAW dI ipCLy Cy mhIinAW dI pwsbu`k dI PotokwpI

10. pirvwr dy swry mYNbrW dy nwm dI c`l-Ac`l zwiedwd Aqy pUMjI invyS dI jwxkwrI

11. Akwl clwxw kr gey mYNbr Aqy bwkI mYNbrW dy jIvn/ishq bImw (ivSyS krky AwXUSmwn Bwrq

srb`q ishq bImw) dI jwxkwrI

12. Akwl clwxw kr gey mYNbr dI mOq dw kwrn, imqI, sQwn Aqy pirvwr dIAW loVW ƒ

drswauNdI vIfIE ieMtrivaU

Awqm prgws d&qr ƒ auprokq jwxkwrI Byjx dI ivDI:

irivaU &wrm smyq auprokq cY~k ilst iv`c drsweI geI swrI jwxkwrI ƒ hyT ilKy pqy qy eImyl
kro[v`K-v`K ikswnW dI jwxkwrI Al`g-Al`g r`Ko Aqy eI-myl dy ivSy iv`c ikswn dw nwm Aqy
pqw ilK ky sMbMDq ikswn dI jwxkwrI n`QI kro[jy qusIN ie`k qoN v`D ikswnW dw irivaU kIqw hY qW
hr ikswn dI jwxkwrI Al`g-Al`g eI-myl rwhIN hI Byjo[quhwfy v`loN irkwrf kIqy geI vIfIE
ieMtrivaU ƒ qusIN WeTransfer jW GoogleDrive rwhIN vI Byj skdy ho[pr ies g`l dw ivSyS iDAwn
r`Ko ik Al`g-Al`g ikswn dI jwxkwrI Al`g-Al`g hI ByjI jwvy[iksy ivcwr ivtWdry leI qusIN
hyT ilKy Pon nMbr qy sMprk kr skdy ho jI[

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