K¨vk K¨vk

Bmdv Kw¤úDUvi
†g‡gv kc K_vqt .....................................................................................................
†g‡gv
†cÖvt
GLv‡b K‡¤úvR, d‡UvKwc, B-‡gBj, Qwe †_‡K Qwe, AbjvB‡b hveZxq PvKzix I MÖwnZvi Bmdv Kw¤úDUvi k‡ci
fwZ© Av‡e`b Kiv nq| GQvovI Kw¤úDUvi cÖwkÿY I mvwf©wmsmn hveZxq ¯^v¶i c‡ÿ-

Bmdv Kw¤úDUvi kc
Kw¤úDUviu, †gvevBj I B‡jKwUªK mvgMÖx weµq Kiv nq|
wVKvbv:, †gvev:
wej bs- ZvwiL:....../....../.........
†cÖvt
bvg t ................................................................................................................ GLv‡b K‡¤úvR, d‡UvKwc, B-‡gBj, Qwe †_‡K Qwe, AbjvB‡b hveZxq PvKzix I
wVKvbv fwZ© Av‡e`b Kiv nq| GQvovI Kw¤úDUvi cÖwkÿY I mvwf©wmsmn hveZxq
Kw¤úDUvi, †gvevBj I B‡jKwUªK mvgMÖx weµq Kiv nq|
t .............................................................................................................. wVKvbv: , †gvev:

µ. bs weeiY `i cwigv UvKv wej bs- ZvwiL:....../....../.........

Y bvg t ................................................................................................................
wVKvbv
t ..............................................................................................................

µ. bs weeiY `i cwigv UvKv

Y

‡gvU
=
AwM
Ög=
e‡Kq
v=
 ‡gvU
=
AwM
Ög=
e‡Kq
v=
K_vqt .....................................................................................................

MÖwnZvi Bmdv Kw¤úDUvi k‡ci

¯^v¶i c‡ÿ-