Kviæwkíx c`K 2023

evsjv‡`k †jvK I Kviæwkí dvD‡Ûkb

ms¯‹…wZ welqK gš¿Yvjq

g‡bvbqb dig

cwiPvjK
evsjv‡`k †jvK I Kviæwkí dvD‡Ûkb
†mvbviMvI, bvivqYMÄ|

1. Kviæwkíxi bvg (g„Z n‡j Zv D‡jøL Ki‡Z n‡e) :......................................................................................

2. wcZvi bvg / ¯^vgxi bvg :...................................................................................................................

3. gvZvi bvg :....................................................................
4. eqm : .................. 5. RvZxqZv : ................................ 6. †Rjv : ................................................
7. ag© : ...............................................................................
8. eZ©gvb wVKvbv :..............................................................................................................................
9. ¯’vqx wVKvbv :.................................................................................................................................
10. Kviæwk‡íi gva¨g / welq / wefvM :.........................................................................
11. KZ eQi †_‡K G gva¨g / welq / wefv‡M KvR Ki‡Qb :................................................
12. c~‡e© †Kvb ms¯’v †_‡K c`K/ cyi¯‹vi †c‡q‡Qb wK bv : n¨vu: bv :
13. c~‡e© c`K/cyi¯‹vi †c‡j cyi¯‹v‡ii aiY I bM` A‡_©i cwigvY I mb (mb‡`i mZ¨vwqZ Qvqvwjwc
ms‡hvRb Kiv hv‡e- Hw”QK)|
14. c`K cÖ`vbKvix ms¯’vi bvg :.............................................................................................................
15. †`k/we‡`k/AvšÍR©vwZKfv‡e Kviæwk‡í †Kvb Ae`vb _vK‡j Zvi weeiY (mb` Gi mZ¨vwqZ Qvqvwjwc
ms‡hvRb Kiv hv‡e -Hw”QK)|
16. g‡bvbqb cÖ`vbKvix‡K Zvi we‡ePbvq wkíxi m‡ev©Ëg GKwU wkíKg© ev Zvi bgybv (mswkøó gva¨g / welq / wefv‡Mi )
ms‡hvRb Ki‡Z n‡e (†dir‡hvM¨) | cyi¯‹v‡ii Rb¨ wbe©vwPZ KviæwkíwU Dchy©³ g~j¨ w`‡q dvD‡Ûkb Rv`yN‡ii Rb¨ msMÖn/µq
Ki‡e Ges Awbe©vwPZ Kviæwkímg~n Av‡e`bKvix‡K †diZ cÖ`vb Kiv n‡e |

17. A½xKvi : (¯^vÿi : ) ............................................................................................................................

Dc‡ivwjøwLZ mKj Z_¨ Avgvi Rvbvg‡Z mZ¨ | †gvevBj ......................................................................................

g‡bvbqb cÖ`vbKvixi ¯^v¶i I ZvwiL t

(cÖwZôvb/ms¯’v n‡j Zvi cÖav‡bi ¯^v¶i)……

18. g‡bvbqb cÖ`vbKvixi wVKvbv ..........................................................................................................

we:`ª: [g‡bvbqb cÖ`v‡bi Rb¨ cyiYK…Z di‡gi mv‡_ wkíxi bvMwiKZ¡ mvwU©wd‡KU/ b¨vkbvj AvB wW Kv‡W©I d‡UvKwc ms‡hvRb
Ki‡Z n‡e ]

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