mYtyff; Fwpg;G : e.f.

vz;………………………

nghUs; : Nkhl;lhh; thfd Ma;thsh;> gFjp mYtyfk;.

nea;Ntyp- Xl;Leh; chpkk; - nghJg;gzptpy;iy
toq;f NfhUtJ-njhlh;ghf.

ghh;it : 1.Nghf;Ftuj;J mikr;rfk; kw;Wk; neLQ;rhiyg;

Nghf;Ftuj;J mwpf;if GSR No.681(E),
ehs;.25.09.2019.
2.Nghf;Ftuj;J Mizah;. nrd;id mth;fspd;
fbjk; vz;.19137/E/2018 ehs;.29.10.2019.

3.jpU/jpUkjp.

j/ng.

mth;fspd; tpz;zg;gk; ehs;.

ghh;it-3y; fhZk; fbjj;jpy; kDjhuhpd; Xl;Leh; chpkk; tptuk;

gpd;tUkhW njhptpf;fg;gl;Ls;sJ.

1. D.L.No :
2. Valid upto :
3. D.O.B :
4. P.V.R.No. :

kDjhuh; chpa gbtj;jpy; fl;lzk; nrYj;jpAk; fhty;Jiw rhd;W

ngw;Wk; nghJg;gzptpy;iy toq;ff;Nfhhp tpz;zg;gpj;Js;shh;.
vdNt> kDjhuUf;F Neh;Kf Njh;T elj;jp nghJg;gzptpy;iy
toq;fyhkh?
cj;jutpw;fhf.
 mYtyff; Fwpg;G : e.f.vz;………………………

nghUs; : Nkhl;lhh; thfd Ma;thsh;> nea;Ntyp gFjp

mYtyfj;jpy; Xl;Leh; chpkk; ngwg;gl;lJ-
jw;NghJ efy; Xl;Leh; chpkk; Ntz;b
tpz;zg;gk; mspj;jy;-njhlh;ghf.
------

jpU/jpUkjp......................................................................vd;gth;
,t;tYtyfj;jpy; Xl;Leh; chpkk;
vz;...........................................................................ehs;......................................
ngw;Ws;shh;.mjd; tptuk; gpd;tUkhW:

1. gpwe;j Njjp :
2. ,Urf;fu thfd Nkw;Fwpg;G ehs; :
3. ,yFuf thfd Nkw;Fwpg;G ehs; :
4. nghJg;gzptpy;iy vz;/ehs;. :
5. fduf thfdk; Nkw;Fwpg;G ehs; :
6. Xl;Leh; chpkk; elg;gpy; cs;s tptuk; :
7. chpa gbtq;fs; g+h;j;jp nra;ag;gl;Ls;sjh? : Mk; cs;sJ.
8. fhty;Jiw rhd;W ,izf;fg;gl;Ls;sjh? : Mk; cs;sJ.
9. &.20/f;fhd cWjpnkhop gj;jpuk; cs;sjh? : Mk; cs;sJ.
10. mYtyf fzpdpapy; Ma;T nra;ag;gl;Ls;sjh? : Mk;.
11. Xl;Leh; chpkk; RUf;Fk;(DLExtract) : Mk; cs;sJ.
,izf;fg;gl;Ls;sjh?
12 Kfthp Mjhuk; (m) Xl;Leh; chpkk; efy; : Mk; cs;sJ.
,izf;fg;gl;Ls;sjh?

Nkw;fhZk; tptuq;fs; midj;Jk; rhpahf cs;sjhy;

tpz;zgjhuUf;F elg;G Njjpapy; efy; Xl;Leh; chpkk; toq;fplyhkh?
cj;jutpw;fhf
mYtyff; Fwpg;G : e.f.vz;………………………

nghUs; : Nkhl;lhh; tpphfd Ma;thsh;. gFjp mYtyfk;.

nea;Ntyp-Xl;Leh; chpkk; fhyhtjpahdJ-kW
Njh;T(Re-Test) elj;jp GJg;gpj;J toq;f NfhUtJ-
njhlh;ghf.
ghh;it : jpU/jpUkjp

mth;fspd; tpz;zg;gk; ehs;.

P
-----

ghh;itapy; fhZk; tpz;zg;gj;ij ghh;itaplTk;. mjpy;

jpU/jpUkjp........................................................................ vd;gth; nea;ntyp gFjp
mYtyfj;jpy; Xl;Leh; chpkk; vz;...........................................................................
ehs;..................................... ngw;Ws;shh;. mjd; tptuk; gpd;tUkhW:

1. gpwe;j Njjp :

2. ,Urf;fu thfd chpkk; vLj;j ehs; :

3. ,yFuf thfdk; chpkk; vLj;j ehs; :

4. nghJg;gzptpy;iy vz;/ehs; :

5. fduf thfdk; chpkk; vLj;j ehs;. :

Nkw;gb Xl;Leh; chpkk; ..................................... Njjp Kbtile;J.......

Mz;Lfshfg; GJgpf;fg;gltpy;iy. jw;NghJ jkf;F Xl;Leuhf gzpahw;w Nkw;gb

chpkj;ij kWNjh;T elj;jp GJgpj;J toq;FkhW Nfhhp chpa gbtq;fis

G+h;j;jp nra;J tpz;zg;gk; mspj;Js;shh;.

vdNt tpz;zgjuuJ Nfhhpf;ifia Vw;W chpa fl;lzk; ngw;W

Nkhl;lhh; thfd rl;lk; 15(4) d;gb kWNjh;T(Re-test) elj;jp jdpaUf;F jFjp

,Ug;gpd; Xl;Leh; ;chpkj;ij GJgpj;J toq;fyhkh?

cj;jutpw;fhf
mYtyff; Fwpg;G : e.f.vz;………………………

nghUs; : Nkhl;lhh; thfdk;-nea;Ntyp gFjp mYtyfk;-thfd

chpikahsh; gjpTr;rhd;W njhiye;J NghdJ-efy;
gjpTr;rhd;W NfhUjy;-njhlh;ghf.

ghh;it : jpU/jpUkjp

mth;fspd; tpz;zg;gk; ehs;.

-----
ghh;itapy; fhZk; thfdj;jpd; chpikahsh; _________________________________
mth;fs; ______________________________ thfdj;jpw;F efy; gjpTr;rhd;W Nfhhp
tpz;zg;gpj;Js;shh;.

;mjd; tptuk; gpd;tUkhW:

1. thfdj;jpd; vz; :
2. gjpT nra;j mYtyfk; :
3. thfdj;jpd; tif :
4. mbr;rl;l vz; :
5. nghwp vz; :
6. thfdj;jpw;F jtizf;nfhs;Kjy; :
Nkw;Fwpg;G cs;sjh? Mk; vdpy;
jtizf;nfhs;Kjy; jhuhplkpUe;J
Ml;Nrgizapy;yhr;rhd;W(m) gbtk;-35
,izf;fg;gl;Ls;sjh?

7. thp nrYj;jpa tptuk; :

8. fl;lzk; nrYj;jpa tptuk; :
9. fhty;Jiwr; rhd;W ngwg;gl;Ls;sjh? :
10. Nkhl;lhh; thfd Ma;thsh; :
Ma;twpf;if ngwg;gl;Ls;sjh?

11. cWjpnkhopgj;jpuk; ngwg;gl;Ls;sjh? :

vdNt Nkw;fz;l thfdj;jpw;F efy; gjpTr;rhd;W toq;fyhkh?

cj;jutpw;fhf