cwiwkó- 2

eq¯‹fvZv gÄyixi Av‡e`b cÎ

(Av‡e`bKvix wb‡R c~iY A_ev ¯^vÿi Ki‡eb A_ev Kv‡iv Øviv c~iY K‡i wb‡R wUcmwn w`‡eb)

eivei, cvm‡cvU©
mgvR‡mev Kg©KZ©v mvB‡Ri
Dc‡Rjv/kni mgvR‡mev Kvh©vjq mZ¨vwqZ
.................................. Qwe
welqt eq¯‹fvZv gÄyixi Rb¨ Av‡e`b|

g‡nv`q,

webxZ wb‡e`b GB †h, Avwg GKRb eq¯‹ e¨w³| Avgvi eZ©gvb eqm .................. ermi| Avwg miKvi
KZ…©K cÖ`Ë eq¯‹ fvZv cÖvwßi Rb¨ Av‡e`b KiwQ| Avgvi Z_¨vw` wb‡gœ cÖ`Ë nj| D‡jøL¨ †h, Avgvi wbgœ ewY©Z
Z_¨vw` mZ¨|

(1) bvg : K)evsjvq .............................................. L) Bs‡iwR‡Z:..............................................

(2) wcZv/¯^vgxi bvg : ............................................(3) gvZvi bvg : ...........................................
(4) RvZxq cwiwPwZ/Rb¥ wbeÜb b¤^i:............................................(5)Rb¥ ZvwiL:............................
(6) wj½:.............................(7) ag©:.......................................(8) †ckv:...................................
(9) wVKvbv :
eZ©gvb : .................................... ¯’vqx: ...........................................
................................... ...........................................
................................... ...........................................
.................................. ...........................................
(10) ‰eevwnK Ae¯’v:..........................................(11) evwl©K Mo Avq : .......................................
(12) ¯^v¯’¨ MZ Ae¯’v : cÖ‡hvR¨ †ÿ‡Î wUK (√) wPý w`b:

1) m¤ú~Y© Kg©ÿgnxb 2) Amy¯’ 3) AcÖK…wZ¯’ 4) cÖwZeÜx 5) AvswkK ÿgZvnxb

(13) Av_©-mvgvwRK Ae¯’v (cÖ‡hvR¨ †ÿ‡Î (wUK) wPý w`b):

(K)Avw_©K Ae¯’v:
(1) wbt¯^ (2) DØv¯‘ (3) f~wgnxb

(L) mvgvwRK Ae¯’v:

(1) weaev (2) ZvjvKcÖvßv (3) wecZœxK (4) cwievi ‡_‡K wew”Qbœ

(14)mbv³KiY wPý : .------------------------------------|

15| Avgvi kvixwiK AÿgZvRwbZ Kvi‡Y eq¯‹ fvZv MÖn‡Yi Rb¨ mkix‡i Dcw¯’Z nIqv m¤¢e bq| ZvB Avgvi
eq¯‹ fvZv MÖn‡Yi Rb¨ wbgœewY©Z e¨w³‡K g‡bvbqb `vb Kijvg| ‡mB mv‡_ bwgbx‡K Avgvi g„Zz¨i ci c~‡e©i
e‡Kqvmn (hw` _v‡K) cieZ©x 3 gv‡mi fvZv MÖn‡Yi Rb¨ g‡bvbqb `vb Kijvg|
bwgbxi
mZ¨vwqZ
Qwe

bwgbxi bvg I wVKvbv fvZv‡fvMxi g‡bvbxZ e¨w³i bgybv eq¯‹ fvZv‡fvMxi

mv‡_ m¤úK© ¯^vÿi cÖwZ¯^vÿi/wUcmwn

Avcbvi AbyMZ,
mbv³Kvixi bvg I ¯^vÿi Av‡e`bKvixi ¯^vÿi/wUcmwn :
(mxj‡gvni) Av‡e`bKvixi bvg :

16| Av‡e`bKvixi eY©bv mZ¨| wZwb eq¯‹ fvZv cÖvwßi †hvM¨/A‡hvM¨| Zuv‡K eq¯‹ fvZv cÖ`vb Kiv †h‡Z
cv‡i/cv‡ibv|

BDwc m`m¨/†Pqvig¨vb/‡cŠimfv/wmwU
K‡c©v‡ik‡bi KvDwÝj‡ii ¯^vÿi
(bv‡gi mxj‡gvni)
gÄyiKvix KZ…c
© ‡ÿi ¯^vÿi
mgvR‡mev Kg©KZ©v
(bv‡gi mxj‡gvni)

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 cwiwkó-2
weaev I ¯^vgx cwiZ¨³v `yt¯’ gwnjv‡`i fvZv gÄyixi Av‡e`b cÎ:
MYcÖRvZš¿x evsjv‡`k miKvi
mgvR‡mev Awa`dZi
Dc‡Rjv/kni mgvR‡mev Kvh©vjq ..................
(Av‡e`bKvix wb‡R c~iY I ¯^v¶i Ki‡eb A_ev Ab¨ Kv‡iv Øviv c~iYc~e©K wb‡R ¯^v¶i/wUcmwn w`‡eb)

cvm‡cvU©
eivei, mvB‡Ri
mgvR‡mev Kg©KZ©v mZ¨vwqZ
Dc‡Rjv/kni mgvR‡mevKvh©vjq,............... Qwe
‡Rjv .................................

welqt weaev I ¯^vgx cwiZ¨³v `yt¯’ gwnjv‡`i fvZv gÄyixi Rb¨ Av‡e`b|

g‡nv`q,
webxZ wb‡e`b GB †h, Avgvi eZ©gvb eqm .................. eQi| Avwg MYcÖRvZš¿x evsjv‡`k miKvi
KZ…©K †NvwlZ.............UvKv nv‡i weaev/¯^vgx cwiZ¨³v `yt¯’ gwnjv‡`i fvZv cÖvwßi Rb¨ Av‡e`b RvbvB‡ZwQ
Ges GB m~‡Î wbgœwjwLZ Z_¨vw` Avcbvi mnvbyf~wZkxj we‡ePbvi Rb¨ †ck Kwi‡ZwQ|
(1) bvg:K)evsjvq:.................................................(L) Bs‡iwR‡Z:........................................
(2) wcZvi bvg:.................................................... (3) gvZvi bvg : .....................................
(4) g„Z/ZvjvKcÖvß/wbiæ‡Ïk/cwiZ¨³vKvix ¯^vgxi bvg :......................................................
(5) Rb¥ ZvwiL:......................... (6) RvZxq cwiwPwZ/Rb¥ wbeÜb b¤^i:......................................
(7) ag©:.................. (8) †ckv:...................
(9) wVKvbv:
(K) eZ©gvb:....................................... (L)¯’vqx:...................................................
............................................... ....................................................
............................................... ....................................................
(10) Av‡e`bKvixi evwl©K Mo Avq :.......................|

(11) ¯^v¯’¨ MZ Ae¯’v : cÖ‡hvR¨ †ÿ‡Î wUK (√) wPý w`b:

1) m¤ú~Y© Kg©ÿgnxb 2) Amy¯’ 3) AcÖK…wZ¯’ 4) cÖwZeÜx 5) AvswkK ÿgZvnxb

(12) Av_©-mvgvwRK Ae¯’v (cÖ‡hvR¨ †ÿ‡Î wUK (√) wPý w`b):

(K)Avw_©K Ae¯’v:
(1) wbt¯^ (2) DØv¯‘ (3) f~wgnxb
(L) mvgvwRK Ae¯’v:

(1) weaev (2) ZvjvKcÖvßv (3) ¯^vgx cwiZ¨v³v (4) cwievi ‡_‡K wew”Qbœ

20
(13) mbv³KiY wPý :
(14) mbv³Kvix :

.........................................................
(IqvW© m`m¨/m`m¨v/KvDwÝji/BDwbqb cwil` †Pqvig¨vb)

(15) Avgvi kvixwiK A¶gZvRwbZ Kvi‡Y Avgvi bv‡g eivÏK…Z fvZvi A_© MÖn‡Yi Rb¨ Avwg Dcw¯’Z nB‡Z
A¶g| GgZve¯’vq, Avgvi bv‡g fvZv MÖn‡Yi Rb¨ wbgœwjwLZ e¨w³‡K g‡bvbqb `vb Kwijvg| D‡jL¨, Avgvi
g„Zz¨i ci wbw`©ó mgq ch©šÍ g‡bvbxZ e¨w³ bxwZgvjv Abyhvqx fvZv D‡Ëvjb Kwi‡Z cvwi‡eb|

bwgbxi cvm‡cvU©
mvB‡Ri
mZ¨vwqZ Qwe

g‡bvbxZ wVKvbv fvZv MÖnxZvi g‡bvbxZ e¨w³i bgybv fvZv‡fvMxi

e¨w³i bvg ms‡M m¤úK© ¯^v¶i/wUcmwn cÖwZ¯^v¶i/wUcmwn

Avcbvi AbyMZ,
mbv³Kvixi bvg I ¯^vÿi Av‡e`bKvixi ¯^vÿi/wUcmwn :
(mxj‡gvni) Av‡e`bKvixi bvg :

(16) Av‡e`bKvixi eY©bv mZ¨| wZwb weaev I ¯^vgx cwiZ¨³v `yt¯’ gwnjv fvZv cÖvwßi †hvM¨/A‡hvM¨| Zuv‡K
weaev I ¯^vgx cwiZ¨³v `yt¯’ gwnjv‡`i fvZv cÖ`vb Kiv †h‡Z cv‡i/cv‡ibv|

BDwc m`m¨/†Pqvig¨vb/‡cŠimfv/wmwU
K‡c©v‡ik‡bi KvDwÝj‡ii ¯^vÿi
(bv‡gi mxj‡gvni)

gÄyiKvix KZ…c
© ‡ÿi
¯^vÿi
mgvR‡mev Kg©KZ©v
(bv‡gi mxjmn)

21