tpisahl;L fofnkhd;iw kPs;gjpT nra;J nfhs;tjw;fhf Kd;itf;fg;gLk;

tpz;zg;gg;gbtk;

gFjp I
tpisahl;Lg; gzpg;ghsu;>
khfhz tpisahl;Lj; jpizf;fsk;>
tl khfhzk;.
1. tpisahl;Lf; fofj;jpd;; ngau;:
jkpopy; :………………………………………………………………………..
Mq;fpyj;jpy; : ………………………………………………………………………
2. fbj Kftup : ………………………………………………………………………
………………………………………………………………………
3. fofk; Muk;gpf;fg;gl;l jpdk; : Mz;L…………. khjk; …………. jpfjp ……...
4. jw;NghJs;s gjpT ,yf;fk;: ………………………………………………………………………….

5. mq;fj;jtu; vz;zpf;if : Mz;fs; ……. ngz;fs; ……. nkhj;jk; ……...

6. tpisahl;Lf; fofj;jpd; Kf;fpa tpisahl;Lf;fs; : nka;ty;Ydh;> JLg;ghl;lk;>

cijge;jhl;lk;> fug;ge;jhl;lk;> tiyg;ge;jhl;lk;> fgb> vy;Ny …………………………
…………………………………………………………………………………………………………
7. eph;thf rigapd; tpguk;
1. nfsut jiytu; mtu;fsJ
KOg;ngah;:……………………………………………………………………………………..
tpyhrk; :………………………………………………………………………………………..
njhiyNgrp ,yf;fk;: ………………………………………………………………………...
2. nfsut nrayhsu; mtu;fsJ
KOg;ngah;:……………………………………………………………………………………..
tpyhrk; :………………………………………………………………………………………..
njhiyNgrp ,yf;fk;: ………………………………………………………………………...
3. nfsut nghUshsu; mtu;fsJ mtu;fsJ
KOg;ngah;:……………………………………………………………………………………..
tpyhrk; :………………………………………………………………………………………..
njhiyNgrp ,yf;fk;: ………………………………………………………………………...

8. nghJf; $l;lj;jpw;F r%fkspj;jpUe;j ngupatu;fspdJk; mur cj;jpNahfj;jpdu;fsJk;

ngau;g;gl;bay;
ngau; ifnahg;gk;
01: ................................................................................. ...............................................
02: ................................................................................. ...............................................
03: ................................................................................. ...............................................
04: ................................................................................. ...............................................
05: ................................................................................. ...............................................

9. ,j;Jld; fPNo fhzg;gLk; Mtzq;fs; ,izf;fg;gl;Ls;sd.

1. nghJf;$l;lj;jpd; cWjpg;gLj;jg;gl;l $l;l mwpf;ifapd; gpujp>
2. nghJf;$l;lj;jpw;F r%fkspj;j mq;fj;jtu;fspd; ifnahg;gj;Jld; $ba
ngau;g;gl;baypd; cWjpg;gLj;jg;gl;l gpujp
3. Nkyjpfkhf ,izf;fg;gl;l mq;fj;jth;fSila ifnahg;gj;Jld; $ba
ngau;g;gl;baypd; cWjpg;gLj;jg;gl;l gpujp (Nj.m.m.,y> njhiyNgrp ,y> Kftup)
4. nghJf;$l;lj;jpw;fhf gpurpj;jg;gLj;jg;gl;l tpsk;guj;jpd; gpujp
10. tpisahl;L ikjhdk; njhlh;ghd tpguk;
1. tpisahl;L ikjhdk; cz;L - Mk; / ,y;iy
2. chpj;Jlik - nrhe;j / khefu rig / efurig / gpuNjr rig /
ghlrhiy / jdpahh; / NtW
vkJ tpisahl;Lf;fofj;jpid kPs;gjpT nra;J 2022k; Mz;Lf;Fhpa Nghl;bfspy; fye;J
nfhs;stjw;fhd mDkjpapid je;JjTkhW gzptd;Gld; Nfl;Lf; nfhs;fpd;Nwhk;. khfhz
tpisahl;Lj; jpizf;fsk; fhyj;jpw;F fhyk; tpjpf;Fk; fl;lisfSf;F Vw;g nraw;gLtjw;F
,zq;Ffpd;Nwhk; vd;gijAk; md;Gld; mwpaj;jUfpd;Nwhk;.

……………………........ …………………..
…………………………..
nfsut jiytu; jpfjp nfsut nrayhsu;

gFjp II

fpuhk cj;jpNahfj;jupd; cWjp ciu

,e;j tpisahl;Lf; fofk; gjpT nra;tjw;F jFjp cilaJ vd;gij cWjpg;gLj;Jfpd;Nwd;.
cWjpg;gLj;jtpy;iyahapd; fhuzk;
:…………………………………………………………………………………………………………………
……………………………………………………………………………………………………………
fpuhk cj;jpNahfj;jupd; ifnag;gk; :…………………………………………………………
jpfjpAk; gjtp Kj;jpiuAk;

gFjp III
tpisahl;L cj;jpNahfj;jupd; cWjp ciu
KjyhtJ gFjpapYs;s tpguq;fs; cz;ikahdit vdTk; ,e;j tpisahl;Lf;fofk; fle;j
tpisahl;Lg; Nghl;bapy; Mu;tj;Jld; fye;J nfhz;ljhy; kPs;gjpT nra;tjw;F rpghu;R nra;fpd;Nwd;.

tpisahl;L cj;jpNahfj;jupd; ifnag;gk; :…………………………………………………………

jpfjpAk; gjtp Kj;jpiuAk;

gpuNjr nrayhsuJ cWjp ciu:

kPs;gjptpw;fhf Kd;dpiyg;gLj;jg;gLfpd;wJ.
gpuNjr nrayhsuJ ifnahg;gk; :………………………………………………..
jpfjpAk; gjtp Kj;jpiuAk;

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mYtyf cgNahfj;jpw;fhf
khtl;l tpisahl;L cj;jpNahfj;juJ cWjp ciu
kPs; gjpT mDkjpf;fhf rpghupR nra;fpd;Nwd;
khtl;l tpisahl;L cj;jpNahfj;jupd; ifnahg;gk; : …………………………………………
jpfjpAk; gjtp Kj;jpiuAk;

kPs; gjpT mDkjpf;fg;gLfpd;wJ / mDkjpf;fg;gltpy;iy

kPs; gjpT nra;ag;gl;l jpfjp : ……………………………………….

gzpg;ghsu; ifnahg;gk; :………………………………………………

jpfjpAk; gjtp Kj;jpiuAk; :………………………………………………