wdo¾Y whÿïm;%h

;dlaIK úoHd,$ld¾ñl úoHd,j,g we;=<;aùu i|yd whÿïm;%h - 2023 wOHhk j¾Ih

ld¾hd,hSh m%fhdackh i|yd

jeo.;a ( ^whÿïm;%h wÞ< ;dlaIK úoHd,fha$ld¾ñl úoHd,fha wOHlaI$úÿy,am;s fj;g heúh hq;=h' ;dlaIK$ld¾ñl
úoHd,j, ,smskhka ;dlaIK úoHd,$ld¾ñl úoHd, ,ehsia;=fõ olajd we;'&

1' ;dlaIK úoHd,fha$ld¾ñl úoHd,fha ku

2' b,a¨ï lrk mdGud,dfõ ku iy mdGud,d fla;h (

3' cd;sl ye÷kqïm;a wxlh :

4' NdId udOHh : isxy, fou< bx.%Sis

5' whÿïlref.a uq,l=re iu. ku ^bx.%Sis lemsg,a wl=ßka& :

6' iïmQ¾K ku ^bx.%Sis lemsg,a wl=ßka& :

7' uq,l=re iu. ku ^isxyf,ka$fouf<ka& :

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8' iaÓr ,smskh ^bx.%Sis lemsg,a wl=ßka& :

9' iaÓr ,smskh ^isxyf,ka& :………………………………………………………………………………...........……

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10' Wmka Èkh : 2023'01'23 jeks Èkg jhi ( wjqreÿ ( udi ( Èk (

11' ia;%S$mqreI Ndjh : ..................................................

12' whÿïlref.a mÈxÑh ms<sn| f;dr;=re (

m<d; : Èia;%slalh :

m%dfoaYSh f,alï fldÜGdih : .%du ks,Odß fldÜGdih :

13' ÿrl;k wxlh ( ksji : foudmsh fyda
Ndrlre

cx.u :

14' NVQ iqÿiqlï u; mdGud,dj,g we;=<;aùug wfmalaId lrk whÿïlrejka i|yd (

,nd we;s NVQ NVQ uÜgu mdGud,dj yeoErE wod< fiajd m<mqreoao yeoErE mdGud,d
iy;slfha ku wdh;kfha ku we;akï tA ms<sn| ld,h
^jD;a;Sh lafIa;%h o iu.& úia;r fláfhka wjqreÿ $ udi

15' wOHdmk iqÿiqlï (

^w& w' fmd' i' ^id' fm<& m%;sM, ^fojrlg fkdjeä jdr .Kkl §&

m<uqjr ( úNd. wxlh :……………………… fojkjr ( úNd. wxlh :………………………

j¾Ih :……………… udOHh :……………… j¾Ih :……………… udOHh :………………
úIhh idud¾:h úIhh idud¾:h
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^wd& w' fmd' i' ^W' fm<& m%;sM, ^tla jrl§& (

úNd. wxlh :………………………

j¾Ih :………………
úIhh idud¾:h

^we& by; i|yka ^w& iqÿiqlu imqrd fkdue;skï ,nd we;s by<u wOHdmk iqÿiqlï (

fY%a‚h :................................. j¾Ih :..................................

mdif,a ku yd ,smskh : ................................................................................

 16' i;s wka;$w¾O ld,Sk mdGud,d i|yd muKla wÞ< fõ'
^/lshd.;j isáh hq;= nj ±lafjk mdGud,d i|yd muKla fuu fldgi fiajdfhdacl úiska iïmQ¾K lrkak'&

16'1 whÿïlref.a ku :……………………………………………………………………………………….……….…

16'2 fiajd ia:dkh yd tys ,smskh :………………………………………………………………………………..……

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16'3 oekg ork ;k;=r yd Bg m;ajQ Èkh :………………………………………………...............……............……

16'4 fiajl w¾:idOl wruqo,a wxlh ( EPF ………… fiajl Ndrldr wruqo,a wxlh ( ETF …………
by; whÿïlre fuu wdh;kfha$ld¾hd,fha fiajh lrk njg iy;sl lrñ'
16'5 fiajd fhdaclhdf.a ku :………………………………………
16'6 ;k;=r :………………………………………
16'7 w;aik :………………………………………

17' iajhx /lshdjl kshqla; kï tys iajNdjh ^.%du fiajd ks<Odß úiska ,smshla u.ska ;yjqre lr ;sìh hq;=h'&

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18' whÿïlref.a m%ldYh (

ud úiska whÿïm;%fha i|yka lr we;s f;dr;=re ud okakd ;rñka ksjerÈ nj;a" b,a¨ï fldg we;s mdGud,djg
wjYH iqÿiqlï ud úiska imqrd we;s nj;a" fuhska iy;sl lrñ' ;jo" ;dlaIK úoHd,j,g$ld¾ñl úoHd,j,g isiqka we;=<;a
lr .ekSu ms<sn| mámdáhg tlÕùug o ld¾ñl wOHdmk yd mqyqKq lsÍfï fomd¾;fïka;=fõ wOHlaI ckrd,af.a wjidk
;SrKh ms<s.ekSug o fmdfrdkaÿ fjñ'

Èkh :…………………………. ……………………………………,

whÿïlref.a w;aik'