xfn;fn} lvlrPsf]

sfof{no k|of]hgsf nflu k|fljlws lzIff tyf Jofj;flos tfnLd kl/ifb\, kf;kf]6{ (35x45mm)
btf{ g+ M ;fOhsf] kmf]6f] 6f+;L,
ldlt M=========================== k/LIff lgoGq0f sfof{no kmf]6f] / kmf/fddf kg]{
cfj]bg kmf/fd a'lemlng]sf] ;xLM ;fgf]l7dL, eQmk'/ u/L k/LIffyL{n] ;xL
================================== ug]{
-cfjZos ;Dk'0f{ sfuhftx? ;+nUg ePsf cfj]bg kmf/fd dfq sfof{non] ?h' u/L btf{ ug'{kg]{5_
b]ze/sf blnt, d'l:nd, lakGg / l;dfGts[t ;d'bfosf 5fq5fqfx?nfO{ l8Knf]df÷k|df0fkq tx cWoogsf nflu k|bfg ul/g] # jif]{ lgMz'Ns
k|fljlws lzIffdf ljz]if 5fqj[lQ sfo{s|dsf] k|j]z k/LIffsf] cfj]bg kmf/fd–@)*)

!= k|j]z k/LIffsf] l;Dan g+M

First Name Middle Name Last Name
@= Name (Capital Letter):

#= gfdy/ -b]jgfu/Ldf_M
$= hGd ldltM lj=;+=============================================== O=;+========================================================== %= lnË M======================================
^= a'jfsf] gfdM========================================================================== &= cfdfsf] gfdM==============================================================================
*= :yfoL 7]ufgfM k|b]z ==================lhNnf====================================== uf=kf=÷g=kf================================================================== j8f g+=====
(= wd{M================== !)= hftLM============ !!= k/LIffyL{sf] ;Dks{ g+=M=============================!@= cleefjssf] ;Dks{ g+=M======================================
l8Knf]df÷k|df0fkq txsf sfo{s|dx?
l8Knf]df Og Plu|sNr/ -KnfG6 ;fOG;_ l8Knf]df Og l;len OlGhlgol/Ë l8Knf]df Og xf]6n Dofg]hd]06
l8Knf]df Og On]lS6«sn P08 On]S6«f]lgS; OlGhlgol/Ë l8Knf]df Og km/]i6«L l8Knf]df Og Plu|sNr/ -Plgdn ;fOG;_

!#= cfkm'n] cWoog ug{ rfx]sf] s'g} Ps z}lIfs sfo{qmd pNn]v ug{'xf];\M =====================================================================================================

!$=tn pNn]lvt nlIft au{ sf]6f / k|b]z pNn]v ug'{xf];\ M -pDd]bjf/x?n] cfkm\gf] gful/stfdf pNn]lvt :yfoL 7]ufgf ePsf] k|b]zdf dfq
cfj]bg kmf/fd a'emfpg' kg]{5_
blnt÷d'l:nd÷lakGg / l;dfGts[t M
k|b]zsf] gfd M

s_ blnt÷d'l:ndsf] xsdf cfkm' ;f] hftL xf] egL lrlgg] ;DjlGwt lgsfoaf6 hf/L ePsf] sfhuft÷k|df0fkq kq
v_ lakGg / l;dfGts[t ;d"xsf] 5gf}6 ubf{ xlnof, sd}of, ckfËtf ePsf, åGå lk8Lt÷;lxb÷hgcfGbf]ng 3fOt] kl/jf/nfO{ ;dfj]z u/L g]kfn ;/sf/af6
;'lrs[t ;'ljwf jl~rt (Disadvantage Group) @@ j6f ;d"xx? -agsl/of, a/fd, af]6], r]kfË, bg'jf/, wfg's, xfo', emfu8, ls;fg, s';'G8f, n]Krf, dfemL,
d]r], s';jfl8of, /fhL, /fp6], ;tf/, l;+;f, l;of/, ;'/]n, yfdL, y'gd_ nfO{ cfly{s ?kdf lakGg egL :yfgLo lgsfoaf6 k|dfl0ft sfuhftsf] cfwf/df lakGg
sf]6fdf ;xefuL x'g ;Sg]_

!%= cfjZos z}lIfs of]Uotf M

z}lIfs of]Uotf cWoog u/]sf] z}lIfs ;+:yfsf] gfd, 7]ufgf ;fd'bflos÷ pQL0f{ ;fn l;Dan g+ >]0fL s'n k|ltzt
;/sf/L k|fKtfÍ
P;=Pn=;L k|ltzt
pQL0f{sf] xsdf
k|fljlws P;=Pn=;L
sf] xsdf
P;=O=O{ cIf/f+sg laifo -u|]8 pNn]v ug'{kg]{_ ;du|
k4lt pQL0f{sf] GPA
xsdf c+u|]hL ul0ft lj1fg
!^= kmf/fd ebf{ ;+nUg ug'{kg]{ sfuhftx?M

l;=g+ sfuhftx? k]z ul/Psf sfuhftx?sf] ;+nUg sfuhft tyf ljj/0fx? ?h' ug]{ s}lkmot
dxndf √ lrGx nufpg'xf]; clwsf/ k|fKt clwsf/Lsf] gfd / x:tfIf/
!= P;=Pn=;L= jf P;=O{=O{= pQL0f{ dfs{l;6 / rfl/lqs
k|df0fkqx?sf] k|dfl0ft k|ltlnkL
@= k|fljlws P;=Pn=;L= pQL0f{ dfs{l;6 / rfl/lqs
k|df0fkqx?sf] k|dfl0ft k|ltlnkL
#= gful/stfsf] k|df0fkq jf g]kfnL gful/s xf] egL
k|dfl0ft x'g] gfjflnu jf hGd btf{sf] k|df0fkqsf]
k|dfl0ft k|ltlnkL
$= dfOu|]zg k|df0fkqsf] k|dfl0ft k|ltlnkL -g]kfn
;/sf/sf] P;=O{=O{ af]8{ afx]ssf cGo af]8{af6
pQL0f{x?sf xsdf_
%= ;dsIftf k|df0fkqsf] k|dfl0ft k|ltlnkL -g]kfn
;/sf/sf] P;=O{=O{= af]8{ afx]ssf cGo af]8{af6
pQL0f{x?sf xsdf_
^= cfkm'n] cfj]bg ug{ rfx]sf] nlIft ju{
s_blnt÷d'l:ndsf] xsdf ;DjlGwt kflnsf÷lhNnf
k|zf;g sfof{non] cfkm' ;f] hftL xf] egL lrlgg]
;DjlGwt lgsfoaf6 k|dfl0ft ul/lbPsf] k|df0fkqsf]
k|dfl0ft k|ltlnkL .
v_lakGg / l;dfGts[t ;d"xsf] 5gf}6 ubf{ g]kfn
;/sf/af6 ;'lrs[t ;'ljwf jl~rt (Disadvantage
Group) @@ j6f ;d"xx? -agsl/of, a/fd, af]6], r]kfË,
bg'jf/, wfg's, xfo', emfu8, ls;fg, s';'G8f, n]Krf,
dfemL, d]r], s';jfl8of, /fhL, /fp6], ;tf/, l;+;f,
l;of/, ;'/]n, yfdL, y'gd_ nfO{ cfly{s ?kdf lakGg
egL :yfgLo lgsfoaf6 hf/L sfuhftsf] k|dfl0ft
k|ltlnkL .
3_k'j{ sd}of÷xlnofx?sf] xsdf ;DjlGwt lhNnf e"ld
;'wf/ sfof{non] hf/L u/]sf] k|df0fkqsf] k|dfl0ft
k|ltlnkL / gftf k|df0fkqsf] k|dfl0ft k|ltlnkL .
u_ åGå lk8Lt, ;lxb kl/jf/, hgcfGbf]ng 3fOt]
kl/jf/sf] ;b:osf] xsdf ;DjlGwt lhNnf k|zf;g
sfof{non] k|dfl0ft ul/lbPsf] k|df0fkq / gftf
k|df0fkqsf] k|dfl0ft k|ltlnkL

!&= d lgodfg';f/ ljz]if k|fljlws lzIff 5fqj[lQdf 5gf}6 ePdf b]xfo cg';f/sf] lzIf0f ;+:yfnfO{ k|fyldlss/0f u/]sf] 5' -l8Knf]df Og l;len
OlGhlgol/Í_ sfo{s|dsf] xsdf dfq_

-s_ =================================================================================================================================================================

-v_ ==================================================================================================================================================================

!*= -s_ o; cfj]bg kmf/d e/]sf ;a} ljj/0fx? tyf ;+nUg sfuhftx? 7Ls, ;fFrf] xf], em'7f 7xl/Pdf k|rlnt sfg"g cg';f/ sf/jfxL ePdf d]/f]
dGh'/L 5 .
-v_ k|fljlws lzIff tyf Jofj;flos tfnLd kl/ifb\n] k|bfg ul/g] o; 5fqj[lt d}n] k|fKt u/]df cWoog kZrft g]kfn ;/sf/n] rfx]df
v6fPsf] :yfgdf uO{ tf]lsPsf] ;do ;Dd ;]jf ug]{5' elg of] sa'lnotgfdf u/]sf] 5' .

cfj]bssf] x:tfIf/M================================ldltM====================

!(= cfj]bg kmf/fd :jLs[t ug]{ sfof{no k|d'v÷k|frfo{sf] gfdM==============================x:tfIf/M================ldltM============sfof{nosf]

5fkM=============================