,yq;if njhz;lu; thd;gilapy;..................

gpuptpy; Mz;/ ngz; thd;gil tPuu;/

tPuhq;fidfSf;fhd tpz;zg;gk;
1. Njrpa ,dk;: ………………………………………………………………………………………………………………………….
(,yq;ifg; gpuirahapd; tk;rhtopapyh my;yJ gjpT Kiwapyh? gjpT Kiwahapd;
rhd;wpjopd; ,yf;fKk; jpfjpiaAk; Fwpg;gpLf).
2. KOg;ngau; (Njrpa Msilahs ml;ilg;gb) : …………………………………………………………………
3. Njrpa Msilahs ml;il ,yf;fk;: …………………………………………………………………………………
4. epue;ju Kfthp: ………………………………………………………………………………………………………………………
5. jw;Nghija mQ;ry; Kfthp : ………………………………………………………………………………………………
6. gpwe;j jpfjp : ………………………………………………………………………………………………………………………..
taJ : (2021> jpnrk;gh; 15 Me; jpfjpf;F)
tUlq;fs; : ........... khjq;fs; : ........... ehl;fs; : ..............
7. cauk; :............... n.r kP. (............... mb .......................mq;Fyk;)
8. epue;ju Kfthpapd; mz;ikapYs;s nghyp]; epiyak; : …………………………………………………
9. khtl;lk;: ………………………………………………………………………………………………………………………………..
10. Nju;jw; njhFjp : …………………………………………………………………………………………………………………..
11. fpuhk mYtyu; gphpT: ……………………………………………………………………………………………………………
12. njhiyNgrp ,yf;fk; : ………………………………………………………………………………………………………….
13. jpUkzkhdtuh ? my;yJ jpUkzkhfhjtuh ? : ……………………………………………………………..
14. ghy; : …………………………
15. ghlrhiy gw;wpa tpguq;fs; : ………………………………………………………………………………………………
16. ghlrhiy mj;Jld; / my;yJ gy;fiyf;fofk; gw;wpa tpguq;fs; :

ghlrhiy / ghPl;irapd; jd;ik Mz;L rpj;jpaile;j

ru;tfyh rhiy ghlq;fSk; (juk;
ngau;fs cl;gl)
f.ngh.j. (rh./j.)
f.ngh.j. (c./j.)
NtW

17. ghlrhiy / gy;fiyf;fofj;jpy; ,Ue;J tpyfpajpypUe;J Ghpe;j njhopy; gw;wpa

tpguq;fs; :
njhopy; jUehpd; ngaUk; Nritf;fhyg;gFjp
KfthpAk; njhopypd; jd;ik ,Ue;J tiu

18. ngw;Nwhu; gw;wpa tpguq;fs; :

KOg;ngau; gpwe;j ,lk; njhopy; jw;Nghija Kfthp
je;;ij
jha;

19. gjtpf;fhd vitNaDk; rpwg;ghd jifikfs; : ……………………………………………………………….

20. tpisahl;by; jw;Nghija rhjidfspd; tpguk; :

………………………………………………………………………………………………………………………………………………….
.…………………………………………………………………………………………………………………………………………………
(FOf;fs; gw;wpa tpguq;fisAk; gq;Fgw;wpa Nghl;bfisAk; jpfjpAlDk; ngw;w
rhjidfSlDk; jUf)
21. Gwk;ghd rhjidfs; ghlrhiy> gy;fiyf;fofk; my;yJ ntsp mikg;Gfspy;
,Uf;Fk; nghOJ ngw;w rhjidfs; (jpfjpfSld; tpguj;ijAk; jUf.) :
………………………………………………………………………………………………………………………………………………….
.…………………………………………………………………………………………………………………………………………………
22. ,jw;F Kd; MAjg; gilapy; njhz;lu; gilapy; gapypsty; gilazpapy; my;yJ
,sk; rhuzu; ,af;fj;jpy; Mw;wpa Nrit :
………………………………………………………………………………………………………………………………………………….
23. ,yq;if thd; gilapy; my;yJ MAjg; gilapy; VNjDk; Nritapy; my;yJ nghyp];
Nritapy; Nru;tjw;F Kd;G tpz;zg;gpj;jPuh ? mt;thwhapd;> tpguq;fisAk; mj;jifa
tpz;zg;gj;jpd; ngWNgw;wpidAk; jUf :
………………………………………………………………………………………………………………………………………………….
.…………………………………………………………………………………………………………………………………………………
24. rptpy; my;yJ ,uhZt ePjpkd;wj;jpdhy; jz;bf;fg;gl;Ls;sPuh ? my;yJ gpizapy;
tplg;gl;Buh ? mg;gbahapd; tpguq;fisj; jUf :
………………………………………………………………………………………………………………………………………………….
.…………………………………………………………………………………………………………………………………………………

25. ,jw;F Kd;du; murhq;fj; jpizf;fsj;jpNyh my;yJ gfpuq;fj; Jiwapy;/ rigapy;>

$l;Lj;jhgdj;jpy; (kj;jpa tq;fp / Njrpa tq;fp / gy;fiyf;fofq;fs; / murhq;fj;jpd;
fl;Lg;ghl;bYs;s $l;Lg;gq;Fj; njhFjpf; fk;gdpfs; cl;gl) Ntiy nra;jpUg;gpd;
Ntiyapy; ,Ue;J tpyfpajd; fhuzk; :
………………………………………………………………………………………………………………………………………………….
.…………………………………………………………………………………………………………………………………………………
26. ew;rhd;wpjo;fs; toq;fpNahu; gw;wpa tpguq;fs; :
ngau; gjtpg; ngau; mQ;ry; Kfthp

27. tpz;zg;gjhuhpd; cWjpAiu :

NkNy nfhLf;fg;gl;Ls;s tpguq;fs; ahTk; vd; mwptpf;Fk; tpRthrj;Jf;Fk;
vl;batiuapy; rhpahdit vd cWjpg;gLj;JfpNwd;. ,yq;ifr; rdehaf Nrhryprf;
Fbaurpd; tu;j;jkhdpapy; ntspaplg;gl;Ls;s ,yq;if thd;gilapdUf;Fj; njhpT
nra;ag;gLk; tpz;zg;gjhuu;fs; njhlu;ghf Nkw;nfhs;sg;gl;l eltbf;if KiwiaAk;
mtu;fSf;Fg; nghUj;jkhd tpjpKiwfisAk; ehd; mwpe;Jf;nfhz;Nld;.
………………….. ……………………………………
jpfjp tpz;zg;gjhuupd;
ifnahg;gk;

Form.lk
28. tpz;zg;gjhuhpd; ngw;Nwhuhy; my;yJ ghJfhtyuhy; ifnahg;gkpl Ntz;ba
ntspg;gLj;Jif :
m. ,yq;if thd;gilapy; gapYduhf tpz;zg;gpj;J NkNy nfhLf;fg;gLk;
tpz;zg;gg;gbtj;jpd; 27 Mk; Rl;bd; ntspg;gLj;Jifapy; ifnahg;gkplg;gl;bUf;Fk;
..................................... ,tUf;F ehd; ngw;Nwhu; / ghJfhtyu; MNtd;.
M. Nkw; $wg;gl;bUf;Fk; tpz;zg;gjhuu; gapw;rpf;Fj; Nju;e;njLf;fg;gLkplj;J
gpd;tUtdtw;Wf;F ehd; nghWg;ghspahNtd; :-
(1) gapw;rpapd; NghJ Mizf;fhd mtuJ Nju;TehLk; epiyapypUe;J jhkhfNt
tpyFkplj;J ,yq;iff; Fbaurpdhy; mf;fhyk; tiu cwg;gl;l nryTfs; ahtw;iwAk;
,yq;if Fbaurpw;F jpUk;gf; nfhLg;gjw;Fk;@
(2) gapw;rpapd;NghJ vr;rkaj;jpYk; elj;ij fhuzkhf my;yJ mtuJ nrhe;j flg;ghL
fhuzq;fSf;fhf Miz toq;fg;gLtjw;Fj; jFjpngwhjtnud mjpfhhpfspdhy;
mwpf;if tplg;gLkplj;J ,yq;if Fbaurpdhy; mf;fhyk; tiu cwg;gl;l nryTfs;
ahTk; ,yq;if FbauRf;F jpUk;gr; nrYj;Jtjw;Fk;
………………………………………
ngw;Nwhu; / ghJfhtyu;
ifnahg;gk;.

jpfjp :.............................................................................................................................................
ngau; : (nfg;gpl;ly; vOj;Jf;fspy;) ..........................................................................................
Kftup :...........................................................................................................................................

…………...........................................
Kjyhk; rhl;rpapd; ifnahg;gk;

jpfjp :.............................................................................................................................................
ngau; : (nfg;gpl;ly; vOj;Jf;fspy;) ..........................................................................................
Kftup :...........................................................................................................................................

…………...........................................
,uz;lhk; rhl;rpapd; ifnahg;gk;.

jpfjp :.............................................................................................................................................
ngau; : (nfg;gpl;ly; vOj;Jf;fspy;) ..........................................................................................
Kftup :...........................................................................................................................................