nim :

srnim&> :

mi[biel :
ti.

p\(t,
pr)xi (nyimk~),
pr)xi (vBig,
mhiriÔ kZONk&mir(s>hJ Bivngr y&(nv(s<T),
Bivngr.
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(vPy : hi[lT)kTmi> s&Firi[ kr) aipvi a>g[.

min. sih[b~),
nmAkir,
s(vny upri[kt (vPy prRv[ jNivvin&> k[ mir) hi[l T)kTmi> n)c[ dSi<v[l B&li[ aiv[l C[ t[ s&Fir) aipvi (vn>t)..,

(vwiY)<n&> nim : ______________________________________________________

pr)xi an[ vP< : ______________________________________________________

s)T n>br: ______________________________________________________

hi[l T)kTmi> aiv[l B&li[ hi[l T)kTmi> s&Firi[ an[ kirNi[

aiBir sh,

aipni[ (vVis&,

mirft rvini : { }