cvV`v‡bi cÖv_wgK Abyg wZi Av‡e`bcÎ

eivei
‡Pqvig¨vb
gva¨wgK I D”Pgva¨wgK wkv‡evW©, Kzwgj­v|
welq : cvV`v‡bi cÖv_wgK AbygwZ cÖm‡½|
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cvV`v‡bi cÖv_wgK AbygwZi Av‡e`bcÎ
g‡nv`q,
Dchy©³ wel‡qi cwi‡cÖw‡Z m`q AeMwZi Rb¨ Rvbv‡bv hv‡”Q †h, . . . . . . . . . . . . . . . . . . . . . . . . . .
K‡jR/D”Pgva¨wgK we`¨vjq (cÖ¯—vweZ) Gi . . . . . . . . . . . .wkve‡l© GKv`k †kªYx †Lvjv I cvV`v‡bi cÖv_wgK AbygwZ
cvIqvi Rb¨ cÖ‡qvRbxq Z_¨vw` wb‡P Dc¯’vcb Kiv n‡jv :
1. cÖ¯—vweZ K‡jR/D”Pgva¨wgK we`¨vj‡qi bvg :
WvKNi :...............................................................Dc‡Rjv : .................................................................
‡Rjv : ................................................................‡dvb/†gvevBj b¤^i :.....................................................
B-‡gBj : .......................................................... I†qe mvBU:..............................................................
2. wefvM : gvbweK welq:................................................................................................................
…..
wefvM : weÁvb welq : ..............................................................................................................
wefvM : e¨emvq wkv welq : ..............................................................................................................
3. Rwgi cwigvY : ..................................................................................................................................
4. fe‡bi weeiY :
K) †kªYxK :.......................L) Awdm :........................M) jvB‡eªwi : (eB‡qi msL¨v ZvwjKvmn)......................
N) weÁvbvMvi (hš¿cvwZi msL¨v ZvwjKvmn) :...........................O) Kgbi“g (msev`c‡Îi bvg) :..........................
P) Kw¤úDUvi j¨ve :........................................... Kw¤úDUv‡ii msL¨v : .....................................................
Q) Uq‡j‡Ui msL¨v : ..........................................R) cvbxq R‡ji e¨e¯’v : ..................................................
5. Avw_©K Ae¯’v :
K) msiwZ Znwej :..........................................L) mvaviY Znwej : .......................................................
M) Ab¨vb¨ Znwej : ............................................N) K‡j‡Ri Av‡qi cÖavb Drmmg~n : ..................................
6. wkK I Kg©Pvixi Z_¨ :
bvg c`ex wkvMZ †hvM¨Zv ‡hvM`v‡bi ZvwiL wbeÜb/Bb‡W·
b¤^i
7. ‡Ljvayjvi myweav msµvš— weeiY :
K. †Ljvi gv‡Vi cwigvY : .....................................L) †Ljvayjvi miÄvgvw`i weeiY :........................................
8. AvmevecÎ : †eÂ- ................ †Pqvi-................. ‡Uwej-................. Avjwgiv-..................Ab¨vb¨-..................
9. Dc‡Rjvi RbmsL¨v : ..................10. GKB Dc‡Rjvfy³/wbKUeZ©x Dc‡Rjvi K‡j‡Ri bvg I `~iZ¡: ......................
11. wbKUeZ©x D”Pwe`¨vjq/mggv‡bi we`¨vj‡qi msL¨v : ...............12. wbe©vnx KwgwU - (†ev‡W©i wewa Abyhvqx MVb Ki‡Z n‡e)
mfvcwZ
wbe©vnx KwgwU
c~Y© bvgmn mxj
†gvevBj b¤^i:
Aa¨
......................................................
†gvevBj b¤^i:
B-‡gBj :
I†qe mvBU:
Pjgvb cvZv-

- 2 -
mshyw³ :
1. Rwgi `wjjmn LvRbv cwi‡kv‡ai iwk‡`i d‡UvKwc (†g‡Uªv- .50 GKi, kni I †cŠi GjvKv-.75 GKi I
gd¯^j- 1.00 GKi)
2. msiwZ Znwe‡ji e¨vsK mb` (GKj) UvKv
3. mvaviY Znwe‡ji e¨vsK mb` (cÂvk nvRvi) UvKv
4. wkK I Kg©Pvixi ZvwjKv- (miKvi wba©vwiZ Rbej KvVv‡gv Abyhvqx)
5. wbe©vnx KwgwUi ZvwjKv
6. Aa¨ wb‡qvM msµvš— mKj KvMRc‡Îi d‡UvKwc
7. fvicÖvß Aa¨‡i †‡Î KwgwUi †iRy‡jk‡bi d‡UvKwc
8. wbKUeZ©x K‡j‡Ri `~i‡Z¡i mb`(Dc‡Rjv wbe©vnx Kg©KZ©v KZ©„K cÖ`Ë)
9. Dc‡Rjvi RbmsL¨vi mb` (Dc‡Rjv cwimsL¨vb Kg©KZ©v KZ©„K cÖ`Ë)
10. jvB‡eªwii eB‡qi ZvwjKv (msL¨v-2000 b~¨bZg)
11. ˆeÁvwbK hš¿cvwZ I ivmvqwbK `ªe¨vw`i ZvwjKv
12. Avmevec‡Îi ZvwjKv
13. e¨w³bv‡g cÖwZôv‡bi †‡Î- GKKvjxb c‡bi j UvKv| Aa¨/mfvcwZ I †Rjv wkv Awdmv‡ii ‡hŠ_
¯^v‡i cwiPvwjZ e¨vsK wnmve _vK‡Z n‡e|
14. K‡jR cÖwZôv msµvš— wbe©vnx KwgwU †iRy‡jkb|
15. cÖv_wgK AbygwZ wd (Qq nvRvi UvKv)|
K‡jR cwi`k©K
gva¨wgK I D”Pgva¨wgK wkv‡evW©
Kzwgj­v