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wf.AvB.

wc-1 ( webvg~j cvc )

wdm Rgv w`q evsK iwm` GLvb jvMvZ ne

AvwjK cvmcvU Awdm ..............................................


Ave`b b^i ............................... ZvwiL ....................
j b^i ..................................... ZvwiL ....................
evsK kvLv ................................................................
MYcRvZx evsjv`k miKvi
ewnivMgb I cvmcvU Awa`i
XvKv |
cvmcvUi Ave`b
Ave`bci cZKwU Kjvg c~iY KiZ ne| chvR Ask wUK wP (9) w`Z ne| AcqvRbxq Ask chvR bq ge
KiZ ne|
c_g Ask

Ave`bKvixi GKwU Qwe


(4050 wgtwgt AvKvii) |
AvVv w`q GuU w`Z ne|

cbi (15) eQii Kg eqmx


mvbi gvZv, wcZv
A_ev ea AwffveKi GKwU
Ki Qwe (3030 wgt wgt
AvKvii) AvVv w`q GuU
w`Z ne

cbi (15) eQii Kg eqmx


mvbi gvZv, wcZv
A_ev ea AwffveKi GKwU
Ki Qwe (3030 wgt wgt
AvKvii) AvVv w`q GuU
w`Z ne

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cyiv bvg ( WvK bvg mn, hw` _vK ) t.................................................................................................................

2|

bvg ( BsiRxZ eo Ai ) t...........................................................................................................................


( cvmcvU hfve `LZ Pvb )
fvUvi cwiwPwZ b^i ( hw` _vK ) t....................................................................................................................
ckv ( BsiRxZ ) t.......................................................................................................................................
Rb ZvwiL t....................................................... 6| Rbvb ( Rjv ) t.............................................................
DPZv t.......................................................... wgUvi.......................................................................mwUwgUvi
PvLi iO t....................................................... 9| Pzji iO t .......................................................................
mbvKiYi DchvMx jYxq wekl wP t...........................................................................................................
wcZvi bvg I bvMwiKZ ( BsiRxZ ) t................................................................................................................
wcZvi ckv I fvUvi cwiwPwZ b^i ( hw` _vK ) t.................................................................................................
gvZvi bvg I bvMwiKZ ( BsiRxZ ) t................................................................................................................
gvZvi ckv I fvUvi cwiwPwZ b^i ( hw` _vK ) t.................................................................................................
^vgx/xi bvg I bvMwiKZ ( chvR ) ( BsiRxZ ) t.....................................................................................
( Ave`bKvix cyil nj xi bvg Ges gwnjv nj ^vgxi bvg )
ea AwffveKi bvg I bvMwiKZ ( BsiRxZ ) t...................................................................................................
ea AwffveKi mv_ mK ..........................................................................................................................
Ave`bKvixi bvMwiKZ t
Rbm~
cwKm~
`kvi MnYi gvag
Ab Kvbfve
eevwnK Aev t
weevwnZ
AweevwnZ
weaev/wecZxK
ZvjvKcv
vqx wVKvbv ( BsiRxZ ) t
Mvg / evox / ivW t.........................................................................................................................................
WvKNi ( KvW mn ) t......................................................................................................................................
_vbv t................................................................................ Rjv t.................................................................
eZgvb wVKvbv ( BsiRxZ ) t...........................................................................................................................
Mvg/ evox/ ivW t...........................................................................................................................................
WvKNi ( KvW mn ) t......................................................................................................................................
DcRjv / _vbv t................................................................................ Rjv t...................................................
cvw_Z cvmcvUi cvZv msLv t
48 cvZv
64 cvZv

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-t 2 t 23| wcZv / gvZv / ea AwffveKi cvmcvU Ab~a 12 eQi eqmx mvbi bvg Afywi ( gv `ywU mvb ) t
Qwe
Qwe
(1)
(2)

Qj

gq

Qj

bvg t ........................................................
Rb ZvwiL t ...............................................
Rbvb t ............................................... ...
24|

gq

bvg t ............................................................
Rb ZvwiL t ...................................................
Rbvb t .......................................................

`k (10) eQi DxY / weK / nvivbv / mgcYKZ ( mvivi&W ) cvmcvUi t


K. c~ei cvmcvU b^i t .................................................
c`vbi ZvwiL t ............................................
cvmcvUi gqv` t ..............................................
c`vbi vb t ..........................................................
L. nvivbvi t wR. wW. b^i .......................... ZvwiL t ........................ _vbvi bvg t ......................................
M. mgcYi KviY t...............................................................................................................................
wZxq Ask (bevqb)

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2.
3.

cvmcvU b^i t ............................................. c`vbi vb t ................................ ZvwiL t .................................


gqv` DxY nIqvi ZvwiL t .............................................................................................................................
KZ eQii Rb bevqb ne t ............................................................................................................................
ZZxq Ask (mshvRb)

1.
2.

cvmcvU b^i t .......................................... c`vbi vb t ..................................... ZvwiL t ...............................


cvmcvU wbgic cwieZb cqvRb t
K. bvgi evbvb t .......................................................................................................................... Gi cwieZ
..................................................................................................................................................... ne|
L. ckv t ............................................................. Gi cwieZ ............................................................. ne|
M. Rb ZvwiL t ...................................................... Gi cwieZ ............................................................. ne|
N. wVKvbv t ................................................................................................................................. Gi cwieZ
...................................................................................................................................................... ne|
O. Abvb t.................................................................................................................................. Gi cwieZ
.................................................................................................................................................... ne|

3.

we`gvb cvmcvU- G Ab~a 12 eQi eqmx mvbi bvg mshvRb (12 eQii Kg eqmx gv `ywU mvbi bvg hy Kiv hve) t
Qwe

Qwe

(1)

(2)

Qj

gq

bvg t ........................................................
Rb ZvwiL t ...............................................
Rbvb t ...................................................

Qj

gq

bvg t ............................................................
Rb ZvwiL t ....................................................
Rbvb t ........................................................

-t 3 t PZy_ Ask (AsMxKvi)


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(K) Avwg kc_ Ki ejwQ h Ave`bc c` me Z_ mZ Ges Kvb wg_v Z_ w`q _vKj Avwg AvBbZt `bxq ne|
(L) Avwg BZtc~e cvmcvU MnY Kwiwb / KiwQ ( b^i ) t ..................................Kwiwb..........................................
c`vbi ZvwiL t ................. c&hvR bq.................... c`vbi vb t ................... c&hvR bq...........................
gqv` DxY nIqvi ZvwiL t .....................................................................................................................

2|

Avwg Aviv cwZv KiwQ h, Kvb KviY AfveM nq covq we`k _K AvgvK A_ev Avgvi cvlK `k cZvevmb Kivi
hveZxq LiP cwikva Avwg eva _vKe Ges we`k Avgvi gZy NUj gi`ni cwienb LiP Avgvi ea DivwaKvix`i
KvQ _K Av`vqhvM ne|
ZvwiL t .................................

Ave`bKvixi ^vi ev wUcmB


( Abcbq KvwjZ )
cg Ask (mZvqb)

Avgvi vb I wekvmgZ Dci ewYZ Z_ mZ Ges Ave`bKvix ................................................................. eQi hver


Avgvi cwiwPZ| wZwb Avgvi myL Ave`bc ^vi ev wUcmB KiQb|
AvevwmK wVKvbv t .............................................................................
....................................................................................................
Uwjdvb b^i (hw` _vK) t ...............................................................

mZvqbKvixi c`exmn bvg I ^vi


( mxjgvni w`Z ne )
ZvwiL t ...............................

l Ask (Awdm eenvii Rb)


BmyKZ cvmcvU b^i t ............................................................ cvmcvU MnYKvixi ^vi t .............................................
c`vbi vb t ....................................... ZvwiL t ................................ gqv` DxY nIqvi ZvwiL t ..................................
cvmcvU ^viKvix KgKZvi ^vi ( mxjgvnimn ) t .......................................................................................................
Ave`bKvixi cvmcvU eenvh ^vi ev wUcmB (Abcbq KvwjZ ) t

..............................................................................................................................................................................
mg Ask (Ave`bc Rgvi iwm`)

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AvwjK cvmcvU Awdm t ...........................................................................


bw_ b^i t .............................................................. Rgvi ZvwiL t ..................................................................
bw_i cKvi t
AvRvwZK
wekl
bZzb
weK
bevqb
mshvRb
mskvab
wd wnme RgvKZ UvKvi cwigvY t ....................................................................................................................
c`vbi ZvwiL t ............................................................................................................................................

iwm` c`vbKvixi c`exmn bvg I ^vi


( mxjgvni w`Z ne )

-t 4 t Ave`bc c~iY I cvmcvU c`vb msv mvaviY Z_vejx t


1| Ave`bKvix wbavwiZ Ave`b dig A_ev Ave`b dgi AweKj UvBc / mvBKvvBj / dUvKwcKZ dgI Ave`b KiZ
cvieb|
2| Ave`bKvixK Kvwj w`q BsiRx A_ev evsjvq `yKwc Ave`bc ( g~j ev dUvKwc ) c~iY KiZ ne|
3| Ave`bKvixi wZbwU cvmcvU mvBR ( 4050 wgt wgt ) I GKwU v mvBR (3030 wgt wgt ) Qwe `iKvi| GKwU Ki
4050 wgt wgt AvKvii Qwe `ywU Ave`bci cwZwUi c_g cvi wbw` vb jvMvZ ne Ges Qwei Dci mZvqb KiZ
ne|
4| cbi (15) eQii Kg eqmx wk`i c_K cvmcvUi gv I evev `yRbi A_ev ea AwffveKi 3030 wgt wgt
AvKvii `ywU Qwe Ave`bci wbw` RvqMvq jvMvZ ne Ges Qwei Dci mZvqb KiZ ne|
5| chvR fvUvi AvB.wW. KvWi (hw` _vK), A_ev cvmwK UKwbKvj mb`mg~ni ( hgb- Wvvi, Bwwbqvi, WvBfvi
BZvw` ) mZvwqZ dUvKwc `vwLj KiZ ne|
6| bZzb cvmcvU eviv ( 12 ) eQii Kg eqmx mvbi bvg Afzwi Pvi Kwc 3030 wgt wgt AvKvii Qwe jvMe|
`ywU digB cwZRbi GKwU Ki Qwe jvwMq Qwei Dci mZvqb KiZ ne I `ywU AwZwi Qwe w`Z ne (digi 1g
Aski 23 b^i GwU `e)|
7| we`gvb cvmcvU eviv (12) eQii Kg eqmx mvbi bvg mshvRbi Pvi Kwc 3030 wgt wgt AvKvii Qwe jvMve|
`ywU digi cwZwUZ cwZRbi GKwU Ki Qwe jvwMq Qwei Dci mZvqb KiZ ne Ges `ywU AwZwi Qwe Rgv w`Z ne
(3q Aski 3 b^i GwU `e)|
8| eviv ( 12 ) eQii Kg eqmx wk`i Ave`bci 1g Aski 14, 15 I 16 b^i GwU c~iYc~eK wcZv A_ev gvZv
A_ev ea AwffveK ^vi Kieb|
9| Ave`bci 4_ Ask ( AsMxKvi ) Ges 6 Ask- Gi wbavwiZ vb Ave`bKvixK `yB vb GKB aiYi ^vi ev wUcmB
w`Z ne| ei wfZii ^vi ev wUcmBwU cvmcvU jvMvbv ne|
10| wbgewYZ ewMY cvmcvUi Ave`c I Qwe mZvqb KiZ cvieb t (1) msm` m`m, (2) wmwU Kcvikbi gqi, WcywU
gqi I KwgkbviMY, (3) MRUW KgKZv, (4) wekwe`vjq wkK, (5) cimfv, DcRjv cwil` I BDwbqb cwil`i
PqvigvbMY, (6) emiKvix KjRi wkK, (7) emiKvix DP we`vjqi cavb wkK, (8) `wbK cwKvi mv`K, (9)
ci KwgkbviMY, (10) ivvq evsK I ^vqZkvwmZ msv ev Kcvikbi bZzb RvZxq eZb ji 7g I Z`~a MWi
KgKZvMY|
11| Ave`b dig AvVv w`q jvMvbv Qwei Dci Ggbfve mZvqb KiZ ne hvZ mZvqbKvixi ^vi I mxjgvni Qwei I
digi wKQz Ask Ryo co Ges GKB KgKZv Qwei Dci I digi 5g Ask mZvqb Kieb|
12| bvg mskvabi Gm Gm wm ev mggvbi cixvi mb` A_ev c_g kYxi gvwRUi Av`vjZi njdbvgv (GwdWwfU)
A_ev cwKvi wew AvekK ne|
13| eqm mskvabi Gm Gm wm ev mggvbi cixvi mb` A_ev Rbmb` A_ev Rb wbexKiY mb`c AvekK ne|
14| ckv cwieZbi cwiewZZ ckvi mc mb` AvekK
ne|
15| vqx wVKvbv cwieZbi fvUvi ZvwjKv A_ev fvUvi
cwiPqc A_ev 10 bs AbyQ` ZvwjKvfy eweM KZK
c` mb` A_ev cwiewZZ wVKvbv mK h Kvb wbfihvM cgvY AvekK ne|
16| mvbi bvg mshvRbi D mvbi Rb mb` Ave`bci mv_ `vwLj KiZ ne|
17| bZzb cvmcvU c`vbi mgqmxgv t
K. AwZ Riyix t evnvi (72) NUvi ga cywjk cwZe`b cvIqv bv MjI cvmcvU c`vb Kiv ne| weic cwZe`b cvIqv
Mj AvBbMZ eev bqv ne|
L. Riix t fvUvi AvBwW KvW _vKj ev cywjk cwZe`b cvIqv Mj GMvi (11) w`b ci, Ab_vq GKzk ( 21 ) w`b ci
cvmcvU c`vb Kiv ne| weic cwZe`b cvIqv Mj AvBbMZ eev bqv ne|
M. mvaviY t fvUvi AvBwW KvW _vKj ev cywjk cwZe`b cvIqv Mj GKzk (21) w`b ci Ab_vq wk (30) w`b ci
cvmcvU c`vb Kiv ne| weic cwZe`b cvIqv Mj AvBbMZ eev bqv ne|
18| RgvKZ cvmcvUi cwieZ hvwPZ bZzb, weK, bevqb, mshvRb BZvw` Riix wd c`vb Kij evnvi (72) NUvi
ga Ges mvaviY wd c`vb Kij mvZ (7) Kgw`emi ga Zv c`vb Kiv ne|

evsjv`k miKvii B-wmwURb mvwfm GwcKkb _K gyw`Z

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