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jkpo;ehL muR - tUtha;j;Jiw - fpU\;zfpup khtl;lk;

rhd;wpjo; vz;.:......................................................
tl;lk;

..................................................

ehs;:

,Ug;gplr;rhd;W
nry;td; / nry;tp:
..............................................................................................................................
j/ng........................................................................... tl;lk;
...............................................................
fpuhkk; fjT vz;.
..............................................................................................................................

....................................................................................................................................
...............................

jkpo;ehL muR - tUtha;j;Jiw - fpU\;zfpup khtl;lk;

vd;w Kftupiar; rhHe;jtH vd rhd;wspf;fg;gLfpwJ.


rhd;wpjo; vz;.:......................................................
tl;lk;
ehs;:

tUkhdr;rhd;W
nry;td; / nry;tp:

....................................................

tl;lhl;rpaH ifnahg;gk;
(mYtyf Kj;jpiuAld;)

..............................................................................................................................
j/ng........................................................................... tl;lk;
...............................................................
fpuhkk; fjT vz;.
..............................................................................................................................

....................................................................................................................................
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.............................

'khz;GkpF jkpo;ehL Kjy; mikr;rupd; rpwg;Gj;


jpl;lj;jpd; fPo; 2012-2013-k; Mz;L
gs;spfs; %yk; Neubahf
toq;fg;gl;l rhd;W

'khz;GkpF jkpo;ehL Kjy; mikr;rupd; rpwg;Gj;


jpl;lj;jpd; fPo; 2012-2013-k; Mz;L
gs;spfs; %yk; Neubahf
toq;fg;gl;l rhd;W

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fpuhk /efu nghJ kf;fs; thf;F%yk;


kDjhuH njuptpj;Js;s tpguq;fis njupe;J nfhz;Nlhk;. mit midj;Jk; ehq;fs; mwpe;jtiu
cz;ikahdit vdj; njuptpj;Jf;nfhs;fpNwhk;.
ngaH

ifnahg;gk;

1. _______________________________

_______________________________

2. _______________________________

_______________________________

3. _______________________________

_______________________________

4. _______________________________

_______________________________

5. _______________________________

_______________________________

//vd; Kd;dhy;//

fpuhk epHthf mYtyH/tUtha; Ma;thsH


_________________________________________________________________________________
__

tUtha;j;Jiw mYtyHfs; gupe;Jiu

gupe;Jiu nra;ag;gLk;
mYtyHfs;

tprhuiz ehs;
rhjp/tFg;G

fpuhk epHthf
mYtyH

tUtha; Ma;thsH
Jiz tl;lhl;rpaH
(g.F/Mjp kl;Lk;)
tl;lhl;rpaH
(g.F.kl;Lk;)

Mz;L tUkhdk;

,Ug;gplk;

ifnahg;gk;/
Kj;jpiu

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jkpo;ehL muR - tUtha;j;Jiw - fpU\;zfpup khtl;lk;


rhd;wpjo; vz;.:......................................................
tl;lk;

..................................................

ehs;:

,Ug;gplr;rhd;W
nry;td; / nry;tp:
..............................................................................................................................
j/ng........................................................................... tl;lk;
...............................................................
fpuhkk; fjT vz;.
..............................................................................................................................

....................................................................................................................................
.............................

- tUtha;j;Jiw - fpU\;zfpup khtl;lk;


vd;w Kftupiar; jkpo;ehL
rhHe;jtH vdmuR
rhd;wspf;fg;gLfpwJ.
rhd;wpjo; vz;.:......................................................
tl;lk;
ehs;:

tUkhdr;rhd;W

....................................................

tl;lhl;rpaH ifnahg;gk;
(mYtyf Kj;jpiuAld;)

nry;td; / nry;tp:
..............................................................................................................................
j/ng........................................................................... tl;lk;
...............................................................
fpuhkk; fjT vz;.
..............................................................................................................................

....................................................................................................................................
.............................

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,izf;fg;gl;l Mtzq;fs;
rhjpr;rhd;W
cwtpduJ rhjpr;rhd;W efy; (cwT Kiw ..............................................................................

,Ug;gplr;rhd;W
FLk;g ml;il efy;

ngw;NwhH thf;fhsH milahs ml;il efy;

tPl;L trjp ,urPJ efy;

gpw Mtzk; (Fwpg;gpLf


............................................................................................................................)

tUkhdr;rhd;W

rk;gsr;rhd;W Kjypa Mtzq;fs; (Fwpg;gpLf


..............................................................................)
kDjhuH xg;Gjy; rhd;W

1. rhjpr;rhd;W

2. tUkhdr; rhd;W

3. ,Ug;gplr;rhd;W ngw;Wf;nfhz;Nld;.

epue;ju rhjpr;rhd;W vz;. ..................................................................


(to be filled by Taluk Office)

//vd; Kd;dhy;//

kDjhuH ifnahg;gk;

jiyikahrpupaH ifnahg;gk;.
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