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LH" fmdaIK yd foaYSh ffjoH wud;HdxYh hgf;a mj;sk

l<ukdlrK iyldr ;dlaIl fkdjk LKav - 2 [MN-01-2006 ^tA&]
fiajd .Khg wh;a ;k;=re i|yd n|jd .ekSf jD; ;r. Nd.h
i|yd whm;a le|u -2017
Nd.hg fmkS isk Nd.h i|yd b,a lrk
NdId udOH ( ;k;=r iy ukdmh
isxy, - 1" 1' .

fou< - 2" 2' .

bx.%Sis - 3 3' .

^w, wxlh fldgqj ;=< ,shkak'&

01' ^a& whlref.a uq,Zl=re iu ku : ^bx.%Sis lemsg,a wl=frka& W (- SILVA A. D.

Mr./Mrs./Miss :...........................................................................................................................................
^b& imQK ku (- ^bx.%Sis lemsg,a wl=frka& : .....................................................................
....................................................................................................................................................................
^c& imQK ku (- ^isxyf,ka$fouf<ka& : .....................................................................................
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02' ^i& iar ,smskh (- ^bx.%Sis lemsg,a wl=frka& : ....................................................................
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^ii& iar ,smskh (- ^isxyf,ka$fouf<ka& :....................................................................................
....................................................................................................................................................................
^iii& mx ia;%slalh : . (iv) rl:k wxlh : ......................................
(v) Nd. m%fY m;%h th hq;= ,smskh ( ^bx.%Sis lemsg,a wl=frka& : ..........................
....................................................................................................................................................................

03' Wmka kh ( jIh ( udih ( kh (

^i& cd;sl yekqm;a wxlh:

^ii& whm;a Ndr.kakd wjidk kg jhi :
wjqre ( udi ( k (

04' Y%S ,dxlsl mqrjeisfhl= o hk j. ( T ke;

^wod, fldgqj ;=< ,l=K we;=<;a lrkak'&

05' wOHdmk iqiql ( ^w, iy;sl weh hq;=h'&

^i& w' fmd' i' ^id' fm'& Nd.h ( Nd. wxlh : . jIh : .........................

Ihh idud:h Ihh idud:h

1' 5'

2' 6'

3' 7'

4' 8' 1
 ^ii& w' fmd' i' ^W'fm'& Nd.h ( Nd. wxlh : jIh :

Ihh idud:h Ihh idud:h

1' 3'

2' 4'

^iii& m,mqreoao (- we; ke;

^w< fldgqj ;=< ,l=K we;=<;a lrkak'&
w< ia;r i|yka lrkak' ^iy;sl uska ikd: l< hq;=h'& ................................................................
....................................................................................................................................................................
^iv& jD;a;Sh iqiql ^;k;=rg w<j& (
we; ke;
^w< fldgqj ;=< ,l=K we;=<;a lrkak'& w< ia;r i|yka lrkak' ^iy;sl uska ikd:
l< hq;=h'& : ...........................................................................................................................................
....................................................................................................................................................................

06' Tn ljrl fyda ljr fyda fpdaokdjla i|yd Widhlska jrolre ;sfo@ T ke;
^w< fldgqj ;=< ,l=K we;=<;a lrkak'&
T k ia;r imhkak' : .............................................................................................................................
....................................................................................................................................................................

07' whlref.a iy;slh (

..........fuys i|yka lr we;s f;dr;=re udf.a kSf yd Yajdih m i;H yd ksjer nj;a" ksh;
Nd. .dia;=j f.jd ,m; fuys w,jd we;s nj;a fuhska iy;sl lr' fuys we;=<;a h lsis
ia;rhla wi;H nj fyda idjoH nj fyda fidhd.kq ,enqjfyd;a tfia fidhd.kakd ,oafoa
f;dard.ekSug fmr k fuu whm; wj,x.= jk njo" f;dard.ekSfuka miqj k h lsis jkahla
fkdue;sj uu fiajfhka mylrkq ,nk njo" ms<s.ks'

uqo,a f.jk ,o ,m; fuys w,jkak' tys Pdhd msgm;la <

;nd.kak'
kh : .. ...
whlref.a w;aik'

whlref.a w;aik iy;sl lsu

fuu whm; bm;a lrkq ,nk ..
uhd$h ud fm!oa.,slj okakd ykk nj;a" Tyq k ud bmsg Tyqf.a
w;aik ;enQ nj;a" uu iy;sl lr'
kh : .. ...
iy;sl lrkakdf.a w;aik'
iy;sl lrk ks,Odhdf.a imQK ku : ...................................................................................................
;k;=r : .......................................................................................................................................................
,smskh : ...................................................................................................................................................
^ks,uqdj ;nd ikd: l< hq;=hs'&
2