wemwgjøvwni ivngvwbi ivwng

ÒdRjyj nK UvIqviÓ
‡`vKvb fvovwUqv AMÖxg eivÏ Pzw³cÎ `wjj
bvg:................................................................wcZv:......................................................
....
MÖvg:............................WvKNi:........................Dc‡Rjv.....................‡Rjv:................
.........|
.................... 1g cÿ|

bvg:................................................................wcZv:......................................................
....

MÖvg:............................WvKNi:........................Dc‡Rjv.....................‡Rjv:................
.........|
.................... 2q cÿ|

cig Kiæbvgq Avjøvni bv‡g A¯’vqx mZ¡ wenxb dRjyj nK gv‡K©U Gi †`vKvb
fvovwUqv AMÖxg eivÏ Pzw³cÎ `wj‡ji D‡Ï‡k¨ wjwLqv hvB‡ZwQ †h, wb¤œ Zdwmj
ewY©Z gv‡K©‡Ui †`vKvb M„‡n Avcwbiv 1g cÿ MY gv‡K©‡Ui gvwjK
mZ¡evb I †fvM `Lj`vi _vKv Ae¯v’q Avcwb 2q cÿ e¨emv evwbR¨ Kivi Rb¨
A¯’vqx fv‡e (3 wZb ermi) †gqv‡` ‡`vKvb fvov cvIqvi AMÖxg cÖv_©bv
Kwi‡j| Avcwbiv 1g cÿMY 2q c‡ÿi gÄyiµ‡g A`¨ PjwZ mb........ ZvwiL n‡Z
h_vixwZ wbqg Kvbyb I kZ© gvwbqv eywKs ZvwiL nB‡Z cieZ©x 1 ermi ci
†`vKvb †KvVv eywSqv †`Iqvi wbwg‡³ HK¨gZ †cvlb K‡ib| †`vKvb †KvVv
AMÖxg eywKs I eywSqv cvIqvi ci Avcwbiv 1g cÿMY 2q cÿ nB‡Z UvKv eyR
cÖ‡eva cvBqv I wbqv Avcbviv 1g cÿ 2q c‡ÿi `L‡j †`vKvbNi eySvBqv w`‡j
Avcwb 2q cÿ †`vKvb †KvVv eyS cÖ‡eva cvBqv I wbqv e¨emv evwbR¨
Kwi‡Z i‡nb ev _vKzb| GB H‡K¨ ev‡K¨ Avcwbiv 1g cÿMY 2q cÿM‡Yi mwnZ
A¯’vqx mZ¡wenxb AMÖxg eywKs I †`vKvb †KvVv eywSqv cvIqvi ci (3 wZb
ermi) †gqv‡` gv‡K©‡Ui †`vKvb †KvVv fvovwUqv KeywjqZ `wjj wjwLqv
w`jvg|

Pjgvb cvZv- 02

cvZv- 02

kZ© mg~n
1| AwMÖg eywKs -
** 1g Zjv m¤ú~Y© Kvc‡oi †`vKvb h_vixw_ A,B,C wZbwU K¨vUvMix‡Z cÖwZ ¯‹qvi
wdU .............../UvKv AMÖxg Ges .............. UvKv K‡i ¯‹qvi wdU fvov|
** 2q Zjv A,B,C,D K¨vUvMix‡Z wbw`©ó AvB‡Ug -
A- ‡R›Um AvB‡Ug, B- wKW&m AvB‡Ug, C- RyZvi AvB‡Ug, D- Km‡gwU·,
cÖwZ ¯‹qvi wdU................... UvKv AMÖxg Ges .............. UvKv K‡i ¯‹qvi wdU fvov|
** 3q Zjv A,B,C,D K¨vUvMix‡Z wbw`©ó AvB‡Ug -
A- ‡gvevBj AvB‡Ug , B- ‡µvKvixR mvgMÖx, C- B‡jKUªwb·, D- dv÷©dzW AvB‡Ug
cÖwZ ¯‹qvi wdU........
UvKv AMÖxg Ges ............... UvKv K‡i ¯‹qvi wdU fvov|
** 4_© Zjvq : Awdm, KwgDwbwU †m›Uvi
** 5g I 6ô Zjvq : d¬vU|
2| AwMÖg eywKs UvKv 50% cwi‡kva| Ges KvR PjvKvjxb mg‡q evwK UvKv cÖ‡qvRb
n‡j w`‡Z eva¨ _vwKe|
3| m¤ú~Y© AwMÖg UvKv eywSqv cvIqvi 1 erm‡ii g‡a¨ †`vKvb †KvVv 2q cÿ‡K
eywS‡q †`Iqv n‡e|
4| 1g cÿM‡Yi AbygwZ e¨ZxZ 2q cÿ Kv‡ivi Kv‡Q †`vKvb n¯ÍvšÍi Ki‡Z cvi‡e bv|
5| cÖwZ gv‡mi: 5 Zvwi‡Li g‡a¨ mvwf©m PvR©,we`y¨r wej I fvovi UvKv cwi‡kva
Kwi‡Z eva¨ _vwKe| mKj cÖKvi †jb‡`b gv‡K©‡Ui KZ…©c‡ÿi e¨vsK wnmv‡e Rgv Ki‡Z
n‡e Ges Rgvi wiwmU KZ©„c‡ÿi wbKU eywS‡q w`‡eb|
6| cÖwZ wZb ermi ci ci †`vKvb †KvVvi †gqv` AwMÖg RvgvbZ I fvov Av‡jvPbv
mv‡c‡ÿ wba©viY Kiv n‡e|
7| 2q c‡ÿi Øviv hw` gv‡K©‡Ui ( †`vKvb) †Kvb ÿq ÿwZ nq Zv n‡j wbR Li‡P wVK K‡i
w`‡Z eva¨ _vwKe|
8| gv‡K©U cÖwZw`b mKvj 8Uv n‡Z ivZ 9Uv ch©šÍ eva¨Zvg~jK †Lvjv ivL‡Z n‡e Ges
we‡kl w`‡b D³ mgq cwieZ©b n‡Z cv‡i|
9| †Kvb †`vKvb/e¨emvqx AbvKvw•LZ fv‡e †`vKvb hw` eÜ iv‡L Zv n‡j gv‡K©U
KZ©„cÿ‡K Aek¨B AewnZ Ki‡Z n‡e|
10| 2q cÿ hw` wbR B”Qvq †`vKvb †KvVv Qvwoqv †h‡Z Pvq gv‡K©U KZ…©cÿ D³
gv‡K©‡Ui ¯^v‡_© 2q cÿ‡K Qvovi Rb¨ cÖ‡qvRb †eva nq| 1g cÿ I 2q cÿ Df‡qB 1Uv w`b
mgq wb‡q †bvwUk w`‡Z cvi‡eb Ges 1g cÿ I 2q c‡ÿi cvIbv I †`bv cwi‡kv‡ai gva¨‡g D³
wm×všÍ gvwbqv wb‡Z eva¨ _vwK‡e|
Pjgvb cvZv -03
cvZv-03
11| 2q cÿ (fvovwUqv) Pzw³c‡Îi g‡a¨ e¨emvi aib e¨ZxZ Ab¨ †Kvb e¨emv Ki‡Z cvi‡e bv|
hw` aib cwieZ©b Ki‡Z PvB‡j Aek¨B gv‡K©U KZ…©c‡ÿi gva¨‡g wm×všÍ wb‡Z n‡e|
12| 2q cÿ‡K Aek¨B Zvi wbR Li‡P AwMœ wbievcK e¨e¯’v ivL‡Z n‡e| AÎ †`vKvb wfwU
†`wL‡q †h †Kvb e¨vsK ev cÖwZôvb ev e¨w³i wbKU nB‡Z FY MÖnY Kwi‡j 1g cÿ `vqx
_vwK‡e bv|
13| 2q cÿ KZ©©©©©©©©©©©„„„K cwiPvwjZ e¨emv cÖwZôv‡bi bv‡g ‡UªW
jvB‡mÝ,f¨vU,BbKvg U¨v· 2q cÿB cwi‡kva Kwi‡e Ges Zvi Rb¨ †Kvb KZ…©c‡ÿi wbKU
1g cÿ `vqx _vK‡e bv Ges †`vKvb wfwU e¨vs‡Ki wbKU `vqe× Kwi‡Z cvwi‡e bv|
14| †`vKvb fvov ci ci 2q cÿ 03 (wZb) gvm cwi‡kva Kwi‡Z bv cvwi‡j †`vKv‡bi AwMÖg
n‡Z 1g cÿ KvwUqv ivwL‡e, Bnv‡Z 2q c‡ÿi †Kvb cÖKvi IRi AvcwË _vwK‡e bv|
15| fvowUqv 2q cÿ †Kvb Ae¯’v‡ZB Dcfvov cÖ`vb Kwi‡Z cvwi‡e bv| Kwi‡j Zvnv
cÖKvk cvB‡j mv‡_ mv‡_ AÎ fvovwUqv Pzw³cÎ evwZj ewjqv Mb¨ nB‡e|
16| †`vKvb wfwU eywSqv †bIqvi mgq †`vKv‡bi †W‡Kv‡ikb †h iKg MÖnb Kiv n‡qwQj,
†`vKvb fvovwUqv Pzw³c‡Îi †gqv` †k‡l †`vKvb eywS‡q †`Iqvi mgq †`vKv‡bi
†W‡Kv‡ikb ms¯‹vi K‡i fvj Ges e¨envi †hvM¨ Kwiqv w`‡Z eva¨ _vwK‡e|
GZØv‡_© Avgiv Dfq cÿM‡Yi ¯^Áv‡b,my¯’¨ wP‡Ë †¯^”Qvq AÎ 03(wZb) eQi
†gqv`x †`vKvb fvovwUqv Pzw³cÎ `wj‡j wb¤œwjwLZ ¯^vÿxM‡Yi m¤§y‡L ¯^vÿi µ‡g
Avgv‡`i wbR wbR bvg m¤úv`b Kwiqv w`jvg I wbjvg|
BwZÑ
Zdwmj ‡PŠnÏx
‡Rjv-eªvþYevwoqv,_vbv-Kmev, †gŠRv Kmev w¯’Z dRjyj nK gv‡K©U.......Zjv ..........bs
Mwj,........eøK, ......... bs †`vKvb,........................ ¯‹qvi wdU ..................mvU©vi|
¯^vÿxM‡Yi ¯^vÿi :
1|

2|

3|
gv‡K©U KZ…©cÿ ¯^vÿi