ÔQK-LÕ

XvKv †Rjv e¨ZxZ Ab¨vb¨ †Rjvi Rb¨ wba©vwiZ Av‡e`b cÎ|

‡WcywU †Rbv‡ij g¨v‡bRvi/

Gwm÷¨v›U †Rbv‡ij g¨v‡bRvi
‡mvbvjx e¨vsK wjwg‡UW
wcÖwÝcvj Awdm/ wiwRIbvj Awdm
......................

welq t †mvbvjx e¨vsK wjwg‡UW Gi c¨v‡bj GW‡fv‡KU wn‡m‡e wb‡qv‡Mi Av‡e`b

cÎ|
g‡nv`q,
Dc‡iv³ wel‡q weMZ ................................................... Zvwi‡L ..................................................................
cwÎKvq cÖKvwkZ weÁwßi Av‡jv‡K Avwg wbgœ ¯^v¶iKvix †mvbvjx e¨vsK wjwg‡UW
Gi................................ ‡Rjvi c¨v‡bj GW‡fv‡KU wn‡m‡e wb‡qvM cÖvwßi Rb¨ Av‡e`b KiwQ|
wb‡gœ Avgvi wk¶vMZ †hvM¨Zv, AwfÁZv, Rxeb e„ËvšÍ I Ab¨vb¨ KvMR-cÎvw`/ weeiY
Avcbv‡`i m`q AeMwZ I we‡ePbvi wbwgË mshy³ Kijvg t

1| bvg t
2| wcZvi bvg t
3| gvZvi bvg t
4| ¯’vqx wVKvbv t
5| eZ©gvb wVKvbv t
6| †P¤^v‡ii wVKvbv t
7| ‡dvb b¤^i t Awdmt evmvt ‡gvevt
8| Rb¥ ZvwiL t
9| RvZxqZv t
10| wk¶vMZ †hvM¨Zvi weeiY t
DËxY© cix¶v mg~‡ni bvg †evW©/ wek¦we`¨vj‡qi cv‡mi mb cÖvß wefvM
bvg
Gm,Gm,wm ev mggvb
GBP,Gm,wm ev mggvb
¯œvZK
Gj,Gj,we/ Gj,Gj,Gg (Abvm©)
¯œvZ‡KvËi /Gj,Gj,Gg

11| AwZwi³ wk¶vMZ †hvM¨Zvi weeiY (hw` _v‡K) t

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

12| AwfÁZv weeiY t (K) wbgœ Av`vj‡Z ........................... ermi (†`Iqvbx I ‡dŠR`vix
Av`vjZ)
(L) evsjv‡`k mycÖxg †KvU t nvB‡KvU© wWwfk‡b
.................................... ermi|
Avcx‡jU wWwfk‡b .................................... ermi|
13| ‡mvbvjx e¨vs‡Ki c¨v‡bj AvBbRxex wn‡m‡e weMZ 2 eQ‡ii gvgjv cwiPvjbv msµvšÍ
Z_¨t
(K) cwiPvjbvaxb gvgjv msL¨v I wb®úwËi nvit
‡gvU gvgjvi wb®úwËK…Z gvgjvi eZ©gv‡b Pjgvb gvgjvi gšÍe¨
msL¨v msL¨v msL¨v

(L) cwiPvjbvaxb gvgjvi weeiYt (AwZwi³ KvMR ms‡hvRb Kiæb)

µtbs gvgjvi gvgjv b¤^i I gvgjv kvLvi me©‡kl gšÍe¨
weeib mvj K¨vUvMix bvg Ae¯’v

/conversion/tmp/activity_task_scratch/527238691.doc
14| eZ©gv‡b AÎ e¨vsK/ Ab¨ †Kvb e¨vsK/ Avw_©K cÖwZôv‡b AvBb Dc‡`óv/
c¨v‡bj GW‡fv‡KU wn‡m‡e wb‡qvwRZ _vK‡j Zvi weeiY t

2q c„t `ªt-

tt- 2 -tt

AZGe, Avgvi Dc‡iv³ Z_¨vw`/ welqvw` we‡ePbvc~e©K Avgv‡K †mvbvjx e¨vsK

wjwg‡UW Gi ......................... ‡Rjvi c¨v‡bj GW‡fv‡KU wn‡m‡e wb‡qvM cÖ`vb Kivi Rb¨ Aby‡iva
Kiv †Mj|

webxZ wb‡e`K,

mshyw³i weeiY t

Av‡e`bKvixi ¯^v¶i

wcÖwÝcvj Awdm/ wiwRIbvj Awdm cÖav‡bi mycvwik|

G g‡g© cÖZ¨qb Kiv hv‡”Q †h, Av‡e`bKvix GW‡fv‡KU
Rbve .....................................................................,
wcZv-................................................................. , gvZv-..................................................................... wVKvbv t
(K) ¯’vqx-......................................................................................................................................................................
(L) eZ©gvb-..................................................................................................................................................................
(M) gšÍe¨-.....................................................................................................................................................................
.....................................................................................................................................................................

AvBbRxex wn‡m‡e wZwb AZ¨šÍ mr, Kg©V, `¶ I AwfÁ| wZwb ivóª/miKvi we‡ivax †Kvb
Kg©Kv‡Û RwoZ bb| Zv‡K AÎv‡ji c¨v‡bj GW‡fv‡KU wn‡m‡e wb‡qvM`v‡bi Rb¨ mycvwik
Kiv n‡jv|

wcÖwÝcvj Awdm/ wiwRIbvj Awdm cÖav‡bi mxjmn ¯^v¶i I ZvwiL

/conversion/tmp/activity_task_scratch/527238691.doc
/conversion/tmp/activity_task_scratch/527238691.doc