Pwrm nM: 35 (vyKo rUl 265) lwBpwqrI

dI qsdIk
pMjwb iblifMg AYNf Adr kMstrkSn vrkrz vYlPyAr borf vlo auswrI ikrqIAW dI lVkIAW dI SwdI Sudw Poto
dy mOky qy 31000/- rupey Sgn skIm dyx sbMDI Pwrm
(i/eo bkGgksoh ;arB ;ehw nXhB gzikp ;oeko dh fe;/ j'o ;z;Ek gk;'A nfijk bkG b? fojk j't/ sK th p'ov
gk;'A ;arB ;ehw nXhB bkG gqkgs eo ;edk j?)

1. pMjIikRq auswrI ikrqI dw nW Aqy pqw (AMgRyjI/ pMjwbI ivc ________________________ lVkI ijsdI
________________________
SwdI hY, dI
2. ipqw dw nwm(AgRyjI/ pMjwbI ivc) ________________________
qsdIk Sudw
3. rijstRySn nMbr ________________________ Poto
4. tYlIPon/mobwiel nMbr ________________________
5. lVkI dw nW ________________________
6. lVkI dI jnm imqI (sbUq vjoN srtIiPkyt) jo ik skUl/rijstRwr
jnm Aqy mOq vloN jwrI kIqw hI mMinAw jwvygw _________________________
7. ivAwh dw sQwn, pUry pqy smyq _________________________
8. ivAwh smyN lVkI dI aumr _________________________
9. auswrI kMmW nwl sbMDq pySw _________________________
10. AwDwr kwrf nMbr
11. AMSdwn dI rwSI iks imqI qk jmW hY _________________________
12. kI pRwrQI ny ies skIm ADIn pihlW lwB ilAw hY[ jykr
hW qW aus lVkI dy nW smyq pUrI jwxkwrI ________________________
13. lwBpwqrI dy bYNk Kwqy sbMDI vyrvy

lVI nM: bYNk/ brWc dw nW Kwqw nMbr AYn.eI.AYP.tI nMbr

mYN GoiSq krdw/krdI hW ik auprokq id`qI sUcnw irkwrf dy ADwr qy s`c Aqy TIk hY [

imqI: (lVkI dy hsqwKr)

(lwBpwqrI dy hsqwKr)
(lokl AQwrtI jW srpMc vloN BirAw jwxw hY)

qsdIk kIqw jwNdw hY ik SRI/SRImqI____________________ p`qr/pqnI

SRI_____________________ bqOr _________________ kMm krdw hY[ ieh ikrqI myry hlky ivc
rihMdw/ rihMdI hY Aqy ausdI lVkI ims ___________ dI SwdI imqI ______________ nMU sMpn hoeI hY Aqy
ikrqI vloN idqI sUcnW pUrI qrHW shI hY[

imqI: lokl AQwrtI/srpMc dy hsqwKr,

(mohr smyq)

mYN ieh qsdIk krdw hW ik aukq swrI sUcnw dI irkwrf Anuswr pVqwl kr leI geI hY jo ik shI pweI
geI hY[ SRI/SRImqI ____________ lwBpwqrI nMU lVkI dI SwdI leI ___________ rupey dI Sgn dI rwSI dyx
dI isPwrS kIqI jWdI hY[

ikrq ieMspYktr dy hsqwKr

mohr smyq

qsdIk kIqw jWdw hY ik mYN ikrq ieMspYktr dI auprokq irport nwl sihmq hW Aqy lwBpwqrI nMU
auprokq lwB dyx dI isPwrS kIqI jWdI hY[

;jkfJe feos efw;aBo$ feos s/

;[bkj nc;o dy hsqwKr Aqy mohr
SrqW :-

1. kyvl do lVkIAW dI SwdI dy mOky qy ie`k vwr hI Sgn skIm lwgU hovygI, nw ik qlwk Awid ho jwx dI
sUrq iv`c dubwrw SwdI krn qy vI[

2. pMjIikRq ikrqI lVkI dI SwdI dI inSicq qwrIK qoN bwAd 3 wjhB/ dy AMdr-AMdr drKwsq dy
skdw hY[SwdI dy sbUq ivc srpMc jW iksy lokl AQwrtI vloN idqw srtIiPkyt drKwsq dy nwl
lgwauNxw zrUrI hovygw[