Avj-nvBAvZzj Djqv wjj-RvwgÔAvwZj KIwgqv evsjv‡`k Qwe

`vIiv‡q nv`xm (ZvKgxj) cixÿv 1445 wnRix/1430 e½vã/2024 Cmvã (QvÎx‡`i Rb¨
cÖ‡hvR¨ bq)
cixÿv_©x wbeÜb dig (e¨w³MZ)
1. µwgK bs (gv`ivmvi Awdm c~iY Ki‡e) :

2. gv`ivmv †KvW : gv`ivmvi bvg :

3. weMZ cixÿvi cv‡mi Z_¨ :

cixÿvi cv‡mi cÖvß
†ivj bs gv`ivmv †evW©
bvg mb wefvM
dhxjZ

`vIiv‡q
nv`xm
4. Av‡e`‡bi aib : (wUKwP‎ý ÔÕ w`b)

(1) wbqwgZ (2) AwbqwgZ : (K) †hgbx (L) gv‡bvbœqb (M) Ab¨vb¨

†hgbx I gv‡bvbœqb cixÿv_©x‡`i †ÿ‡Î wb‡Pi Z_¨ mwVKfv‡e †`qv Riæwi

cixÿvi †h wKZv‡ei cixÿv w`‡e cÖvß wefvM
†ivj bs gv`ivmvi †KvW I bvg
mb (†hgbx cixÿvi †ÿ‡Î) (gv‡bvbœqb cixÿvi †ÿ‡Î)

5. Av‡e`bKvixi Z_¨ : (RvZxq cwiPqcÎ/Rb¥ wbeÜb Abyhvqx c~iY Kiæb)

Aviex :
bvg : evsjv :
Bs‡iwR :
Aviex :
wcZvi bvg : evsjv :
Bs‡iwR :
Aviex :
gvZvi bvg : evsjv :
Bs‡iwR :

cvZv 2 `ªóe¨
Rb¥ ZvwiL (w`b/gvm/eQi) :

Rb¥ wbeÜb/RvZxq cwiPqcÎ bs :

MÖvg/gnjøv : WvKNi :
¯’vqx wVKvbv :
Dc‡Rjv/_vbv : †Rjv :

†hvMv‡hv‡Mi †gvevBj bs :

A½xKvibvgv : Avwg A½xKvi KiwQ †h, (K) Avwg Avnjym mybœvn Iqvj RvgvÔAv‡Zi AvKx`v Ges `viæj Dj~g
†`Ie‡›`i Av`k©, g~jbxwZ I gZ-c‡_i Abymvix; (L) †jevm-†cvkvK, †ekf‚lv, Pvj-Pjb I Pzj-`uvwo‡Z mybœ‡Zi
cve›`; Ges (M) evsjv‡`‡ki Rgn~i (msL¨vMwiô) Djvgv‡q †Kiv‡gi gZvgZ I wm×všÍ‡K gvb¨ Kwi|

Avwg Av‡iv A½xKvi KiwQ †h, Dc‡iv³ Z_¨vejx m¤ú~Y© mwVK| †Kvb Z_¨ AmZ¨ cÖgvwYZ n‡j KZ©…c‡ÿi wm×všÍ
†g‡b wb‡Z eva¨ _vKe|

ZvwiL : ...................................... Av‡e`bKvixi ¯^vÿi

6. gv`ivmvi gynZvwgg/bv‡h‡g ZvÕjxgv‡Zi mZ¨vqb :

Av‡e`bKvixi cÖ`Ë Z_¨mg~n mwVK Ges Zv RvZxq cwiPqcÎ/Rb¥ wbeÜb Abymv‡i c~iY Kiv n‡q‡Q|

ZvwiL : ...................................... ¯^vÿi I wmj

we: `ª: mv`v/bxj is‡qi e¨vKMÖvD‡Û cvm‡cvU© mvB‡Ri m`¨ †Zvjv iwOb Qwe, RvZxq cwiPqcÎ/Rb¥
wbeÜb/cvm‡cvU© I dhxjZ/`vIiv‡q nv`xm cixÿvi b¤^ic‡Îi mZ¨vwqZ d‡UvKwc mshy³ Ki‡Z n‡e| (QvÎx‡`i
Rb¨ Qwei weavb cÖ‡hvR¨ bq)