Bs‡iwR wefvM

ivRkvnx wek¦we`¨vjq
mܨvKvjxb Gg. G. †kªYx‡Z fwZ©i cvm‡cvU© mvB‡Ri Qwe
cÖv_wgK Av‡e`bcÎ
wk¶vel©: 2022-2023 (6ô e¨vP) RvbyqvwiÕ23

Av‡e`bcÎ QvÎ/QvÎx‡K (fwZ© cixÿvi †ivj b¤^i ev‡`) c~iY Ki‡Z n‡e| Am¤ú~Y© Av‡e`bcÎ evwZj e‡j MY¨ n‡e|

†h †cÖvMÖv‡g fwZ© n‡Z B”QzK: fwZ© cix¶vi †ivj b¤^i: (Bs‡iRx‡Z)

(wefvM c~iY Ki‡e)
wUK w`b: 1. Gg. G. Bb Bswjk (1 eQi †gqvw`) 2. Gg. G. Bb B. Gj. wU. (1 eQi †gqvw`)
3. Gg. G. Bb Bswjk (2 eQi †gqvw`) 4. Gg. G. Bb B. Gj. wU. (2 eQi †gqvw`)
1| Av‡e`bKvixi bvg (evsjvq) : i‡³i MÖæc:..........................

(Bs‡iwR‡Z: Block Letter) :

2| wcZvi bvg (Bs‡iwR‡Z: Block Letter) :

3| gvZvi bvg (Bs‡iwR‡Z: Block Letter) :

4| c~Y© wVKvbv: moK/MÖvg/gnjøv: ......................................... WvKNi: ................................ _vbv/ Dc‡Rjv:......................
†Rjv:....................................... †cvó‡KvW: ............................ †gvevBj b¤^i: ........................................................
RvZxq cwiPq cÎ b¤^i:.......................................................... Rb¥wbeÜb b¤^i:............................................................
wcZvi AeZ©gv‡b Awffve‡Ki bvg I m¤úK©:............................................. wcZvi/Awffve‡Ki †gvevBj b¤^i...................................
email id:..........................................................................................
5| wk¶vMZ †hvM¨Zvi weeiY:
cix¶vi cÖvß
cix¶vi bvg wk¶v †evW© wk¶v cÖwZôv‡bi bvg kvLv †ivj b¤^i
eQi wRwcG/wmwRwcG
GmGmwm/mggvb

GBPGmwm/mggvb

weG (cvk/m¤§vb)

Gg.G.
weKv‡k UvKv †`Iqvi †ÿ‡Î
weKvk b¤^i : 01715650175, 01742191344
†h b¤^‡i UvKv cvVv‡bv n‡”Q:...............................................
†h b¤^i †_‡K UvKv cvVv‡bv n‡”Q:.........................................
UvKv cvVv‡bvi ZvwiL Ges Transaction AvBwW:.................................

Av‡e`bKvixi bvg/¯^v¶i I ZvwiL

................................................................................. ....................................................................................................
fwZ© cix¶vi †ivj b¤^i (Bs‡iwR‡Z)
(†ivj wefvM c~iY Ki‡e)
Bs‡iwR wefvM
ivRkvnx wek¦we`¨vjq
mܨvKvjxb Gg. G. †kªYx‡Z fwZ© cix¶v, wk¶vel©: 2022-2023 (6ô e¨vP) RvbyqvwiÕ23
cÖ‡ek cÎ
cvm‡cvU© mvB‡Ri Qwe
(fwZ© cix¶vi mgq cÖ‡ekcÎ †`Lv‡Z n‡e)
†h †cÖvMÖv‡g fwZ© n‡Z B”QzK:
Av‡e`bKvixi bvg (evsjvq):
(Bs‡iwR‡Z: Block Letter):

Av‡e`bKvixi bvg/¯^v¶i wefvMxq mfvcwZi wmjmn ¯^v¶i