ÔÔAcÖZ¨vnvi‡hvM¨ e¨vcK ¶gZvhy³ Avg-‡gv³vi bvgv `wjjÓ

( ïaygvÎ m¤úwË evqbvcÎ, †NvlYvcÎ, iÿYv‡eÿY I ‡Kbv-‡ePvi Rb¨ )

`wj‡ji µwgK bst.......................................... ewn bst ................................................ `wjj bst ....................................................

Kvh©vj‡qi bvg I wVKvbv t .........................................................................................................................................................
`wj‡ji cÖK…wZ †gŠRvi bvg BDwbqb Dc‡Rjv / _vbv †Rjv
Avg-‡gv³vi bvgv

m¤úwËi cwigvY ‡kÖwY

1| m¤úv`‡bi ZvwiL (evsjv I Bs‡iRx‡Z) t

(evsjv) t w`em........................... gvm ..................................... mvj ...........................|
(Bs‡iRx) t w`em........................... gvm ..................................... mvj ............................|
2| Avg-‡gv³vi `wjj `vÎxi bvg, ¯^v¶i I wVKvbvt
bvg t
wcZvi bvg t
¯^vgxi bvg t
gvZvi bvg t
Rb¥ ZvwiL / eqm t
RvZxqZv t
ag© t
†ckv t
cvm‡cvU© bs t
¯’vqx wVKvbv t MÖvg/evmv bs/d¬¨vU bs : ................................................. ‡ivW/eøK/‡m±i : ....................................................
WvKNi : ....................................... Dc‡Rjv/_vbv : ........................................ †Rjv : ..............................
eZ©gvb wVKvbv t .........................................................................................................................................................

3| Avg-‡gv³vi `wjj MÖwnZvi bvg, ¯^v¶i I wVKvbvt

bvg t
wcZvi bvg t
gvZvi bvg t
Rb¥ ZvwiL / eqm t
RvZxqZv t
ag© t
†ckv t
RvZxq cwiPqcÎ bs t
¯’vqx wVKvbv t MÖvg/evmv bs/d¬¨vU bs : ................................................. ‡ivW/eøK/‡m±i : ....................................................
WvKNi : ....................................... Dc‡Rjv/_vbv : ........................................ †Rjv : ..............................
eZ©gvb wVKvbv t .........................................................................................................................................................

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4| Avg-‡gv³vi `vZv I Avg-‡gv³vi MÖwnZv Df‡qi RvZxq cwiPqc‡Îi ev Rb¥-wbeÜb mb‡`i ev cÖ‡hvR¨ †¶‡Î cvm‡cv‡U©i b¤^imn Dnvi
d‡UvKwct
`vÎxi bvg RvZxq cwiPq cÎ/e¨w³MZ cwiPqcÎ/ cvm‡cvU©

MÖwnZvi bvg RvZxq cwiPq cÎ/e¨w³MZ cwiPqcÎ/ cvm‡cvU©

5| `wj‡ji c¶M‡bi AwfcÖvq cÖwZdj‡bi cÖ‡qvRbxq Z_¨vw`mn cvIqvi `vZv KZ©„K cÖ‡`q we‡kl, mvavib, AcÖZ¨vnvi †hvM¨ ¶gZv Ges Avg-‡gv³vi
MÖwnZv KZ©„K m¤úvw`Ze¨ `vwqZ¡ I KZ©e¨mg~‡ni we¯ÍvwiZ weeiYt
K) Avgvi c‡¶ cvIqvi Ae A¨Uwb© mv‡ne Zdwmj ewY©Z m¤úwË †`Lv-ïbv, i¶bv-‡e¶b I ch©‡e¶b Kwi‡eb|
L) Avgvi wbhy³xq cvIqvi Ae A¨Uwb© mv‡ne Zdwmj ewY©Z m¤úwË mvd Kejv `wjj Øviv weµq, †Nvlbv cÎ, evqbv cÎ BZ¨vw` `wjj Dchy³
†iwR÷ªx Awd‡m Dcw¯’Z nBqv `wjj m¤úv`b I †iwR÷ªx Kwiqv w`‡Z cvwi‡eb, Zvnv‡Z †h mg¯Í mwn ¯^v¶‡ii cÖ‡qvRb nB‡e Avgvi wbhy³xq cvIqvi
Ae A¨vUwb© mv‡ne Avgvi bvg ÔeÕ Kj‡g ¯^v¶i Kwiqv H mg¯Í Kvh©vw` cwiPvjbv Kwi‡Z cvwi‡eb|
M) cÖKvk _v‡K †h, Avgvi wb¤œ Zdwmj ewY©Z m¤úwˇZ hw` †Kvb cÖKvi gvgjv †gvKÏgv †`Lv †`q ev m¤úwË i¶bv-‡e¶‡bi Rb¨ gvgjv-†gvKÏgv
hv Kivi cÖ‡qvRb nq †m †¶‡Î wbhy³ Avg-‡gv³vi mv‡ne gvgjv-‡gvKÏgv `v‡qi Kwi‡Z cvwi‡eb| cÖ‡qvR‡b Av‡cvl wggvskv mn DwKj, e¨vwióvi,
AvBbRxwe wb‡qvM, njd bvgv m¤úv`b mwn ¯^v¶i BZ¨vw` Kvh©vw` Avgvi c‡¶ Avg-†gv³vi mv‡ne Zvnv Kwi‡Z cvwi‡eb| Avwg m¤§wZ cÖKvk Kwi‡ZwQ †h,
AÎ Avg-‡gv³vi bvgvq Avgvi hveZxq kZ©vejx I Kvh©vejx Avgvi Avg-‡gv³vi cÖ‡qvR‡b hvnv m¤úv`b I wbe©vn Kwi‡e Zvnv Avwg Aby‡gv`b I mg_©b
Kwie|
N) D‡jøL _vKv cÖ‡qvRb †h, hw` Avgvi `Ljxq/gvwjKvbvaxb m¤úwË †Kvb mgq miKvi evnv`yi KZ©„K ûKzg `Lj Kiv n‡q _v‡K ev fwel¨‡Z
ûKzg `Lj Kiv nq, Zvn‡j Avg-‡gv³vi mv‡ne ûKzg `Lj msµv‡šÍ mswkøó f~wg ûKzg `Lj Awd‡m cÖ‡qvRbxq gyû‡Z© hveZxq Kvh©vw` m¤úv`b/m¤úbœ Kwi‡Z
cvwi‡eb| Bnv Avgvi wbR¯^ Kvh©vw` ewjqv me© Av`vj‡Z Mb¨/MÖnY‡hvM¨ nB‡e Ges ûKyg `LjK…Z m¤úwË ev Dnvi wecix‡Z avh©¨K…Z ¶wZc~i‡Yi mgy`q UvKv
wbhy³xq Avg-‡gv³vi mv‡ne MÖnY/D‡Ëvjb Kwi‡Z cvwi‡eb|
O) f~wg Rwic msµvšÍ Kvh©vw` †m‡Uj‡g›U mv‡f© msµvšÍ †h †Kvb cÖvwaKvix ev AwaKvix‡`i wbKU Avgvi Zi‡d Kw_Z Avg-‡gv³vi mv‡ne Dcw¯’Z
_vwKqv Zdwmj ewY©Z m¤úwËi mxgvbv wba©vib ev Avek¨K Rwicvw`KivB‡Z cvwi‡eb Ges Zw×l‡q †Kvb AvcwË `iLv¯Í, AviwR Avwcj `vwLj ev
`v‡qi Kiv ¯^qs ev G‡R›U ev GW‡fv‡KU Øviv ‡gvKÏgv msµvšÍ Kvh©vw`i e¨e¯’vcbv I cwiPvjbv Kiv Av‡`‡ki cÖgvwYZ ev AcÖgvwYZ cÖwZwjwc MÖnY Kiv
cÖf„wZ Kvh©mg~n m¤úv`b Kwi‡Z cvwi‡eb|
P) evsjv‡`k miKv‡ii †h †Kvb Awd‡m `߇i †h †Kvb wgDwbwmc¨vj Kwgkbvi, †g¤^vi M‡bi wbKU ev Zvnv‡`iwefvMxq wKsev Aaxb¯Í Kg©Pvixe„‡›`i
wbKU Avgvi c‡¶ †Kvb bvwjk, †gvKÏgv ev `iLv¯Í nB‡j Zvnvi ¯^v¶ gvb¨ Kiv, Reve †`Iqv ev Z`mgÜxq Avek¨K Kvh©vw` m¤úv`b Kwi‡Z cvwi‡eb|
Q) `wjjvw` wbeÜbt Kw_K Avg-‡gv³vi mv‡ne Avgvi m¤úvw`Z mvd Kejv, evqbvcÎ, eÜKcÎ, Pzw³ ev A½xKvi cÎ, ZgmyK, nvZ wPwV iwk` cÎ
ev Ab¨vb¨ hveZxq `wjj `¯Ív‡eR Dchy³ †iwR÷ªx Awd‡m `vwLj KiZt Avgvi AbyKy‡j †h †Kvb `wjj ev †jL¨ †iwR÷ªx Kwi‡Z cvwi‡eb|
R) wbgœ Zdwmj ewY©Z m¤úwË Avgvi c‡¶ mKj cÖKvi LvRbv, Ki, ivR¯^ cÖ`vb Kwi‡eb Ges Rwgi `Lj eywSqv Zvnv †µZv‡K n¯ÍvšÍi Kwi‡Z
cvwi‡eb Ges cÖ‡qvRb‡ev‡a †e-`LjKvix‡K D‡”Q‡`i Rb¨ Av`vj‡Z gvgjv `v‡qi Kwi‡Z cvwi‡eb|
S) Avwg Avg-‡gv³vi `wjj `vÎx †h wb‡`©k ev Av‡`k ev ¶gZv Avgvi Avg-‡gv³vi †K cÖ`vb Kwijvg, Zvnv‡Z Avgvi IqvwikMb †Kvb evav w`‡Z
cvwi‡ebv ev fwel¨‡Z Zvnv‡`i †Kvbiƒc IRi AvcwË MÖnY †hvM¨ nB‡e bv|
T) Avgvi wbhy³xq Avg-‡gv³vi mv‡ne Avgvi c‡¶ evsjv‡`k miKv‡ii ivR¯^ `߇i mnKvix Kwgkbvi (f~wg) Gi Kvh©vj‡q Avgvi bv‡g bvgRvix I
RgvfvM KivBqv LvRbvw` Av`vq w`qv †PK `vwLjv MÖnY Kwi‡Z cvwi‡eb|Ges miKvix Avav miKvix †h †Kvb cÖwZôv‡b Avgvi bv‡g bvgRvix iwk` cÎvw`
MÖnY Kwi‡Z cvwi‡eb|
U) wbgœ Zdwmj ewY©Z m¤úwËi Dci fwel¨‡Z †Kvb gvgjv †gvKÏgv nB‡j Avgvi wbhy³xq Avg-‡gv³vi mv‡ne Avgvi c‡¶ evsjv‡`k miKv‡ii wbgœ
Av`vjZ nB‡Z D”P Av`vjZ A_v©r mnKvix hyM¥ †Rjv RR Av`vjZ, †Rjv RR Av`vjZ nB‡Z nvB‡KvU©, mywcÖg †KvU© mn †h †Kvb Av`vj‡Z nvwRi nBqv
gvgjv cwiPvjbv Kwi‡Z cvwi‡eb|
V) Avgvi wbhy³xq Avg-‡gv³vi mv‡ne Avgvi c‡¶ ÔeÕ Kj‡g Zvnvi bvg e¨envi Kwi‡Z cvwi‡eb, †hgb- IKvjZ bvgv, AviwR bvgv, iæRy bvgv, †h
†Kvb KvMR c‡Î mwn Kwiqv Av`vj‡Z nvwRi nBqv DwKj, †gv³vi, †iwfwbD DwKj, e¨wióvi wb‡qvM mn gvgvjv †gvKÏgv cwiPvjbv Kwi‡Z cvwi‡eb|
W) Avgvi wbhy³xq Avg-‡gv³vi mv‡ne Avgvi c‡¶ wb¤œ Zdwmj ewY©Z m¤úwË †ePv-wewµ, `vb-gU©‡MR BZ¨vw`Kvh© m¤úv`b Kwi‡Z I Avgvi bv‡g
ÒeÓ Kj‡g e¨envi Kwiqv mvd Kejv `wjj †iwR÷ªx m„Rb c~e©K weµq Kwi‡Z cvwi‡eb|
GZØv‡_© Avcb †¯^”Qvq, ¯^Áv‡b, my¯’ kix‡i Ges Ab¨ Kvnv‡iv Øviv †Kvb cÖKvi cÖ‡ivwPZ bv nBqv AÎ e¨vcK ¶gZv m¤úbœ Avg-‡gv³vi bvgv
`wj‡ji gg© m¤ú‡K© AeMZ nBqv wb¤œ ¯^v¶iKvix ¯^v¶xM‡bi †gvKv‡ejvq Avwg AÎ `wjj `vÎx AÎ Avg-‡gv³vi bvgv `wjj mwn m¤úv`b Kwiqv w`jvg|

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6| ¯’vei m¤úwË weµq, weµ‡qi Pzw³ ev Fb MÖn‡bi wewbg‡q eÜK cÖ`vb msµvšÍ ¶gZv cÖ`Ë nB‡j Dnvi weeibmn m¤úwËi eY©bv, A_ev f~wg Dbœqb
msµvšÍ †Kvb ¶gZv cÖ`Ë nB‡j Dnvi weeiY I Dnv‡Z m„wRZe¨ c-‡Ui ev wbwg©Ze¨ fe‡bi we¯ÍvwiZ weeiYmn m¤úwËi Zdwmj eY©bv A_ev f~wg Dbœqb
e¨ZxZ ¯’vei m¤úwË e¨e¯’vcbv msµvšÍ †Kvb ¶gZv cÖ`Ë nB‡j Dnvi weeiY mn m¤úwËi Zdwmj eY©bv A_ev cÖ‡hvR¨ †¶‡Î m¤úwËi Zdwmj eY©bv t
K) m¤úwËi gvwjKvbvt cig Kiæbvvgq Avjøvni bvg ¯^iY Kwiqv AÎ Avg-‡gv³vi bvgv `wj‡ji eqvb Avi¤¢ Kwi‡ZwQ †h,

L) m¤úwËi Zdwmj cwiPq t

†Rjv t
_vbv t
†gŠRv t
†R, Gj, b¤^i t
LwZqvb b¤^i t
`vM b¤^i t

Rwgi gvwjK‡`i bvg weeiY t

Dˇit `wÿ‡Yt
c~‡e©t cwð‡gt

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7| f~wg Dbœqb msµvšÍ †Kvb ¶gZv cÖ`Ë nB‡j, cÖ¯vÍ weZ f~wg Dbœqb Kvh© m¤ú‡bœi ci Dnv nB‡Z AwR©Z †h Ask cvIqvi MÖwnZv cøU, BgviZ ev †¯úm
AvKv‡i weµq ev n¯ÍvšÍ‡ii ¶gZvcÖvß nB‡e Dnvi weeibt

8| AvB‡bi aviv 2 (2) Abymv‡i m¤úwËi cYg~j¨ t

9| cvIqvi `vZv KZ©„K †Kvb A_© (hw` _v‡K) ev †Kvb Avw_©K †jb‡`b (hw` nq) Z‡e Dnvi weeiY t

10| Avw_©K Øvq I ØvwqZ¡ (hw` _v‡K) Dnvi weeiY t

11| cÖ‡`q ¶gZv cÖ‡qv‡Mi wbw`©ó †gqv` t

12| cvIqvi Ae A¨Uwb©K…Z `vZv GKvwaK nB‡j Zvnviv †hŠ_fv‡e ev c„_Kfv‡e ¶gZv cÖ`vb Kwiqv‡Qb wKbv Dnvi weeiY Ges wbhy³ cvIqvi MÖwnZv
GKvwaK nB‡j Zvnviv †hŠ_fv‡e ev c„_Kfv‡e A_ev †hŠ_ I c„_K Dfqfv‡eB Kvh©¨ m¤úv`‡bi ¶gZvcÖvß nBqv‡Qb wKbv Dnvi weeiYt-

`vÎxi bvg Avg‡gv³viK…Z gvwjKvbvi cwigvY

MÖwnZvi bvg Avg‡gv³viK…Z gvwjKvbvi cwigvY

13| c‡¶M‡Yi AwfcÖvq cÖwZdj‡bi wbwgË Ab¨ †Kvb Z_¨ ev we‡kl kZ© t cÖ‡hvR¨ b‡n|

14| Avg-‡gv³viK…Z MÖwnZvi m¤gwZm~PK ¯^v¶i t

bvg ¯^vÿi

15| Avg-‡gv³viK…Z `vÎxi bvg I ¯^v¶i t

`vÎxi bvg ¯^vÿi

16| (K) mv¶x / mv¶xM‡Yi bvg, wVKvbv I ¯^v¶i t

bvg ¯^v¶i I
t t
ZvwiL
wcZvi bvg t gvZvi bvg t
MÖvg/†ivW bs t BDwbqb t
Dc‡Rjv/_vbv †Rjv
t t

(L) mv¶x / mv¶xM‡Yi bvg, wVKvbv I ¯^v¶i t

bvg ¯^v¶i I
t t
ZvwiL
wcZvi bvg t gvZvi bvg t
MÖvg/†ivW bs BDwbqb
t t

Dc‡Rjv/_vbv t †Rjv t

৪/৫
 (M) mbv³Kvixi bvg, wVKvbv I ¯^v¶i t

bvg ¯^v¶i I
t t
ZvwiL
wcZvi bvg gvZvi bvg
t t

MÖvg/†ivW bs t BDwbqb t
Dc‡Rjv/_vbv t †Rjv t

17| Avg-‡gv³viK…Z m¤úwËi mwVK cwigvY Ges evRvi g~j¨ mg¨K AewnZ nBqv Avwg ¯^v ¶iKvix AÎ `wjj gymvwe`v KwiqvwQ/ wjwLqv w`qvwQ Ges
c¶MY‡K cvV Kwiqv ïbvBqvwQ| AÎ `wjj .......... cvZvq K‡¤úvRK…Z Ges ¯^v¶x ............... Rb e‡U| gymvwe`v KviK ev `wjj †jL‡Ki bvg,
c~Y© wVKvbv I `wjj †jL‡Ki mb` bs (Awd‡m bvg mn) t

`wjj †jL‡Ki ¯^vÿi t

bvg t
c~Y© wVKvbv t
mb` b¤^i t
Awd‡mi bvg t

wet`ªt cÖ‡qvRb n‡j AwZwi³ KvMR e¨envi Kiæb|

৫/৫