{kr÷fLkku Vkuxku ¼kzwykíkLkku Vkuxku

Ãkku÷eMk MxuþLk{kt ¼kzwykík ytøkuLke òý fhðk ytøkuLkku Lk{wLkku ( Ãkku÷eMk MxuþLk )

1. {fkLk/ËwfkLk {kr÷fLkwt Lkk{ :- ___________________________________________

hnuXkýLkwt MkhLkk{wt :- ___________________________________________
_________________________ {ku._______________
2. Lkkufhe ÄtÄkLkwt MkhLkk{wt :- ___________________________________________
3. ¼kzu ykÃku÷ søÞkLke rðøkík :- ___________________________________________
___________________________________________
4. ¼kzwykíkLkwt Lkk{ :- ___________________________________________
___________________________________________
{w¤ ðíkLkLkwt MkhLkk{wt :- ___________________________________________
_______________________ {ku._________________
5. ¼kzwykíkLkk ÃkheðkhLkkt MkÇÞkuLkkt Lkk{ :-
(1) ________________________________________ MkçktÄ : ________ W.ð.: _____
(2) ________________________________________ MkçktÄ : ________ W.ð.: _____
(3) ________________________________________ MkçktÄ : ________ W.ð.: _____
6. {fkLk/ËwfkLk ¼kzk WÃkh hk¾íkk Ãknu÷kLkwt {fkLk/ËwfkLk/ykuVeMkLkwt MkhLkk{wt VkuLk Lktçkh íkÚkk AkuzâkLke íkkhe¾.
:-________________________________________________________________
7. yøkkW ¼kzk WÃkh hnuíkk níkk íku {fkLk {kr÷fLkwt Lkk{ MkhLkk{wt íkÚkk VkuLk Lkttçkh :
_________________________________________________________________
8. {fkLk {kr÷f íku{s ¼kzwykíkLke yku¤¾Lkkt Ãkwhkðk Lke[u ÃkifeLke fkuR yufLke Íuhkuûk Lkf÷, ÃkkMkÃkkuxo, zÙkRðªøk
÷kRMkLMk, huþLkfkzo, R÷uõþLkfkzo, ykÄkhfkzo íkÚkk ¼kzk fhkhLke Lkf÷.
9. ¼kzwykíkLke yku¤¾ký ykÃkLkkh Ë÷k÷Lkwt Lkk{ MkhLkk{wt íkÚkk VkuLk Lktçkh :
________________________________________________________________

_________________ _________________
{fkLk {kr÷fLke Mkne ¼kzwykíkLke Mkne