gvIjvbv fvmvbx weÁvb I cÖhyw³ wek¦we`¨vjq

m‡šÍvl, Uv½vBj-1902|
3(wZb) Kwc cvm‡cvU©
cÖfvlK/mnKvix Aa¨vcK c‡` PvKzixi Av‡e`b dig mvB‡Ri mZ¨vwqZ Qwe

[c‡`i bvg ........................................ wefvM.......................................................................................... ]

1. (K) c~Y© bvg (evsjvq) ..........................................................................................................................

(L) Bs‡iRx‡Z (eo A¶‡i) ....................................................................................................................

2. K) wcZvi bvg (evsjvq) ................................................................ L) ¯^vgxi bvg .......................................

M) gvZvi bvg (evsjvq)............................................................................................................................

3. K) Rb¥ ZvwiL .............................................................. L) Rb¥¯’vb .............................................

(gva¨wgK cix¶vi mb` Abyhvqx)

4. K) RvZxqZv .................................... L) ag© ......................... M) ‰eevwnK Ae¯’v .............................

5. K) ¯’vqx wVKvbv t L) †hvMv‡hv‡Mi wVKvbv t

........................................................................ ..........................................................................

....................................................................... .........................................................................

....................................................................... ........................................................................

....................................................................... .........................................................................

........................................................................ .........................................................................

‡gvevBj bs ......................................................... ‡gvevBj bs ................................................................

(‡hvMv‡hv‡Mi ‡ÿ‡Î e¨envi Kiv n‡e) (‡hvMv‡hv‡Mi ‡ÿ‡Î e¨envi Kiv n‡e)

6. wk¶vMZ †hvM¨Zv (gva¨wgK n‡Z D”PZi wWMÖx ch©šÍ) t

AaxZ ermi cÖvß djvdj
DËxY© cix¶vi bvg mvj n‡Z mvj ch©šÍ ‡evW©/wek¦we`¨vjq cv‡ki mb kvLv/welq
I †gavµg

7. D”PZi wk¶vi Rb¨ ZË¡veavbKvixi bvg I wVKvbv t ........................................................................................

8. ‡h ‡Kvb we‡kl †Kv‡m© AskMÖn‡Yi weeiY t ...................................................................................

9. `¶Zv Abymv‡i wewfbœ fvlv Áv‡bi weeiY t i) ...................................................................................

ii) ...................................................................................

iii) .................................................................................

10. cÖKvkbvi ZvwjKv t ………………………………………………………………………………………………

 (cÖ‡qvR‡b AwZwi³ KvMR e¨envi Kiv hv‡e)

11. AwfÁZv

K) eZ©gvb c` t ..................................................................................................

‡eZb‡¯‹j t ………………………………………………………………………………………………..

†hvM`v‡bi ZvwiL t ……………………………………………………………………………………………….

g~j ‡eZb t ……………………………………………………………………………………………….

ms¯’vi bvg t ……………………………………………………………………………………………….

(c~Y© wVKvbvmn)

L) AZxZ AwfÁZv t ……………………………………………………………………………………………….

(cwi¯‹vifv‡e c‡`i bvg, †eZb‡¯‹j, me©‡kl g~j †eZb,
PvKzixi Kvj I ms¯’vi bvg D‡jøL Ki‡Z n‡e| cÖ‡qvR‡b ……………………………………………………………………………………………….
AwZwi³ KvMR e¨envi Kiv hv‡e)
……………………………………………………………………………………………….

M) me©‡gvU wk¶KZv/Ab¨vb¨ †ckvMZ AwfÁZv t ……………………………………………………………………………………………….

(Av‡e`bcÎ `vwLj Kiv ch©šÍ)

12. †Kvb †kªYx/welq cvV`vb Kiv n‡q‡Q t……………………………………………………………………………………………….

13. ‡Kvb cÖwZôv‡b wbw`©ó mg‡qi Rb¨ PvKzixi †¶‡Î t……………………………………………………………………………………………….

A½xKvive× wKbv (_vK‡j Zvi weeiY)

14. KLbI †Kvb PvKzwi n‡Z eiLv¯Í/c`Py¨Z n‡q _vK‡j t……………………………………………………………………………………………….

(KviY D‡jøL Kiæb)

15. †cbkbcÖvß n‡j Dnvi cwigvY Ges Dnv t……………………………………………………………………………………………….

†Kvb ms¯’v n‡Z cÖvß Zvi bvg

16. ‡Kvb cÖwZwôZ cÖwZôb/ms¯’v/mwgwZi mwnZ t……………………………………………………………………………………………….

RwoZ _vK‡j Zvnvi bvg I weeiY|

17. cwiwPZ wKš‘ ÁvwZ ev AvZ¥xq bb (hv‡`i wbKU †_‡K Avcbvi m¤^‡Ü Rvbv hv‡e) Ggb `yBRb e¨w³i bvg I wVKvbvt
1)......................................................................................................................................................................

2)......................................................................................................................................................................

18. e¨vsK WªvdU/†c-AW©vi bs t.......................................................... ZvwiLt ................................. UvKv t…………..

e¨vs‡Ki bvgt .......................................................................... kvLvt ................................................

Av‡e`‡bi ZvwiLt .................................... .........................................

Av‡e`bKvixi ¯^v¶i

wet `ªt K) GKRb cÖv_©x‡K gvÎ GKwU g~j Av‡e`b dig mieivn Kiv n‡e| wZwb cÖ‡qvRbxq msL¨K d‡UvKwc K‡i e¨envi Ki‡Z cvi‡eb|
L) cÖv_©x cÖ‡qvRb‡ev‡a AwZwi³ KvMR e¨envi Ki‡Z cvi‡eb| M) mZ¨vwqZ Qwe Ges mZ¨vwqZ mKj mb`c‡Îi Abywjwc, RvZxqZv mb`cÎ
mshy³ Ki‡Z n‡e| N) Am¤ú~Y© Av‡e`b evwZj‡hvM¨|