kk ©e Mðkr{LkkhkÞý Lk{: kk kk ©e økýuþkÞ Lk{: kk kk ykE ©e ¾kuzeÞkh {kíkkÞ Lk{: kk

{ktøkr÷f «Mktøkku

þw¼ rËLk, .............................................

þw¼ rËLk, ..........................................

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

kk xnwfku kk

kk økýuþ MÚkkÃkLkk / {tzÃk {wnqoík kk

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MÚk¤ : y{khk rLkðkMk MÚkkLku

kk økeík økhçkk kk

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MÚk¤ : .............................

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kk òLk «MÚkkLk kk

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

MÚk¤ : y{khk rLkðkMk MÚkkLkuÚke

kk nMík {u¤kÃk kk

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

MÚk¤ : ................................

fkuÞ÷Lku fwtsLk rðLkk Lk [k÷u ¼ðhkLku økwtsLk rðLkk Lk [k÷u,

y{Lku ík{khk rðLkk Lk [k÷u íkku

y{khk Ônk÷k fkfk / {k{k Lkk ÷øLk{kt s÷w÷ s÷w÷Úke ykðòu.......

Code 1

kk ©e økwÁðu Lk{: kk kk ©e økýuþkÞ Lk{: kk kk ©e rðLæÞðkrMkLÞu Lk{: kk

{ktøkr÷f «Mktøkku

fw¤Ëuðe ©e rðLæÞðkrMkLke {kíkkSLke yMke{f]ÃkkÚke rþðrþðkLke Mkkûke{kt Ãkrh[ÞLku ÃkrhýÞ{kt Ãk÷xðkLkwt

þw¼ {wnwíko ykÃkLke WÃkrMÚkríkLke Ít¾Lkk, yðMkh Au.....

íkk. ...................................................

kk økýuþ MÚkkÃkLkk kk..........................

kk {tzÃk {wnwíko kk..........................

kk økúnþktrík kk..........................

kk þw¼ MÚk¤ kk..............................................................................................

kk ËþoLkkr¼÷k»ke kk

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

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

Code 2

kk ©e økýuþkÞ Lk{: kk

Mktðík 2072 ..........................................................

kk yðMkhLkw yktøkýw kk

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

kk MLkunkrÄLk kk..................................

kk þw¼ MÚk¤ kk......................................................................................................

Mktðík 2072 ..............................................

kk òLk ykøk{Lk kk.......................

kk nMík {u¤kÃk kk.......................

kk ¼kusLk Mk{kht¼ kk.......................

kk fLÞk rðËkÞ kk.......................

{ktøkr÷f «Mktøkku

kk økýuþ MÚkkÃkLk kk....................

kk {tzÃk {wnwoík kk....................

ykÃk çkLLku / Mknfwxwtçk

ykÃk çkLLku / Mknfwxwtçk

Code 3

kk ©e økýuþkÞ Lk{: kk

«ríkfLkk yðMkhkuLke nkh{k¤k

:: Mk÷wýk Mk{whíkk ::...........................................................................

:: yLkku¾w ykýwt ::...........................................................................

:: {ktøkÕÞ {trËh ::..................................................

:: {tøk÷ {ktzðk ::...........................................................................

:: nkUþe÷ku nMík {u¤kÃk ::...........................................................................

:: Mkwh{Þe Mktøkeík MktæÞk ::..................................................

:: «eík Ãkðo {trËh ::..................................................

:: y{ yktøký ::..................................................

:: rLkðurËík ::..................................................

:: MktøkeíkLkwt þkr{Þkýwt ::..................................................

Code 4

kk ©e økýuþkÞ Lk{: kk

kk {ktøkr÷f «Mktøkku kk

MkkuLkuhe Ãk¤Lkku hýfkh

þw¼rËLk : ...................................................................

Yze huþ{Lke økktX çktÄkþu

MðY[e ¼kusLk

:

:

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9 {tøk÷ {ktzðku 9.............................................................................................

9 y{kYt yktøkýwt 9.............................................................................................

9 þw¼uåAf 9.............................................................................................

9 ykÃkLkk ykþeðkoË yus WÃknkh 9

Code 5