¹ãÆ£ãã¶ã ½ãâ¨ããè ½ãì³ã ¾ããñ•ã¶ãã (¹ããè.†½ã.†½ã.Ìãã¾ã.) ‡ãñŠ ¦ã֦㠨ãɥ㠇ãñŠ ãäÊㆠ‚ããÌãñª¶ã ¹ã¨ã (ãäÍãÍãì ¨ãɥ㠇ãñŠ ¦ãÖ¦ã Á.50,000/- ¦ã‡ãŠ ¨ãɥ㠇ãñŠ ãäÊã†)

ºãö‡ãŠ ‚ããõÀ ÍããŒãã ‡ãŠã ¶ãã½ã, •ãÖãâ Ôãñ ¨ãÉ¥ã ÞãããäÖ† ¾ãîãä¶ã¾ã¶ã ºãö‡ãŠ ‚ããù¹ãŠ ƒâã䡾ãã, ÍããŒãã________________

½ãö /ֽ㠆¦ãªá ´ãÀã ¶ã‡ãŠª-ÔããŒã / ‚ããä£ããäÌã‡ãŠÓãà / ãä½ã¾ããªãè ¨ãÉ¥ã Á._________„ÿñ;ã _______________‡ãñŠ ãäÊㆠ‚ããÌãñª¶ã ‡ãŠÀ¦ãã/‡ãŠÀ¦ããè Öîâ/ ‡ãŠÀ¦ãñ Öö.

‚ããÌãñª¶ã ‰ãŠ½ããâ‡ãŠ : ã䪶ããâ‡ãŠ :

‚ããÌãñª‡ãŠ ‡ãŠã ¶ãã½ã 1. 2.

ãä¹ã¦ãã / ¹ããä¦ã ‡ãŠã ¶ãã½ã 1.. 2..

ÔãâØ㟶ã ( ) ̾ããä§ãŠØã¦ã Ôãâ¾ãì§ãŠ ¹ãÆãñ¹ãÆホÀ I ¼ããØããèªãÀãè I ‚㶾ã ãä¶ãÌããÔã ‡ãŠã ¹ã¦ãã

ãä‡ãŠÀã¾ãñ ¹ãÀ/ÔÌã¾ãâ ‡ãŠã ‡ãŠãÀãñºããÀ ‡ãŠã ¹ã¦ãã ãä‡ãŠÀã¾ãñ ¹ãÀ/ÔÌã¾ãâ ‡ãŠã •ã¶½ã ãä¦ããä©ã ‚ãã¾ãì : ãäÊãâØã : ¹ãìÁÓã / Ô¨ããè Íãõàããä¥ã‡ãŠ ¾ããñؾã¦ãã ( ) ‚ã¶ã¹ãü¤ 10 Ìããé ¦ã‡ãŠ 12 Ìããé ¦ã‡ãŠ Ô¶ãã¦ã‡ãŠ ̾ããÌãÔãããä¾ã‡ãŠ ‚㶾㠇ãñŠ.Ìãã¾ã.Ôããè. ªÔ¦ããÌãñ•ã Ìããñ›À ¹ãÖÞãã¶ã ¹ã¨ã ‰ãŠ. ‚ãã£ããÀ ‰ãŠ. ¡Èã¾ããäÌãâØã ÊããƒÔãòÔã ‰ãŠ. ‚㶾㠇ãŠãñƒÃ ¹ãÖÞãã¶ã ¹ãƽãã¥ã (‡ãðŠ¹ã¾ãã „ÊÊãñŒã ‡ãŠÀò) ãä¶ãÌããÔã ¹ãƽãã¥ã (‡ãðŠ¹ã¾ãã „ÊÊãñŒã ‡ãŠÀò) ›ñÊããè¹ãŠãñ¶ã ¶ãâ.: ½ããñºããƒÊã ¶ãâ.: ƒÃ-½ãñÊã :

‡ãŠãÀãñºããÀãè Øããä¦ããäÌããä£ã („ÿñ;ã) Ìã¦ãýãã¶ã ‚ãÌããä£ã ¹ãÆÔ¦ãããäÌã¦ã

ÌãããäÓãÇ㊠ãäÌã‰ãŠ¾ã (Á.ÊããŒã ½ãò) Ìã¦ãýãã¶ã ¹ãÆÔ¦ãããäÌã¦ã: ‚ã¶ãì¼ãÌã, ¾ããäª ‡ãŠãñƒÃ Öãñ Ôãã½ãããä•ã‡ãŠ ÔãâÌãØãà (‡ãðŠ¹ã¾ãã ã䛇㊠‡ãŠÀò ) Ôãã½ã㶾㠂ã¶ãìÔãîãäÞã¦ã •ãããä¦ã •ã.•ãã. ‚ã.ãä¹ã.Ìã. ‚ãʹãÔã⌾ã‡ãŠ Ôã½ãìªã¾ã ¾ããäª ‚ãʹãÔã⌾ã‡ãŠ( ) ºãìãä®Ô› ½ãìãäÔÊã½ã ƒÔããƒÃ ãäÔ㋌㠕ãõ¶ã ¾ãÖîªãè ‚ã¶¾ã ‚ããÌã;ã‡ãŠ ¨ãɥ㠇ãŠãè ÀããäÍã ¶ã‡ãŠª-ÔããŒã / ‚ããä£ããäÌã‡ãŠÓãà - ãä½ã¾ããªãè ¨ãÉ¥ã - ãäÌã²ã½ãã¶ã Œãã¦ããò ‡ãñŠ ãäÌãÌãÀ¥ã, ¾ããäª ‡ãŠãñƒÃ Öãò ¹ãƇãŠãÀ (‡ãðŠ¹ã¾ãã ã䛇㊠‡ãŠÀò )

(•ã½ãã / ¨ãÉ¥ã) ºãö‡ãŠ ‚ããõÀ ÍããŒãã

‡ãŠã ¶ãã½ã

Œãã¦ãã ¶ãâ.. ¾ããäª ¨ãɥ㠌ãã¦ãã Öõ ¦ããñ, Êããè ØãƒÃ ¨ãÉ¥ã ÀããäÍã Á. ÜããñÓã¥ãã: ½ãö/ֽ㠆¦ãªá ´ãÀã ÜããñÓã¥ãã ‡ãŠÀ¦ãã/‡ãŠÀ¦ããè Öîâ / ‡ãŠÀ¦ãñ Öö ãä‡ãŠ ½ãñÀñ/Ö½ããÀñ ´ãÀã ¹ãƪã¶ã ‡ãŠãè ØãƒÃ Ôã¼ããè ÔãîÞã¶ãã†â Ô㦾ã, ÔãÖãè ‚ããõÀ ¹ãî¥ãà Öö. •ãõÔãããä‡ãŠ ƒÔã ‚ããÌãñª¶ã ¹ã ã̈ ½ãò „ÊÊãñŒã Öõ, „Ôã‡ãñŠ ‚ãÊããÌãã ½ãñÀãè/Ö½ããÀãè ‡ãŠãñƒÃ ¼ããè ªñ¶ãªãÀãè ¶ãÖãé Öõ. ½ãõ¶ãñ/Ö½ã¶ãñ ãä‡ãŠÔããè ‚ããõÀ ºãö‡ãŠ ½ãò ‚ããÌãñª¶ã ¶ãÖãé ãä‡ãŠ¾ãã Öõ. ½ãñÀã/Ö½ããÀã ‡ãŠãñƒÃ ¼ããè ‚ããä¦ãªñ¾ã / ÔãâÌãõ£ãããä¶ã‡ãŠ ªñ¾ã¦ãã ¶ãÖãé Öõ. ½ãñÀã/Ö½ããÀñ ã̈ɥ㠂ããÌãñª¶ã ‡ãñŠ Ôãâºãâ£ã ½ãò ºãö‡ãŠ ´ãÀã Ìããâã䜦ã Ôã¼ããè ÔãîÞã¶ãã†â ¹ãƪã¶ã ‡ãŠãè •ãã†âØããè. ¾ããäª ‚ãã¹ã „ãäÞã¦ã ½ãã¶ã¦ãñ Öö ¦ããñ ¾ãñ ÔãîÞã¶ãã†â ‚㶾㠆•ãòãäÔã¾ããò Ôãñ Ôãã¢ãã ‡ãŠãè •ãã Ôã‡ãŠ¦ããè Öö. ‚ãã¹ã, ‚ãã¹ã‡ãñŠ ¹ãÆãä¦ããä¶ããä£ã ¾ãã ¼ããÀ¦ããè¾ã ãäÀ•ãÌãà ºãö‡ãŠ ¾ãã ½ãì³ã ãäÊããä½ã›ñ¡ ¾ãã ‚ãã¹ã‡ãñŠ ´ãÀã ¹ãÆããä£ã‡ãðŠ¦ã ‚㶾㠇ãŠãñƒÃ †•ãòÔããè ã́Àã „¹ãÀãñ§ãŠ ¹ã¦ãñ ¹ãÀ ½ãñÀãè/Ö½ããÀãè ¹ãñŠ‡ã‹›Èãè/‡ãŠãÀãñºããÀãè ¹ããäÀÔãÀ ‡ãŠã ãä‡ãŠÔããè ¼ããè Ôã½ã¾ã, ‚ãããäÔ¦ã¾ããò, ÊãñŒããºããäÖ¾ããò ‡ãŠã ãä¶ãÀãèàã¥ã/Ô㦾ãã¹ã¶ã ãä‡ãŠ¾ãã •ãã Ôã‡ãŠ¦ãã Öõ. ºãö‡ãŠ ‡ãñŠ ªñ¾ããò ‡ãŠãè ÔãìÀàãã/ÌãÔãîÊããè ‡ãñŠ ãäÊㆠ‚ãã¹ã „ãäÞã¦ã ‡ãŠãÀÃÌããƒÃ ‡ãŠÀ Ôã‡ãŠ¦ãñ Öö. ã䪶ããâ‡ãŠ: Ô©ãã¶ã: ‚ããÌãñª‡ãŠ/‡ãŠãò ‡ãñŠ ‚ãâØãîŸã ãä¶ãÍãã¶ã/ÖÔ¦ããàãÀ

(‡ãñŠÌãÊã ‡ãŠã¾ããÃÊã¾ã „¹ã¾ããñØã ‡ãñŠ ãäÊã†)

¹ããÌã¦ããè ãäÔÊã¹ã ‰ãŠ. __________________ ¨ãɥ㠂ããÌãñª¶ã ‰ãŠ.. ________________________ ã䪶ããâ‡ãŠ ___________________

¹ãÆ㹦ã‡ãŠ¦ããà _________________________

ã䪶ããâ‡ãŠ: Ô©ãã¶ã:

¹ãÆããä£ã‡ãðŠ¦ã ÖÔ¦ããàãÀ‡ãŠ¦ããà (ÍããŒãã ÔããèÊã ‚ããõÀ ÖÔ¦ããàãÀ)

-----------------------------------------------------------------¾ãÖãâ Ôãñ ‡ãŠã›ò------------------------------------------------------------- ¹ããÌã¦ããè ãäÔÊã¹ã ‰ãŠ.------------------- ¹ããè.†½ã.†½ã.Ìãã¾ã. ‡ãñŠ ¦ãÖ¦ã ------------------------‡ãñŠ ãäÊㆠ¨ãɥ㠂ããÌãñª¶ã (‚ããÌãñª‡ãŠ ¹ãÆãä¦ã) Ñããè/Ñããè½ã¦ããè------------------------------------------Ôãñ Ôã£ã¶¾ãÌã㪠¹ãÆ㹦ã Öì‚ãã. ¨ãɥ㠂ããÌãñª¶ã ‡ãŠãè ¦ããÀãèŒã-------------ÀããäÍã-------------. ã䪶ããâ‡ãŠ: Ô©ãã¶ã:

¹ãÆããä£ã‡ãðŠ¦ã ÖÔ¦ããàãÀ‡ãŠ¦ããà (ÍããŒãã ÔããèÊã ‚ããõÀ ÖÔ¦ããàãÀ)

¹ãŠãñ›ãñ

(¹ãŠãñ›ãñ ‡ãñŠ …¹ãÀ ÖÔ¦ããàãÀ)

•ããâÞã ÔãîÞããè (Þãñ‡ãŠ ãäÊãÔ›) : (‚ããÌãñª¶ã ‡ãñŠ Ôãã©ã ¹ãÆÔ¦ãì¦ã ãä‡ãŠ¾ãñ •ãã¶ãñ ÌããÊãñ ªÔ¦ããÌãñ•ã) 1. ¹ãÖÞãã¶ã ¹ãƽãã¥ã - Ìããñ›À ‚ããƒÃ.¡ãè.‡ãŠã¡Ã / ¡ÈãƒãäÌãâØã ÊããƒÔãòÔã / ¹ãõ¶ã ‡ãŠã¡Ã / ‚ãã£ããÀ ‡ãŠã¡Ã / ¹ããÔã¹ããñ›Ã /ÔãÀ‡ãŠãÀãè ¹ãÆããä£ã‡ãðŠ¦ã

‚ããä£ã‡ãŠãÀãè ´ãÀã •ããÀãè ¹ãŠãñ›ãñ ¹ãÖÞãã¶ã ¹ã¨ã ‚ãããäª ‡ãŠãè ÔÌã-¹ãƽãããä¥ã¦ã ¹ãÆãä¦ã. 2. ãä¶ãÌããÔã ¹ãƽãã¥ã - ¶ãÌããè¶ã¦ã½ã ›ñÊããè¹ãŠãñ¶ã ãäºãÊã / ãäºã•ãÊããè ãäºãÊã / Ôã½¹ãªã ‡ãŠÀ ÀÔããèª (ªãñ ½ããÖ Ôãñ ‚ããä£ã‡ãŠ ¹ãìÀã¶ãã ¶ã Öãñ) / Ìããñ›À

‚ããƒÃ.¡ãè.‡ãŠã¡Ã / ‚ãã£ããÀ ‡ãŠã¡Ã /̾ããä§ãŠØã¦ã ¹ããÔã¹ããñ›Ã / ºãö‡ãŠ ‚ããä£ã‡ãŠããäÀ¾ããò ´ãÀã ãäÌããä£ãÌã¦ã Ô㦾ãããä¹ã¦ã ¹ãÆãñ¹ãÆã¾ã›À ¾ãã ¼ããØããèªãÀ ‡ãŠã ºãö‡ãŠ ¹ããÔãºãì‡ãŠ ¾ãã ¶ãÌããè¶ã¦ã½ã Œãã¦ãã ãäÌãÌãÀ¥ã/ ãä¶ãÌããÔã ¹ãƽãã¥ã¹ã¨ã / ÔãÀ‡ãŠãÀãè ‚ããä£ã‡ãŠãÀãè/ Ô©ãã¶ããè¾ã ¹ãâÞãã¾ã¦ã / ½¾ãî¶Ôããè¹ãÊã ´ãÀã •ããÀãè ¹ãƽãã¥ã¹ã¨ã.

3. ‚ããÌãñª‡ãŠ ‡ãŠã ¶ãÌããè¶ã¦ã½ã ¹ãŠãñ›ãñØãÆã¹ãŠ (2 ¹ãÆãä¦ã¾ããâ) 6 ½ããÖ Ôãñ ‚ããä£ã‡ãŠ ¹ãìÀã¶ãã ¶ã Öãñ. 4. ŒãÀãèªãè •ãã¶ãñ ÌããÊããè ½ãÍããè¶ãÀãè/ ‚㶾㠽ãªãò ‡ãñŠ ‡ãŠãñ›ñÍã¶ã. 5. ŒãÀãèªãè •ãã¶ãñ ÌããÊããè ½ãÍããè¶ãÀãè/ ‚㶾㠽ãªãò ‡ãñŠ Ôã¹Êãã¾ãÀ ‡ãñŠ ãäÌãÌãÀ¥ã / ‡ãŠãè½ã¦ã. 6. ¹ãÖÞãã¶ã ¹ãƽãã¥ã/ ¹ã¦ãñ ‡ãŠã ¹ãƽãã¥ã - Ôãâºãâãä£ã¦ã ÊããƒÔãòÔããò ‡ãŠãè ¹ãÆãä¦ã¾ããâ / ¹ãâ•ããè‡ãŠÀ¥ã ¹ãƽãã¥ã¹ã¨ã /

‚ããñ¶ãÀãäÍã¹ã Ôãñ Ôãâºãâãä£ã¦ã ‚㶾㠪ԦããÌãñ•ã, ‡ãŠãÀãñºããÀãè ¹ãÖÞãã¶ã †Ìãâ „¹ã‰ãŠ½ã ‡ãŠã ¹ã¦ãã, ¾ããäª ‡ãŠãñƒÃ Öãñ. 7. ÔãâÌãØãà ‡ãñŠ ¹ãƽãã¥ã •ãõÔãñ - ‚ã¶ãìÔããäÞã¦ã •ãããä¦ã / •ã¶ã•ãããä¦ã /‚ã.ãä¹ã.Ìã./‚ãʹãÔã⌾ã‡ãŠ ‚ãããäª.

¶ããñ› :

1. ‡ãŠãñƒÃ Ôã½¹ãããäÍÌãÇ㊠¹ãÆãä¦ã¼ãîãä¦ã ¶ãÖãé

2. Þãì‡ãŠãõ¦ããè ‚ãÌããä£ã 5 ÌãÓãà ¦ã‡ãŠ

3. ‚ããÌãñª‡ãŠ ãä‡ãŠÔããè ¼ããè ºãö‡ãŠ / ãäÌã§ããè¾ã ÔãâÔ©ãã ‡ãŠã Þãî‡ãŠ‡ãŠ¦ããà ¶ãÖãé Öãñ¶ãã ÞãããäÖ†.

ºãö‡ãŠ ‡ãñŠ ¹ãƾããñØã ‡ãñŠ ãäÊㆠ: ‡ãñŠ.Ìãã¾ã.Ôããè. ½ãã¶ã‡ãŠãò ‡ãñŠ ‚ã¶ãì¹ããÊã¶ãã ¹ãÀ ã䛹¹ã¥ããè :

¡¿ãî ãä¡ãäÊã•ãòÔã / ãä¶ãÀãèàã¥ã / ‰ãñŠãä¡› ãäÀ¹ããñ›Ã ¹ãÀ ã䛹¹ã¥ããè :

½ãîʾããâ‡ãŠ¶ã ¦ã©ãã ÔãâÔ¦ãìãä¦ã¾ããò ¹ãÀ ã䛹¹ã¥ããè ( ãä¶ã¾ã½ã ‚ããõÀ Íã¦ãô - ‚ã¶ãìÊãضã‡ãŠ ÔãâÊãضã)

½ãì³ã ‡ãŠã¡Ã

ÔÌããè‡ãðŠ¦ã / ‚ãÔÌããè‡ãðŠ¦ã ‰ãŠ._____________________•ããÀãè

ÍããŒãã ¹ãƺãâ£ã‡ãŠ ÍããŒãã ¹ãƺãâ£ã‡ãŠ

¾ãîãä¶ã¾ã¶ã ºãö‡ãŠ ‚ããù¹ãŠ ƒâã䡾ãã ¾ãîãä¶ã¾ã¶ã ºãö‡ãŠ ‚ããù¹ãŠ ƒâã䡾ãã

ÍããŒãã_________ ÍããŒãã_________

¹ãÆ£ãã¶ã ½ãâ̈ ããè ½ãì³ã ¾ããñ•ã¶ãã (¹ããè.†½ã.†½ã.Ìãã¾ã.) ãäÍãÍãì ¨ãÉ¥ã ÔãâÌãØãà ‡ãñŠ ¦ãÖ¦ã