dig bs t wmwk‡ev K‡jR- 0510

gva¨wgK I D”Pgva¨wgK wk¶v †evW©, wm‡jU|

ÒQvoc‡Îi AbygwZi Rb¨ Av‡e`b digÓ
eivei,
K‡jR cwi`k©K
gva¨wgK I D”Pgva¨wgK wk¶v †evW©, wm‡jU|
gva¨g t (K) Aa¨¶ (Aa¨qbiZ cÖwZôvb)
...............................................................................................K‡jR EIIN t
WvKNi t .......................................... Dc‡Rjv t ...................................... †Rjv t ..................................|

(L) Aa¨¶ (fwZ©”Qy cÖwZôvb)

.............................................................................................. K‡jR EIIN t
WvKNi t ...........................................Dc‡Rjv t ........................................ †Rjv t ..................................|
welqt Qvoc‡Îi AbygwZi Rb¨ Av‡e`b|
g‡nv`q,
webxZ wb‡e`b GB †h, Avwg eZ©gv‡b............................................................................................ K‡jR/D”Pgva¨wgK
we`¨vj‡qi GKRb wbqwgZ QvÎ/QvÎx| wb¤œewY©Z Kvi‡Y Avwg ...........................................................................................
K‡jR/D”Pgva¨wgK we`¨vj‡q Qvoc‡Îi gva¨‡g fwZ© n‡Z B”QyK| AbyMÖnc~e©K Avgv‡K QvocÎ MÖnY I fwZ©i AbygwZ `v‡bi cÖ‡qvRbxq
e¨e¯’v MÖn‡Y ‡hb Avcbvi m`q gwR© nq| Avgvi cÖ‡qvRbxq Z_¨vw` wb‡¤œ Dc¯’vcb Kiv n‡jv t
 bvg (evsjvq) t ...............................................................................................................................
 bvg ( Bs‡iwR‡Z) t .................................................................................................................................
 wcZvi bvg t .................................................................................................................................
 gvZvi bvg t.................................................................................................................................
 wefvM t weÁvb/ gvbweK/ e¨emvq wk¶v  wk¶vel© t.................................
(mwVK N‡i  wPý w`‡Z n‡e)
 ‡kªwY t ...............................................  ‡kªwY †ivj b¤^i t ............................
 GmGmwm/mggvb cix¶v msµvšÍ Z_¨ t
‡iwRt bs wk¶vel© ‡ivj bs cv‡mi mvj ‡evW© cÖvß wRwcG

 Aa¨qbiZ cvV¨ welqmg~n (welq †KvWmn) t

 evsjv (101-102)  Bs‡iwR (107-108)  Z_¨ I †hvMv‡hvM cÖhyw³ (275)
 1..............................................................  2...........................................................
 3..............................................................  4 (Hw”QK welq)..............................................
 QvocÎ MÖn‡Yi KviY t (mwVK Kvi‡Y () wUK wPý w`‡Z n‡e Ges ¯^c‡¶ cÖvgvY¨ KvMRcÎ Av‡e`bc‡Îi mv‡_ Aek¨B Rgv w`‡Z n‡e)
(K) miKvwi PvKwiRxwe Awffve‡Ki e`jx| (L) miKvwi PvKwiRxwe Awffve‡Ki Aemi MÖnY|
(M) Awffve‡Ki evm¯’vb cwieZ©b| (N) weevn RwbZ Kvi‡Y evm¯’vb cwieZ©b|
(O) Ab¨ KviY t
Awffve‡Ki ¯^v¶i t QvÎ/QvÎxi ¯^v¶i t ‡gvevBj t
 Aa¨‡¶i mycvwik t (fwZ©”Qy cÖwZôvb Avmb k~b¨ bv _vK‡j Qvoc‡Îi gva¨‡g fwZ©i Rb¨ mycvwik Kiv hv‡e bv|)

Avmb msµvšÍ Z_¨ t (fwZ©”Qy K‡jR KZ…©K c~iYxq)

weÁvb kvLvi k~b¨ Avmb msL¨v t gvbweK kvLvi k~b¨ Avmb msL¨v t e¨emvq wk¶v kvLvi k~b¨ Avmb msL¨v t

(K) wk¶v †ev‡W©i AbygwZ cvIqv †M‡j QvocÎ (L) D³ QvÎ/QvÎxi cwVZ welq¸wj AÎ K‡jR/D”Pgva¨wgK we`¨vj‡q
i‡q‡Q|
†`Iqv n‡e| wk¶v †ev‡W©i AbygwZmn wewa †gvZv‡eK QvocÎ cvIqv †M‡j fwZ© Kiv n‡e|

...................................................... ................................................................
Aa¨‡¶i ¯^v¶i, ZvwiL I mxj‡gvni Aa¨‡¶i ¯^v¶i, ZvwiL I mxj‡gvni

Av‡e`bc‡Îi mv‡_ wb¤œwjwLZ KvMRcÎ mshy³ Ki‡Z n‡e t

 mwPe, gva¨wgK I D”Pgva¨wgK wk¶v †evW©, wm‡jU Gi AbyK~‡j †mvbvjx e¨vsK Gi †h ‡Kvb kvLv †_‡K 1500/= (GK nvRvi cuvPkZ)
UvKvi Wªvd&U/†c-AW©vi|
 QvocÎ MÖn‡Yi Kvi‡Yi ¯^c‡¶ cÖvgvY¨ KvMRcÎ|
 mswkøó cÖwZôvb cÖavb KZ„©K mZ¨vwqZ QvÎ/QvÎxi eSIF Gi Kwc|
 GmGmwm/mggvb cixÿvi GKv‡WwgK UªvÝwµ‡Þi d‡UvKwc|
C:\Documents and Settings\Admin\Desktop\Notice\T. C Form-1.doc