Appl 22

gva¨wgK I D”P gva¨wgK wk¶v †evW©, wm‡jU
Avjgcyi, wm‡jU
Av‡e`bcÎ
mswkó wk¶v cÖwZôv‡bi
[wØ-bKj/wÎ-bKj/†PŠ-bKj/mb`cÎ/gvK©kxU/GKv‡WwgK UªvÝwµÞ/cÖ‡ekcÎ-Gi Rb¨ Av‡e`b|] cÖavb KZ…©K cÖv_x©i
gvbbxq mZ¨vwqZ
01 (GK) Kwc Qwe
cix¶v wbqš¿K GLv‡b jvMvb|
gva¨wgK I D”Pgva¨wgK wk¶v †evW©
wm‡jU|
welq t wØ-bKj/wÎ-bKj/†PŠ-bKj /gvK©kxU/GKv‡WwgK UªvÝwµÞ/cÖ‡ekcÎ-Gi Rb¨ Av‡e`b|
Rbve
webxZ wb‡e`b GB †h, Avgvi g~j mb`cÎ/gvK©kxU/GKv‡WwgK UªvÝwµÞ/cÖ‡ekcÎ/ nvwi‡q‡Q/cy‡o‡Q/ bó
n‡q‡Q| AbyMÖnc~e©K D³ WKz‡g‡›Ui wØ-bKj/wÎ-bKj/†PŠ-bKj Kwc cÖ`vb K‡i evwaZ Ki‡eb| cix¶v
msµvšÍ hveZxq Z_¨vw` wb‡¤œ Dc¯’vcb KiwQ t
1| bvg (Bs‡iwR‡Z) t ..............................................................................................................
2| wcZvi bvg (Bs‡iwR‡Z) t .....................................................................................................
3| gvZvi bvg (Bs‡iwR‡Z) t ......................................................................................................
4| wk¶v cÖwZôv‡bi bvg t ..........................................................................................................
5| wk¶v cÖwZôv‡bi wVKvbv t ....................................................................................................
MÖvg t ...................................WvK t .........................................................
_vbv / Dc‡Rjv t ............................... †Rjv t .........................................
cixÿv msµvšÍ Z_¨vw`
6|
cixÿvi bvg t JSC / SSC / HSC, †K›`ª †KvW t ....................................
cixÿv cv‡ki mvj t 20..........., †ivj t ………..................‡iwR t…….....................
4_© welq e¨wZZ cÖvß wRwcG t ................................ wRwcG t.....................................
...................................., ...................
7| cix¶v_x©i aib t wbqwgZ / AwbqwgZ / cÖvB‡fU / gvb Dbœqb
8| RgvK…Z wd Gi weeib t ...................UvKv, K_vq t ........................................................ UvKv
e¨vsK t †mvbvjx e¨vsK, kvLv t ......................... wWwW/†c-AW©vi b¤î t.............................ZvwiL t.............. .......
9| wØ-bKj/wÎ-bKj/†PŠ-bKj/ mb`cÎ/ gvK©kxU/ GKv‡WwgK UªvÝwµÞ/ cÖ‡ekcÎ-Gi Rb¨ wb‡Pi Z_¨ cÖ‡hvR¨ t
K) _vbvi wRwW b¤î t ................ _vbvi bvg t .................................ZvwiL t ........................ ...........
L) weÁvwcZ cwÎKvi bvg t .................................................cÖKv‡ki ZvwiL t .................................
10|†hvMv‡hv‡Mi wVKvbv t
---------------- ............................................................................. .............................................
MÖvg t ................................. WvK t ............................ Dc‡Rjv t ............................ .
†Rjv t ................................... †gvevBj t 0 1
webxZ
¯§viK bs t Avcbvi AbyMZ
cÖavb wk¶K / Aa¨¶ .......................................

(¯^v¶i, bvgmn mxj‡gvni _vK‡Z n‡e) Av‡e`bKvixi c~Y© ¯^v¶i I ZvwiL
cÖ‡hvR¨ †¶‡Î cÖv_x©i mZ¨Zv hvPvB‡qi Rb¨
‡gvevBj b¤î t 0 1
Aek¨B cvjbxq wb‡`©kvejx
1| mKj cÖKvi wd ÔmwPe, gva¨wgK I D”Pgva¨wgK wk¶v †evW©, wm‡jUÕ wk‡ivbv‡g evsjv‡`k †mvbvjx e¨vs‡Ki †h †Kvb kvLv n‡Z wb‡Pi
ZvwjKv n‡Z WKz‡g›U Abyhvqx †c AW©vi / wW.wW.Rgv w`‡Z n‡e| wb‡¤œv³ wd 01/07/2015 ZvwiL nB‡Z Kvh©Ki|
‡mev/ WKz‡g‡›Ui cÖKvi wØ bKj wÎ bKj ‡PŠ bKj
(100UvKv Riæix wdmn) (100UvKv Riæix wdmn) (100UvKv Riæix wdmn)
gvK©kxU/GKv‡WwgK UªvÝwµÞ/mb`cÎ (cÖwZ Kwc) 1100/- 2000/- 3000/-
cÖ‡ekcÎ (cÖwZ Kwc) 600/- 2000/- 2000/-
2| WKz‡g›U nviv‡bv / cy‡o / bó n‡j welqwU D‡jøL c~e©K mswkøó _vbvq cix¶vi mvj, †ivj b¤î, †iwR‡÷ªkb b¤î, †ev‡W©i bvg, BZ¨vw`
D‡jøL c~e©K wRwW.Gw›Uª Ki‡Z n‡e| D³ welqmg~n D‡jøLc~e©K (wRwW b¤î I _vbvi bvgmn) eûj cÖPvwiZ ˆ`wbK cwÎKvq Ônviv‡bv weÁwßÕ
cÖKvk Ki‡Z n‡e| Av‡e`bc‡Îi mv‡_ wR wW Gi g~jKwc I g~j cwÎKvi mswkøó cvZvwU mshy³ Ki‡Z n‡e| GQvov Av‡e`bKvix KZ…©K
wbe©vnx A_ev RywWwkqvj g¨vwR‡÷ª‡Ui wbKU m¤úvw`Z njdbvgv mshy³ Kwi‡Z nB‡e|
3| wØ bKj / wÎ bKj/ †PŠ bKj WKz‡g›U - cÖv_x© / Zvui cÖwZwbwa/ Awffve‡Ki wbKU cÖ`vb Kiv n‡e bv| Zv †KejgvÎ †iwRóªvW© WvK‡hv‡M
mswkøó wk¶v cÖwZôv‡b †cÖiY Kiv n‡e| cÖ‡Z¨K Av‡e`‡bi mv‡_ AwZwi³ 01 (GK) Kwc Qwe mshy³ Ki‡Z n‡e|
4| wØ bKj / wÎ bKj WKz‡g‡›Ui Ave`bc‡Îi mv‡_ mswkøó cix¶vi †iwR‡óªkb Kv‡W©i g~j Kwc Ges †iwR‡÷ªkb Kv‡W©i 01 (GK) wU
K‡i d‡UvKwc mshy³ K‡i w`‡Z n‡e| Am¤ú~Y© / ÎæwUc~Y© Av‡e`bc‡Îi Kvh©µg mswkøó cÖv_x©i mv‡_ †hvMv‡hvM QvovB ¯’wMZ ivLv n‡e||
cix¶v wbqš¿K

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

cÖavb wk¶K / Aa¨¶ .......................................

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