Palanhar Application Form

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jktLFkku ljdkj

cky vf/kdkfjrk foHkkx


ikyugkj ;kstkuk ds vUrxZr vkfFkZd lgk;rk ds fy, vkosnu i=
vkosnu&i=
ikyugkj dh Js.kh ¼d`i;k lEcfU/kr Js.kh ij dk¼√½ fpUg yxkosAa ½
1- vukFk cPpksa ds ikyugkjA 4- iquZfookfgr fo/kok ekrk ds cPpksa ds ikyugkjA
2- U;kf;d izfØ;k ls e`R;q n.M@vkthou dkjkokl izkIr 5- ,M~l ihfM+r ekrk@firk ds cPpksa ds ikyugkjA
3- Ekrk&firk ds cPpksa ds ikyugkjA 6- dq"B jksx ls ihfM+r ekrk@firk ds cPpksa ds ikyugkjA
4- fo/kok ekrk ikyugkjA 7- ukrk tkus okyh ekrk ds cPpksa ds ikyugkjA
5- fo’ks"k ;ksX;tu ds cPpksa ds ikyugkjA

Ikyugkj dk QksVks
cPpksa dh QksVks o uke] ftlds fy, ikyugkj }kjk vkfFkZd lgk;rk pkgh xbZ gSA

1- ikyugkj dk uke % --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------


2- ikyugkj ds firk@ifr dk uke % ----------------------------------------------------------------------------------------------------------------------------------------------------------
3- tUe frfFk % ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
4- tkfr oxZ ¼d`Ik;k½ % --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
lEcfU/kr Js.kh ij dk ¼√½ fpUg yxkosaA¼vuqlfw pr tkfr@vuqlfw pr tutkfr@vU; fiNM+k oxZ@vYila[;d@lkekU;½
5- /keZ % ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
6- fuokl LFkku dk iw.kZ % --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
irk ¼;Fkk edku uEcj --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
eksgYyk] xyh] iksLV ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
vkWfQl] rglhy] ftyk ½ ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
7- nqjHkk"k fuokl %&
dk;kZy; %&
eksckbZy %&
8- orZeku O;oLkk; % ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
9- okf"kZd vk; % vadks esa --------------------------------------------------¼'kCnksa es½a ------------------------------------------------------------------------------------------------
¼fu/kkZfjr izi= esa vk;½ % -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
izek.k i= layXu djsa
10- D;k ch-ih-,Yk- esa % ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------
fpfUgr gSa] ;fn gk¡ rks % ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Øekad o o"kZ vafdr djsa %
11- Ikyugkj dk SBBJ : …………………………………………………………………………………………………………………
cSad dk [kkrk la[;k % -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
o cSad dk uke] irk % -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
IFSC Code : ………………………………………………………………………………………………………………….
12- Ikkyugkj }kjk ftu cPpksa ds fy, vkfFkZd lgk;rk pkgh xbZ gS] mudk fooj.k
uke tkfr fyax tUefrfFk orZeku d{kk vU;
1
2
3
4
5
13- cPpksa ds firk dk fooj.k %&
uke Ikq.kZ irk e`R;q frfFk @ e`R;q @ n.Mkns’k n.Mkos’k @ e`R;q izek.k vU;
n.Mkns’k frfFk dk dkj.k i= la[;k o fnukad

14- cPpksa dh ekrk dk fooj.k %&


uke Ikq.kZ irk e`R;[email protected]’k e`R;q @ n.Mkos’k n.Mkns’k @e`R;q @ vU;
gksus@ iqufZ ookg gksus @ iqufZ ookg iquZfookg @ ukrk izek.k
frfFk @ ukrk tkus frfFk@ ukrk ds i= la[;k o fnukad
dh frfFk le; vk;q

15- ?kks"k.kk %&


eSa 'kiFk iwoZd c;ku djrk@djrh gw¡] fd vkosnu i= esa vafdr fooj.k o layXu fd, nLrkost ds rF; lgh
o lR; gSaA eSuas ikyugkj ;kstuk ds fu;e iw.kZr% i<+@lqu@tku@fy, gSaA eSa ;kstuk ds vuqlkj vkosnu esa mYysf[kr
cPpksa dks vius ifjokj esa j[kdj vius Lo;a ds cPpksa dh Hkkafr Hkkstu] oL=] vkokl] f’k{kk o vU; lqfo/kk,sa miyC/k
djkus ds fy, Lo;a dks vkc) djrk gw¡A esjs }kjk fn, x, rF; vlR; @viq.kZ@Hkzked ik, tkus ij vFkok ;kstuk ds
fu;eksa dh ikyuk ugh djus ij foHkkx }kjk fn, x, vkns’[email protected];@fof/kd dk;Zokgh dh esjs iw.kZr% vuqikyuk dh
tkosxhA

LFkku % ----------------------------------- gLrk{kj


fnukad % --------------------------------- ¼ikyugkj½

layXu fd, tkus okys nLrkost %&


1- Ikyugkj dk fu/kkZfjr izi= esa vk; izek.k&i= ¼fo/kok is’a ku ;kstuk esa ykHkkfUor gksus ij isa’ku Hkqxrku vkns’k ¼ih-
ih-vks½ dh izfr layXu djus ij vk; izek.k&i= o ifr dk e`R;q izek.k i= dh vko’;drk ughaA
2- cSad [kkrk dh ikl cqd dh izfrA
3- vukFk cPpksa ds izdj.kksa esa ekrk&firk dk e`R;q izek.k i=A
4- U;kf;d n.Mkns’k ls nf.Mr ekrk&firk ds cPpksa ds izdj.kksa esa n.Mkns’k dh izfrA
5- iquZfookfgr fo/kok ekrk dh larku izdj.kksa esa fo/kok ekrk ds iquZfookg ds izek.k i= dh izfrA
6- ukrk tkus okys ekrk dh larku ds izdj.kksa esa ekrk dks ukrs x, gq, ,d o"kZ ls vf/kd le; gksus dk izek.k i=A
7- tkfr izek.k i=A
8- vukFk cPpks@ a U;kf;d n.Mkns’k ls nf.Mr ekrk&firk ds cPpksa @ukrk tkus okyh ekrk @ iquZfookfgr ekrk dh
larku ds izdj.kksa esa ljiap @okMZ ik"kZn dk izek.k i= ¼ftlesa cPpksa dk ikyugkj }kjk mudh ns[kHkky fd;k tkuk
izekf.kr gSA½
9- ikap o"kZ ls vf/kd vk;q ds cPpksa dk fo|ky; }kjk tkjh v/;;ujr izek.k&i=A
10- ,M~l jksx ls fifM+r ekrk@firk dh larku ds izdj.kksa esa fifM+r dk jktLFkku ,M~l dUVªksy lkslk;Vh@ ,-vkj-Vh
lsUVj }kjk tkjh ,-vkj-Mh Mk;jh@xzhu Mk;jh dh izfrA
11- dq"B jksx ls ihfM+r ekrk&firk dh larku ds izdj.kksa esa ihfM+r dks l{ke fpfdRlk cksMZ }kjk tkjh fd;k x;k
fpfdRlk izek.k&i=A
Ikkyugkj }kjk vukFk cPpksa ds ikyu&iks"k.k djus dk izek.k&i=
izekf.kr fd;k tkrk gS fd Jh@Jherh-------------------------------------------------------firk@iRuh Jh-----------------------------------------------------------
fuoklh------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
fuEu vUkkFk cPpksa dks vius ifjokj esa j[kdj Lo;a dh larku dh Hkkafr ikfjokfjd ekgkSy esa ikyu&iks"k.k] f’k{kk vkfn
dh lqfo/kk,sa miyC/k djk jgs gSa&

Ø-la- vukFk firk dk uke fyax tUe frfFk orZeku ikyugkj ds


ckyd@ckfydk dk d{kk@vkaxuckM+h ikl dc ls jg
uke dsUnz dk uke jgsa gSa

fnukad %& ¼gLrk{kj½


¼ljiap]xzke iapk;r@iz/kku]iapk;r lfefr@okMZ ik"kZn] uxjh; fudk;½
uke % -----------------------------------------------------------------------------------------------------------------------
eksgj % -----------------------------------------------------------------------------------------------------------------------

os cPps]a ftuds ekrk&firk dh e`R;q gks xbZ gks vFkok U;kf;d izfØ;k }kjk e`R;qn.M@vkthou dkjkokl ls nf.Mr fd,
x, gks vFkok ftudh fo/kok ekrk us fof/kor iquZfookg ds i'pkr viuh larkuksa dks R;kx fn;k gks ds fy, gh mä izek.k
i= dh iwfrZ djkbZ tkuh gSaA

dk;kZy; ¼f’k{k.k laLFkk dk uke½ %& --------------------------------------------------------------------------------------------------------------------------------------------------------------------


Øekad fnukad %& --------------------------------------------
fo|ky; esa v/;;ujr gksus dk izek.k&i=
izekf.kr fd;k tkrk gSa fd f’k{k.k laLFkk ds fjdkWMkZuqlkj fuEu fo|kFkhZ bl fo|ky; esa pkyw 'kS{kf.kd l=--------------
-------------------------------- esa fu;fer :i ls v/;;ujr gSa%&

Ø- fo|kFkhZ dk uke firk dk uke fyax tUefrfFk orZeku d{kk f’k{k.k laLFkk esa
la- iath;u@ukekdu la[;k ,oa
fnukad

¼gLrk{kj½
f'k{k.k laLFkk iz/kku
tkjh drkZ dk uke %& -----------------------------------------------------------
eksgj %& -------------------------------------------------------------------------------------
dk;kZy; ¼xzke iapk;r½ --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Øekad fnukad %& -------------------------------------

Ukrk tkus okyh ekrkvksa dh larku gsrq ikyugkj ;kstukUrxZr lgk;rk Lohd`fr ckcr lEcfU/kr xzke iapk;r ¼xzkeh.k {ks=
gsrq½ }kjk tkjh fd;k tkus okys izek.k i=
izekf.kr fd;k tkrk gSa fd Jherh --------------------------------------------------------------iRuh Jh ------------------------------------------------------------------
fuoklh -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
vius ifjokj dks NksMd + j de ls de ,d o"kZ iwoZ vU; iq:"k ¼uke ;fn Kkr gks½ ----------------------------------------------------------- ds lkFk
ukrk pyh xbZ gSa ,oa vius iwoZ ifr ls mRiUUk fuEu larkuksa dks R;kx fn;k x;k gSa%&

Ø-la- larku dk uke fyax tUe frfFk

;g izek.k i= xzke lHkk dh fnukad --------------------------------------------------- dks vk;ksftr cSBd esa dh xbZ vuq’ka"kk ds vk/kkj ij vkt
fnukad -------------------------------- dks esjs gLrk{kj ,oa dk;kZy; dh eksgj ls tkjh fd;k tkrk gSaA

¼gLrk{kj½
¼lfpo] xzke iapk;r½
TkjhdrkZ dk uke %-----------------------------------------------
Ekksgj %-----------------------------------------------------------------------

dk;kZy; ¼uxj fuxe@uxjifj"kn@uxj ikfydk½ -----------------------------------------------------------------------------------------------------------------------------------------


Øekad fnukad %& -------------------------------------

Ukrk tkus okyh ekrkvksa dh larku gsrq ikyugkj ;kstukUrxZr lgk;rk Lohd`fr ckcr lEcfU/kr LFkkuh; fudk; ¼uxjh; {ks=
gsrq½ }kjk tkjh fd;k tkus okys izek.k i=
izekf.kr fd;k tkrk gSa fd Jherh --------------------------------------------------------------iRuh Jh ------------------------------------------------------------------
fuoklh -----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
vius ifjokj dks NksMd + j de ls de ,d o"kZ iwoZ vU; iq:"k ¼uke ;fn Kkr gks½ ----------------------------------------------------------- ds lkFk
ukrk pyh xbZ gSa ,oa vius iwoZ ifr ls mRiUUk fuEu larkuksa dks R;kx fn;k x;k gSa%&

Ø-la- larku dk uke fyax tUe frfFk

;g izek.k i= vkt fnukad --------------------------------------------------- dks esjs gLrk{kj ,oa dk;kZy; dh eksgj ls tkjh fd;k tkrk gSaA

¼gLrk{kj½
¼eq[; dk;Zdkjh vf/kdkjh@vk;qä@vf/k’kk"kh vf/kdkjh½
TkjhdrkZ dk uke %-----------------------------------------------
Ekksgj %-----------------------------------------------------------------------

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