You are on page 1of 1

eivei

e¨e¯’vcbv cwiPvjK
XvKv Iqvmv| cvm‡cvU© mvB‡Ri
03wU mZ¨vwqZ Qwe
Av‡e`bK„Z c‡`i bvg t .......................................................................................
b¨vkbvj AvBwW bs t ..........................................................................................

Av‡e`bKvixi bvg (Bs‡iRx eo nv‡Zi A¶i) t .......................................................................


Av‡e`bKvixi bvg (evsjvq) t .......................................................................

wcZvi bvg t....................................... ¯^vgx / ¯¿xi bvg t .....................................


gvZvi bvg t........................................ .....................................
eZ©gvb wVKvbv t ¯’vqx wVKvbv t ‡Rjv t.......................
t...................................... (weevwnZv gwnjvi Dc‡Rjv t ......................
t...................................... †¶‡Î ¯^vgxi ¯’vqx WvKNi t ......................
t...................................... wVKvbv) Mªvg/moK t......................
†gvevBj / †Uwj‡dvb t .......................................e-mail address :...........................................
RvZxqZv t...................................... ‡c-AW©vi/wWgvÛ WªvdU BZ¨vw`i Z_¨ t
Rb¥ ZvwiL t...................................... b¤^i I ZvwiL t ...................................................
ag© t...................................... A‡_©i cwigvY t ...................................................
e¨vsK t ..................................................
wk¶vMZ ‡hvM¨Zv t
wWMªx Mª“c/welq ‡evW©/wek¦we`¨vjq wk¶v cªwZôv‡bi bvg cv‡mi ermi wefvM/wRwcG

PvKyixi AwfÁZv t
c‡`i bvg ‡eZbµg PvKyixiKvj cªwZôv‡bi bvg
/‡MªW
ZvwiL nB‡Z ZvwiL ch©š—

wet `ªt cª‡qvR‡b AwZwi³ cvZv e¨envi Kiv hv‡e|


cª‡hvR¨ †¶‡Î √ wPý gyw³‡hv×vi mš—vb wefvMxq cªwZeÜx DcRvZxq gwnjv
w`b cªv_x©

Av‡e`bKvixi ¯^v¶i I ZvwiL

You might also like