-t evqbv bvgv `wjj t-

evqbvK…Z g~j¨ gs ......................../-

(.................................) UvKv,
evqbvK…Z m¤úwËi cwigvY ...........
(..............................) kZvsk,
‡gŠRv- ......................,
.........................................., wcZvÑ ................................,
gvZv- ..............................., mvs- ..........................,
WvKNi- ......................., _vbv- iƒcMÄ, †Rjv- bvivqbMÄ, ag©-
Bmjvg, †ckv- e¨emv, RvZxqZv- evsjv‡`kx|
********* evqbv `wjj MÖwnZv

.........................................., wcZv- ................................,

gvZv- ..............................., mvs- ..........................,
WvKNi- ......................., _vbv- iƒcMÄ, †Rjv- bvivqbMÄ, ag©-
Bmjvg, †ckv- e¨emv, RvZxqZv- evsjv‡`kx|
******* evqbv `wjj `vZv/`vÎx

cig Kiæbvgq gnvb Avjøvn cv‡Ki bvg ¯^iY c~e©K AÎ evqbv

cÎ `wjj m„R‡bi D‡Ï‡k¨ ewY©Z nB‡Z‡Q †h, mv‡eK XvKv eZ©gv‡b
bvivqbMÄ †Rjvi iƒcMÄ _vbvaxb AšÍM©Z .........................
MÖvg ..................................... wbgœ wjwLZ Zdwm‡j ewY©Z

cvZv - 1
evqbvK…Z m¤úwË ..................... my‡Î cÖvß nBqv gvwjK I
†fvM`LjKvi wbqZt miKvi wbiƒwcZ LvRbvw` cwi‡kvav‡šÍ GhverKvj
cig myL I kvwšÍc~Y©fv‡e †fvM`Lj Kwiqv Avwm‡ZwQ|
eZ©gv‡b Avwg AÎ evqbv bvgv `wjj `vZvi we‡kl cÖ‡qvR‡b
bM` UvKvi Avek¨K nB‡j wbgœ wjwLZ Zdwmj ewb©Z m¤úwË
weµ‡qi cÖ¯Íve cÖKv‡k¨ ‡Nvlbv Kwi‡j ci Avcwb AÎ evqbv bvgv
`wjj MÖnxZv Zvnv Lwi` Kwievi B”Qv cÖKvk Kwiqv‡Qb ev m¤§Z
nBqv‡Qb| ‡mg‡Z Dnvi g~‡j¨i mvK~j¨ UvKv nB‡Z A`¨ †ivR
nvwRivb gRwj‡k wbgœ wjwLZ ¯^v¶xM‡Yi ‡gvKv‡ejvq evqbv
eve` bM` gs ............................../- (..........................................)
UvKv nv‡Z nv‡Z eywSqv cvBqv I eywSqv wbqv wbgœ wjwLZ
Zdwmj ewY©Z m¤úwË Avcbvi eive‡i `Lj Qvwoqv I eySvBqv w`qv
GB A½xKvi I ¯^xKvi Kwi‡ZwQ †h, A`¨ nB‡Z ..............
(...............) ................ †gqv‡`i g‡a¨ evqbvi UvKv ev‡` g~‡j¨i
Aewkó UvKv Avcwb AÎ `wjj MÖwnZv Avwg AÎ `wjj `vZv‡K
eySvBqv w`‡j ci wbgœ wjwLZ Zdwmj ewY©Z m¤úwË ev Rwg
Avwg AÎ `wjj `vZv Avcwb `wjj MÖwnZvi eive‡i mvd Kejv `wjj
Øviv m¤úv`b µ‡g †iwRw÷ª Kwiqv w`‡Z eva¨ AvwQ I iwnjvg|
cÖKvk _v‡K †h, D³ †gqv‡`i g‡a¨ evqbvi UvKv ev‡` Aewkó UvKv
eywSqv cvBqv I eywSqv wbqv hw` Avwg AÎ `wjj `vZv, Avcwb AÎ
`wjj MÖnxZvi eive‡i mvd Kejv `wjj †iwRw÷ª Kwiqv bv †`B wKsev
†Kvb `yyó †jv‡Ki Kzcivg‡k© Zvj evnvbv Kwi, Zvnv nB‡j Avcwb
`wjj MÖwnZv AÎ evqbv bvgv `wjj Av`vj‡Z `vwLj w`qv Av`vj‡Zi
LiPmn evqbvi evwK UvKv Av`vj‡Z `vwLj w`qv webv †bvwU‡k
Av`vjZ KZ©„K mvd Kejv `wjj Øviv ‡iwRw÷ª
Kwiqv wb‡Z cvwi‡eb I cvwi‡eK| Bnv‡Z Avwg AÎ `wjj `vZv wKsev
Avgvi ¯’jeZ©x I cieZ©x Ajx IqvwikMY µ‡g †Kn ‡Kvb cÖKvi IRi
AvcwË I `vwe `vIqv Kwi‡Z cvwi‡ebv ev cvwi‡eK bv, Kwi‡jI Zvnv

cvZv - 2
me© AvBb Av`vj‡Z AMÖvn¨ I evwZj ewjqv MY¨ nB‡e| Av‡iv
cÖKvk _v‡K ‡h, evqbvK…Z wbgœ wjwLZ Zdwmj ewY©Z m¤úwË
hw` †KD †Kvb iKg ¯^Z¡ gvwjKvbv `vex K‡i ev evqbvK…Z
m¤úwˇZ †Kvb ZÂKZv cÖKvk cÖvq, Zvnv nB‡j Avwg AÎ `wjj `vZv
Avcwb `wjj MÖwnZvi evqbv eve` ‡`Iqv UvKv I Av`vj‡Zi LiPmn
mg~`q UvKvi ¶wZc~iY GKKvjxb †diZ cÖ`v‡b eva¨ _vwKe I
iwnjvg, Ab¨_vq AvB‡bi gva¨‡g Avgvi wbKU nB‡Z `wj‡j ewY©Z
mg~`q UvKv Av`vq Kwiqv wb‡Z cvwi‡eb I cvwi‡eK| c~bt cÖKvk
_v‡K †h, mvd Kejv `wjj ‡iwRw÷ª Kwiqv ‡`Iqvi c~‡e© wbgœ
Zdwmj ewY©Z m¤úwËi mgy`q KvMR cÎ I we.Gm Rixc cP©v I
bvgRvix Rgv LvwiR Ges nvj mb ch©šÍ LvRbv cwi‡kva Kwiqv
m¤ú~Y© KvMR cÎ Avcwb AÎ `wjj MÖwnZv‡K eySvBqv w`‡Z eva¨
_vwKe I iwnjvg| wbgœ Zdwmj ewY©Z m¤úwË m¤ú~Y©
wb‡`©vl, wb`©vqx I wbt®KÈK Ae¯’vq Avwg AÎ `wjj `vZv Avcwb
AÎ `wjj MÖwnZvi mwnZ evqbv bvgv `wjj Øviv Pzw³‡Z Ave×
nBjvg|

GZØv‡_© †¯^”Qvq, ¯^Áv‡b, my¯’ kix‡i, A‡b¨i webv

cÖ‡ivPbvq AÎ evqbv bvgv `wj‡ji hveZxq gg©K_v m¤ú‡K©
m¤ú~Y© AeMZ nBqv Dnv wb‡R cwoqv Ges A‡b¨i Øviv covBqv
Dnvi eZ©gvb I fwel¨Z djvdj fvjfv‡e eywSqv evqbvi UvKv bM`
eywSqv cvBqv I wbqv AÎ evqbv bvgv `wj‡j mwn m¤úv`b Kwiqv
w`jvg| BwZ, ZvwiL t
evqbvK…Z m¤úwËi Zdwmj cwiPq
‡Rjv- bvivqbMÄ, _vbv/Dc‡Rjv iƒcMÄ I mve-‡iwRw÷ª Awdm iƒcMÄ
Aaxb mv‡eK .............. bs, Avi.Gm .............. bs †gŠRv
........................... w¯’Z|

cvZv - 3
LwZqvb- Gm.G ....................Avi.Gm .....................bs, we.Gm
wW.wc ............... bs LwZqvbf~³|
`vM- wm.Gm I Gm.G .................... (......................................) bs,
Avi Gm ..................... (......................................) bs
`v‡M ................... 1& ‡lvj Avbvq ........... kZvsk nB‡Z ..............
(..............................................) kZvsk AÎ evqbv bvgv `wjj g~‡j
evqbvK…Z e‡U|
hvnvi †PŠnwÏt Dˇi- ............................., `w¶‡Y- .........................,
c~‡e©- ........................, cwð‡g- ........................|
D³ †PŠnwÏi A›`‡i ............... (.......................................) kZvsk
bvj Rwg AÎ `wjj Øviv evqbvK…Z e‡U|
AÎ `wj‡j 2 d‡`© K‡¤úvRK…Z Ges ¯^v¶x ......... (..............) Rb|

¯^v¶xM‡Yi ¯^v¶i
1|
`vZvi ¯^v¶i

2|

cvZv - 4