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                  N®w¯ÁhN® ïu®±ãq¬ y®äš®Š®o xS®î®± x‡®±ï±q®

ïu®±ãq¬ š®Š®…Š¯c± x…ºuÂ®wµ 1998 Š® x…ºuÂ®wµ -7 Š® y®äN¯Š® 66 A.ý®./50 O.î¯. HŒ¬.i.ïu®±ãq¬ š®Š®…Š¯dS¯T AdÁ w®î®±²wµ

AdÁu¯Š®Š® / š®ºšµÚ‡®± œµš®Š®±: ________________________________________
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                                      N®Xµ°‹ Ey®‡µ²°S®NµÊ î®¾¯q®ä

N®ä. š®º ______________

§°/§°î®±r/îµ±|| ________________________ Aî®‹Sµ Nµ²iÔuµ.

Nµ²hÔ Évw¯ºN® _________________________

y¯î®r›u® wµ²°ºu®p ý®±©Ê Š®². ___________ Š®›°v š®º _________ vw¯ºN® _____________

N®Xµ°‹‡®± îµ²œ®Š®± _____________                      š®œ¯‡®±N® Hºdx°‡®±Š¬ (ï)
                                                              q¯ºräN® ý¯Pµ

x°l®©ÞhÔ wµ²°º.wµ²°º. š®ºPµã ___________ š®ºy®N®Á x°mu® vw¯ºN® ___________

                                     D AdÁ‡®±w®±Ý î®S¯Á‰±š®±î®ºr©å

                              N®w¯ÁhN® ïu®±ãq¬ y®äš®Š®o xS®î®± x‡®±ï±q®

ïu®±ãq¬ š®Š®…Š¯c± x…ºuÂ®wµ 1998 Š® x…ºuÂ®wµ -7 Š® y®äN¯Š® 66 A.ý®./50 O.î¯. HŒ¬.i.ïu®±ãq¬ y®½Šµ¶NµS¯T š®ªåš®±î® AdÁ w®î®±²wµ

Sµ,
1. N¯‡®±Áxî¯Áœ®N® Hºdx‡®±Š¬(ï).
2. ___________ y¯ î®±q®±Ù x ï„Â¯S®
3. š®œ¯‡®±N® N¯‡®±Áxî¯Áœ®N® Hºdx‡®±Š¬ (ï)
4. ___________ y¯ î®±q®±Ù x Ey® ï„Â¯S®
5. N®w¯ÁhN® ïu®±ãq¬ y®äš®Š®o xS®î®± x‡®±ï±q® _____________

î®¾¯w®ãŠµ,
„Â¯Š®r°‡®± ïu®±ãq¬ N¯‰±uµ 1910 Š® Aw®±…ºuÂ®u® 6wµ° N®©ï±w® y®äN¯Š® Kºu®± rºS®¡µ²¡®Sµ As®î¯ D vw¯ºN®vºu® ïu®±ãq¬ y®‹ï°£®N®Š®± Aw®±î®±rš®…œ®±u¯u® Aî®vÃ‡µ²¡®Sµ ïu®±ãq¬ ïq®Š®nµ y®äuµ°ý®uµ²¡®Sµ CŠ®±î® w®w®Ý/w®î®±â š®æºq® Bî®Š®o / î¯š®š®Ú¡®NµÊ ïu®±ãq¬ š®Š®…Š¯c± î®¾¯l®©± w¯w®±/w¯î®¼ Nµ²°Š®±qµÙ°wµ/Nµ²°Š®±qµÙ°îµ.

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D AdÁ‡®±ªåŠ®±î® HŒ¯å ïî®Š®S®¡®w®±Ý w¯w®±/w¯î®¼ LvuµÛ°wµ/LvuµÛ°îµ. î®±q®±Ù D AdÁ‡µ²l®wµ HŒ¯å AS®q®ã u¯QŒµS®¡®w®±Ý ©S®rÙ›uµÛ°wµ/©S®rÙ›uµÛ°îµ.

1. AdÁu¯Š®Š® œµš®Š®± / š®ºšµÚ‡®± œµš®Š®±
2. š®Ÿ î®¾¯l®©± AvÃN¯Š® y®lµvŠ®±î®î®Š® œµš®Š®±
3. q®ºuµ‡®± œµš®Š®± _____________ (î®¾¯ª°N®q®æu® N®ºy®xS®¢Sµ î®¾¯q®ä)
4. AdÁu¯Š®Š® î®‡®±š®±é ____________ î®Ç®ÁS®¡®±.
5. AdÁu¯Š®Š® Euµ²Û°S® / œ®±uµÛ. ___________
6. ïu®±X®ÐOÙ „µ°N¯u® š®Ú¡® ___________ ï¡¯š® ___________
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8. š®º…ºvÃ›u® y¯ävÃN¯Š®u® Œµ¶š®w¬é y®lµ‡®±Œ¯Tuµ‡µ± : œ¹u®±/C©å (Nµ.J.H.m.†/Nµ.Hš¬.Hš¬.J.m.› y®äuµ°ý®S®¢Sµ ‡®¾¯î®¼uµ° Œµ¶š®w¬é „µ°O©å)
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10. š®ºy®N®Áî®¼ œµ²š®uµ / œ®¡µ° š¯Úy®w®NµÊ œµX®±Ïî®‹‡µ±?
11. ïu®±ãq¬ Aî®ý®ãN®qµ‡®± ïî®Š®S®¡®±:
Kºu®± yÂµ°š¬ ________ A.ý®. _________ O.î¯.S®¡®±
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u®²Š®î¯p š®ºPµã _________ Hš¬.i.m š®ºPµã _________
15. ©S®q®±ÙS®¡® ïî®Š®:
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†) CrÙ°YSµ y¯î®r›u® g¯ãN¬é Š®›°v.
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m) š¯Úy®w®î®w®±Ý q®©±y®©± î®¾¯S®Á š®²Y w®£µ.
C) S®±rÙSµu¯Š®Š¯u®ªå wµ²°ºu¯‰±q® S®±rÙSµ N®Š¯Š®± y®q®ä
H‚¬) y®‡®¾¯Áî®Š®o r°Š®±î®¢ y®äî®¾¯o y®q®ä ( Bw®æ‰±š®±î® š®ºu®„Â®ÁS®¡®ªå ) AdÁ°u¯Š®‹Sµ Nµ²iÔŠ®±î® OŠ®±y®¼š®ÙN®u®ªåŠ®±î® š®²X®wµS®¡®w®±Ý w¯w®±/w¯î®¼ LvuµÛ°wµ/ LvuµÛ°îµ. î®±q®±Ù HŒ¯å N¯©ºS®¡®w®±Ý q®±º†uµÛ°wµ/ q®±º†uµÛ°îµ. Hºu®± y®äî®¾¯p°N®‹š®±qµÙ°wµ/qµÙ°îµ.

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vw¯ºN® ___________

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