D "Q' HVM 2 Eqi GQV'X Evox Fvovi PZW Cî: Kz©Vejx WB Œiƒc

D‡”Q`‡hvM¨ 2 eQi †gqv`x evox fvovi Pzw³cÎ
নামঃ ..........., পিতাঃ .................., ঠিকানাঃ ........................, RvZxqZv - evsjv‡`kx,

ag© - .........|
cÖ_g cÿ/evoxi gvwjK
নামঃ ..........., পিতাঃ .................., ঠিকানাঃ ........................।
wØZxq cÿ/ fvovwUqv
Avwg cÖ_g cÿ নামঃ ..........., পিতাঃ .................., ঠিকানাঃ ........................, Aew¯’Z

evoxi 5g Zjvi ‡gvU 16 wU iæg fvov †Ìqvi †Nvlbv Kwi‡j Avcwb wØZxq cÿ নামঃ
..........., পিতাঃ .................., ঠিকানাঃ ........................, wb¤œ kZ© †gvZv‡eK fvov
wb‡Z ivwR I m¯§Z nIqvq A`¨ wb¤œ ¯^vÿiKvix ¯^vÿxM‡bi Dcw¯’wZ‡Z Avwg
cÖ_g cÿ, wØZxq c‡ÿi wbKU D³ 5g Zjvi ‡gvU 16 wU iæg gvwmK wfwË‡Z fvov
w`jvg|
kZ©vejx wb¤œiƒc
01| 5g Zjvi ‡gvU 16 wU iæg wewkó evwoi gvwmK fvov †gvU 80,000/- (Avwk
nvRvi) UvKv avh©¨ Kiv nBj| avh©¨K…Z gvwmK fvov cÖwZ PjwZ gv‡mi GK
nB‡Z `k Zvwi‡Li g‡a¨ wØZxq cÿ (fvovwUqv) (cÖ_g cÿ) gvwjK eive‡i Aek¨B
cwi‡kva Kwi‡Z eva¨ _vwK‡e Ges cÖ_g cÿ fvov cvIqvi ci wØZxq cÿ‡K cÖvwß
iwk` eySvBqv w`‡eb|
02| D³ evwoi AwMÖg RvgvbZ eve` 1,60,000/ (GK jÿ lvU nvRvi) UvKv avh©¨ Kiv
nBj| hvnv Avwg 1g cÿ (gvwjK) 2q cÿ (fvovwUqvi) wbKU nB‡Z bM` MÖnb
Kwijvg|
03| D³ g¨vP fvovi †gqv` 1jv GwcÖj 2017 Bs ZvwiL nB‡Z ïiæ nBqv AvMvgx 30‡k
GwcÖj 2019 Bs ZvwiL ch©šÍ 02 erm‡ii Rb¨ ejer _vwK‡e| D³ †gqv` †k‡l Dfqcÿ
Av‡jvPbv/mg‡SvZvi gva¨‡g cybivq bZzb Pzw³ Kwiqv mgq ewa©Z Kwi‡Z
cvwi‡e|
04| Pzw³cÎ nIqvi ci evwowUi ìRv, Rvbvjv, Rvbvjvi KuvP, c`©vi ó¨vÛ, M¨vm jvBb,
we`y¨r jvBb, cvwbi jvBb, ev_iæ‡gi †gvRvBK ev UvBjm& BZ¨vw`mn Ab¨vb¨
AvmevecÎ 2q cÿ (fvovwUqv) eywSqv wb‡e Ges Ni Qvwoqv hvIqvi mgq Aek¨B
1g cÿ‡K (gvwjK) c~e©ve¯’vq eySvBqv w`‡Z eva¨ _vwK‡e Ges fv½v, bó ev ÿwZ
nB‡j 2q cÿ ÿwZcyiY w`qv hvB‡e|
05| wØZxq cÿ (fvovwUqv) Zvnvi fvovK…Z evwo‡Z G/wm, wd«R Ges Avqib
eënvi Kwi‡Z cvwi‡eb bv|
06| evwoi gy‡Li wmuwo 2q cÿ (fvovwUqv) wbR `vwq‡Z¡ cwi¯‹vi cwiQbœ

ivwL‡eb|
07| cvwb, M¨vm, we`y¨r †Kvb KviY ekZt miKvixfv‡e eÜ _vwK‡j ev bv Avwm‡j 2q
cÿ (fvovwUqv) wbR †Póvq eë¯’v Kwi‡eb Ges gqjv AveR©bvq ev_iæg R¨vg
Kwi‡j Zvnv 2q cÿ (fvovwUqv) wbR Li‡P cwi¯‹vi Kwi‡eb|
08| wba©vwiZ Wv÷web Qvov wmuwoi gy‡L wKsev hÎZÎ gqjv AveR©bv †djv
ev ivLv †Kvbµ‡gB MÖnY‡hvM¨ bq| 2q cÿ (fvovwUqv) wmuwoi gy‡Li
ìRvi mvg‡bi jvBU ivÎ 12Uv ch©šÍ R¡vwj‡q ivL‡eb|
09| fvovwUqv KZ…©K †Kvb Dc-fvovwUqv fvov †Ìqv †Kvbµ‡gB MÖnY‡hvM¨ bq|
e¨v‡Pjvi fvovwUqv _vwK‡j Zvnvi †Kvb AvZœxq cwiRb ev †gngvb Avwmqv
ivwÎhvcb Kwi‡Z Pvwn‡j Aek¨B 1g cÿ (gvwj‡Ki) AbygwZ jvwM‡e Ab¨_vq
gvwj‡Ki m‡›`n fvRb nB‡j h_vh_ AvBb cÖ‡qvMKvix ms¯’v‡K Rvbv‡Z eva¨
_vwK‡e|
10| 2q cÿ (fvovwUqv) A‰ea Kvh©Kjvc ev AmvgvwRK KvR Kwi‡Z cvwi‡e bv Ges

2q cÿ fvovwUqvi PvjPj‡b †Kvb ai‡bi D”Q…sLjZv wKsev GjvKvevmx ev 1g cÿ
(evoxIqvjvi) weiw³i KviY N‡U G‡nb Kvh©Kjvc cwijwÿZ nB‡j 2q cÿ
(fvovwUqv) evox Qvwoqv w`‡Z eva¨ _vwK‡e| Ab_¨vq 1g cÿ (gvwjK) AvB‡bi
AvkÖq wb‡Z cvwi‡e|
11| 2q cÿ (fvovwUqv) †Kvb ai‡bi A‰ea gvjvgvj gRy` A_ev mieivn Kwi‡Z
cvwi‡e bv|
12| 2q c‡ÿi (fvovwUqv) cÿ n‡Z evwoi Ae¯’vb Kvwi mKj m`‡mï RvZxq cwiPq c‡Îi
d‡UvKwc 1g cÿ (evwoi gvwjK) eivei mievin Ki‡Z n‡e| GKB fv‡e 1g cÿ (gvwjK
M‡bi) 2 Rb e¨w³i RvZxq cwiPq c‡Îi d‡UvKwc I †gvevBj b¤î 2q c‡ÿi wba©vwiZ
cÖwZôv‡b mieivn Ki‡Z n‡e |
13| 1g c‡ÿi (gvwjK) †Kvb m‡›`n nB‡j †h †Kvb mgq iæg cwi`k©b Kwi‡Z
cvwi‡e|
14| 2q cÿ (fvovwUqv) evox Qvwoqv hvB‡Z Pvwn‡j 1g cÿ‡K (gvwjK) 2 gvm c~‡e©
AeMZ Kwi‡Z nB‡e|
15| 1g c‡ÿi (gvwjK) cÖ‡qvR‡b NiLvwj Ki‡Z nB‡j 2 gv‡mi †bvwU‡k fvovwUqv
NiLvwj Kwiqv Qvwoqv w`‡Z eva¨ _vwK‡e|
16| 2q cÿ (fvovwUqvi) mKj m`m¨ evoxi evwni nB‡j iæ‡gi cvwbi Kj, M¨vm jvBb,
d¨vb I jvBU eÜ Kwiqv hvB‡e| Bnv‡Z †Kvb µwU nB‡j gvwjK fvovwUqvi Zvjv
fv½‡Z eva¨ _vK‡e| Bnvi LiP fvovwUqv enb Kwi‡e|
17| D‡jøwLZ 1g nB‡Z 16 bs `dvi †h †Kvb kZ© f½ Kwi‡j 2q cÿ (fvovwUqv)

D‡”Q`‡hvM¨ ewjqvMY¨ nB‡e Ges GB Pzw³cÎ evwZj ewjqv we‡ewPZ
nB‡e|
GZØv‡_© †m”Qvq, ¯^Áv‡b, my¯’ kix‡i mij g‡b A‡bï webv cÖ‡ivPbvq AÎ
fvovwUqv Pzw³cÎ `wjj cvV Kwiqv Dnvi gg© I djvdj AeMZ nBqv wbR wbR bvg
¯^vÿi Kwijvg|
¯^vÿxM‡Yi ¯^vÿi

D "Q' HVM 2 Eqi GQV'X Evox Fvovi PZW Cî: Kz©Vejx WB Œiƒc

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D "Q' HVM 2 Eqi GQV'X Evox Fvovi PZW Cî: Kz©Vejx WB Œiƒc

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D‡”Q`‡hvM¨ 2 eQi †gqv`x evox fvovi Pzw³cÎ

নামঃ ..........., পিতাঃ .................., ঠিকানাঃ ........................, RvZxqZv - evsjv‡`kx,

cÖ_g cÿ/evoxi gvwjK

নামঃ ..........., পিতাঃ .................., ঠিকানাঃ ........................।

wØZxq cÿ/ fvovwUqv

Avwg cÖ_g cÿ নামঃ ..........., পিতাঃ .................., ঠিকানাঃ ........................, Aew¯’Z

06| evwoi gy‡Li wmuwo 2q cÿ (fvovwUqv) wbR `vwq‡Z¡ cwi¯‹vi cwiQbœ

10| 2q cÿ (fvovwUqv) A‰ea Kvh©Kjvc ev AmvgvwRK KvR Kwi‡Z cvwi‡e bv Ges

17| D‡jøwLZ 1g nB‡Z 16 bs `dvi †h †Kvb kZ© f½ Kwi‡j 2q cÿ (fvovwUqv)

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