n j d bv gv

ZgmyK (eÛ)

Avwg ‡gvt Bgivb †nv‡mb, wcZvt †gvt Rvjvj DwÏb †gvj¨v (†gvt
Rvjvj DÏxb), MÖvgt `wÿY kiæïbv, WvKNit kiæïbv, Dc‡Rjvt kvwjLv,
†Rjvt gv¸iv, ag©t Bmjvg, †ckvt PvKzix, RvZxqZvt evsjv‡`kx, XvKv
kn‡ii 1/4 Kj¨vYcyi, wgicyi †ivW, XvKv, Aew¯’Z w` GK&wg
j¨ve‡iUwiR wjwg‡U‡Wi mywbw`©ó `vwq‡Z¡ wb‡qvMK…Z Gg.wc.I
(Avgvi wb‡qvMc‡Îi mwnZ hy³ kZ© mg~n) Avwg GB g‡g© A½xKvi
Kwi‡ZwQ †h, Avwg ¯^qs Avgvi wba©vwiZ GjvKvi D³ †Kv¤úvwbi
Jlya mvgMÖxi ‡mj&m GÛ cÖ‡gvkb wi‡cÖ‡Rb‡UwUf‡`i Kv‡Ri Z`viKx
Kwie Ges Avwg Avgvi GjvKvi Jlya mvgMÖxi †µZv wbe©vP‡bi
`vwqZ¡, UvKv Av`v‡qi Z`viwK †mj&m GÛ cÖ‡gvkb
wi‡cÖ‡Rb‡UwUf‡`i KvRKg© I UvKv cqmv Av`v‡qi KvR †`Lv-ïbv
Kwie Ges mvwe©K fv‡e †Kv¤úvwbi e¨emvi cÖmvi I DbœwZ mvab
BZ¨vw` KZ©e¨ wek¦Z¡Zvi mwnZ cvjb Kwie|

Pjvgvb cvZv-02
 cvZv-02

Avgvi Dci b¨¯Í GjvKvi †Kv¤úvwbi †Kvb †mj&m GÛ cÖ‡gvkb

wi‡cÖ‡Rb‡UwUf hw` Zvnvi Dci Awc©Z `vwqZ¡ cvj‡b Ae‡njv K‡i ev
†Kv¤úvwbi Jlya mvgMÖx weZi‡b Awbqg ev A`ÿZvi cwiPq ‡`q ev
e¨_© nq ev †µZv/e¨emvqx/Jlya we‡µZv‡`i wbKU nB‡Z Av`vqK…Z
UvKv cqmv †Kv¤úvwbi Znwe‡j mwVKfv‡e mgqgZ Rgv bv †`q,
Zvnv nB‡j Avwg †Kv¤úvwbi KZ©„c‡ÿi wbKU ev Avgvi DaŸ©Zb
Kg©KZ©vi wbKU wjwLZfv‡e RvbvB‡ev| hw` Avgvi wb‡Ri Dci
D‡cvi³ KZ©e¨ mg~n, hvnv †mj&m GÛ cÖ‡gvkb wi‡cÖ‡Rb‡UwU‡fi
¯^vfvweK `vwq‡Z¡ †`Iqv nq, Zvnv nB‡j Avwg wb‡R Dnv mZZv,
wek¦¯ÍZv Ges wePÿYZvi mwnZ cvjb Kwie Ges H Av`vqK…Z A_©
†Kv¤úvwbi cÖavb Kvh©vj‡q Dnvi Znwe‡j mgqgZ Rgv w`e| hw`
Avwg H Av`vqK…Z A_© †Kv¤úvwbi Znwe‡j Rgv w`‡Z e¨_© nB,
Zvnv nB‡j Avwg †Kv¤úvwbi wbKU A_© AvZ¥mv‡Zi Rb¨ `vqx
_vwKe Ges Avgvi weiæ‡× †Kv¤úvwb AvBbvbyM †dŠR`vix I †`Iqvbx
Dfq cÖKvi Kvh©µg MÖnb Kwi‡Z cvwi‡eb|

‡KvU mxj
...............
...................

‡NvlYvKvix

b¤^i............................ZvwiL:-
Rbve,
†gvt Bgivb †nv‡mb

hvnv‡K Rbve
†NvlYvKvix Rbvet †gvt Bgivb
†nv‡mb ................................................AvBbRxex
Avgvi cwiwPZ Ges wZwb Avgvi m¤§y‡L D³ mbv³
Kwiqv‡Qb| wZwb AÎ gyP‡jKv Avgvi m¤§‡L
njdbvgvq ¯^vÿi Kwiqv‡Qb| kc_ c~e©K
A`¨...............Zvwi‡L ¯^xKvi
Kwi‡jb Ges ¯^vÿi
Kwi‡jb|
.....................
AvBbRxex ...............................
............................
(mxj) 1g †kÖYxi wbe©vnx
g¨vwR‡óªU/RywWwkqvj g¨vwR‡óªU
(mxj)

n j d bv gv
Rvwgb bvgv (wmDwiwU eÛ)

Avwg †gvt Rvjvj DÏxb †gvj¨v, wcZvt-g„Z BmgvBj †gvj¨v, MÖvgt-

`wÿY kiæïbv, WvKNit-kiæïbv, _vbvt-kvwjLv, †Rjvt-gv¸iv, ag©t-
Bmjvg, †ckvt-K…wl, eqmt-58 ermi, RvZxqZvt-Rb¥MZ m~‡Î
evsjv‡`kx, GZØviv kc_ MÖnb c~e©K GB g‡g© †NvlYv Kwi‡ZwQ †h,

1. Avwg †gvt Bgivb †nv‡mb, wcZvt-†gvt Rvjvj DÏxb †gvj¨v (†gvt

Rvjvj DÏxb), MÖvg-`wÿY kiæïbv, WvKNit-kiæïbv, _vbvt-
kvwjLv, †Rjvt-gv¸iv, Avgvi †Q‡j (m¤úK©) Ges †m eZ©gv‡b
Gg.wc.I c‡`, w` GK&wg j¨ve‡iUwiR wjwg‡UW 1/4, Kj¨vYcyi,
wgicyi †ivW, XvKv‡Z Kg©iZ Av‡Q|
2. Avwg †gvt Bgivb †nv‡mb Gi AbyK‚‡j Zvi KZ©e¨ K‡g©i †Kvb
cÖKvi †`vlÎæwU ev Ae‡njvi Rb¨ Rvwgb`vi wnmv‡e iwnjvg|
hw` Rbve Bgivb †nv‡mb †Kvb cÖKvi †`vlÎæwU K‡i ev
†Kv¤úwbi Znwej Zmiƒc/AvZ¥mvr K‡i Avwg †mRb¨
m¤ú~Y©fv‡e `vqx I D³ cwigvY A_© cÖ`v‡b/cwi‡kva Kwi‡Z
eva¨ _vwKe|
 3. Avwg Av‡iv GB g‡g© †NvlYv Kwi‡ZwQ †h, Rbve †gvt Bgivb
†nv‡mb Gi Rb¨ cwic~Y©fv‡e Rvwgb`vi iwnjvg Ges †m hw`
†Kv¤úvwbi †Kvb cÖKvi ÿwZmvab K‡i Z‡e Zvnvi weiæ‡×
cÖ‡qvRbxq e¨e¯’v MÖnb Kwi‡Z eva¨ _vwKe| hw` Avwg Dc‡iv³
cÖwZkÖæwZ cvj‡b AcivM nB †Kv¤úvwb KZ©„cÿ Rbve †gvt
Bgivb †nv‡mb Gi Ges Avgvi (wb¤œ¯^vÿKvixi) weiæ‡×
AvBbvbyM †h †Kvb e¨e¯’v MÖnb Kwi‡Z cvwi‡eb|

Pjgvb
cvZ-02

cvZv-02

4. Avgvi eZ©gvb me©‡gvU gvwmK Avq 5,000/-(cuvP nvRvi)

UvKv Ges Avgvi cÖvq 20,00,000/-(wek jÿ) UvKv g~‡j¨i ¯’vei I
A¯’vei m¤úwË iwnqv‡Q|
Dc‡iv³ †NvlYv Avgvi Ávb I wek¦vmg‡Z mZ¨ I mwVK|

‡KvU
mxj .......................................

Rvwgb`vZv(‡NvlYvKvix)

b¤^i............................ZvwiL:-
Rbve,
†gvt Rvjvj DÏxb †gvj¨v
 hvnv‡K Rbve
†NvlYvKvix Rbvet †gvt Rvjvj DÏxb
†gvj¨v ................................................AvBbRxex
Avgvi cwiwPZ Ges wZwb Avgvi m¤§y‡L D³ mbv³
Kwiqv‡Qb| wZwb (Rvwgb`vZv)
njdbvgvq ¯^vÿi Kwiqv‡Qb| AÎ gyP‡jKv Avgvi
m¤§‡L kc_ c~e©K A`¨
...........Zvwi‡L ¯^xKvi
Kwi‡jb Ges ¯^vÿi
Kwi‡jb|
.....................
AvBbRxex ........................................
...................
(mxj) 1g †kÖYxi wbe©vnx
g¨vwR‡óªU/RywWwkqvj g¨vwR‡óªU
(mxj)

A½xKvi bvgv
Avwg †gvt Bgivb †nv‡mb wcZvtцgvt Rvjvj DÏxb †gvj¨v (‡gvt Rvjvj
DÏxb), MÖvgtÑ`wÿY kiæïbv, WvMNitÑkiæïbv, _vbvt-kvwjLv, †RjvtÑ
gv¸iv‡Z emevmiZ| w` GK&wg j¨ve‡iUwiR wjwg‡U‡Wi Aax‡b
Gg.wc.I wnmv‡e wb‡qv‡Mi Rb¨ g‡bvbxZ n‡qwQ, GB g‡g© A½xKvi
Kwi‡ZwQ †h, AG †Kv¤úvwbi Aax‡b Avgiv PvKzwi m¤ú~Y© A¯’vqx
Ges †Kv¤úvwb KZ…©cÿ †Kvb iKg KviY `k©v‡bv e¨wZ‡i‡KB (wÎk)
w`‡bi †bvwU‡ki gva¨‡g A_ev †bvwU‡ki cwie‡Z© 30 (wÎk) w`‡bi
g~j †eZ‡bi mgcwigvb A_© cÖ`vb mv‡c‡ÿ Avgv‡K †Kv¤úvwbi
PvKzix nB‡Z Ae¨vnwZ cÖ`vb Kwi‡Z cvwi‡eb|

Pjgvb cvZ-
02

cvZv-02
Avwg GB g‡g© Av‡iv A½xKvi Kwi‡ZwQ †h, Avwg fwel¨‡Z †Kvb
mgq w` GK&wg j¨ve‡iUwiR wjwg‡U‡Wi Aax‡b PvKzix nB‡Z
Ae¨nwZ MÖnY Kwi‡Z PvB, Zvnv nB‡j †Kv¤úvwbi wewa †gvZv‡eK
wjwLZfv‡e Avgiv c`Z¨vM cÎ †ck Kwie Ges hZw`b ch©šÍ Avgiv
c`Z¨vM cÎ †Kv¤úvwbi KZ…©cÿ M„nxZ bv nq, ZZw`b ch©šÍ
†Kv¤úvwbi Kv‡R Kg©iZ _vwKe|

Avwg Av‡iv AeMZ nBjvg †h , hw` BwZc~‡e© ev fwel¨‡Z †dŠR`vwi

Av`vj‡Z `wÛZ, ivR‰bwZK A_ev wbwl× †Kvb Kvh©Kjv‡ci mwnZ
RwoZ _vKvi Aciv‡a `wÛZ Ges †MÖdZvi A_ev †Kv¤úvwbi PvKzix
wewai k„sLjvfsM RwbZ Kvi‡Y †`vlx mve¯Í nB‡j †Kv¤úvwb KZ…©cÿ
†Kvb iKg KviY `k©v‡bv e¨wZ‡i‡KB ZvrÿwYKfv‡e Avgv‡K
†Kv¤úvwbi PvKzix nB‡Z Ae¨nwZ cÖ`vb Kwi‡Z cvwi‡eb|

Pjgvb
cvZ-03

cvZv-03

cvZv-03
hw` KLbI Avgvi `vwLjK…Z wkÿvMZ †hvM¨Zv Òmb` cÎÕÕ (fzqv/Rvj)
Ges Rxeb e„Iv‡šÍ D‡jøwLZ Z_¨ wg_¨v A_ev †Mvcb ivLv nBqv‡Q
ewjqv cÖgvwbZ nq Zvnv nB‡j †Kv¤úvwbi KZ…©cÿ Avgv‡K
ZvrÿwbKfv‡e †Kv¤úvwbi PvKzix nB‡Z Ae¨nwZ cÖ`vb Kwi‡Z
cvwi‡eb Ges ‡Kv¤úvwb‡K cÖZiYv Kivi `v‡q Avgvi weiæ‡×
AvBbvbyM e¨e¯’v MÖnY Kwi‡Z cvwi‡eb|

mvÿx (¯^vÿimn bvg I wVKvbv)

1|
¯^vÿi ............ ...............
..............

cÖv_x©/ cÖv_x©wbi ¯^vÿi

bvgt................................................................
MÖgt.................................WKNit ..........................
_vbvt....................,†Rjvt........................
†gvevBjt

2| ¯^vÿi .......................
bvgt ...............................
MÖvgt ...................., WvKNit...................
_vbvt .................., †Rjvt .................
†gvevBjt

Rbve, ............., weMZ..... ermi hveZ Avgiv cwiwPZ | Avgiv

Rvbvg‡Z wZwb GKRb DbœZ Pwi‡Îi AwaKvwi Ges w` GK&wg
j¨ve‡iUwiR wjwg‡U‡Wi PvKzix‡Z e¨vNvZ NU‡Z cv‡i Ggb †Kvb
NUbvi mv‡_ RwoZ b‡nb| wZwb Avgvi m¤§y‡L AÎ A½xKvi c‡Î ¯^vÿi
Kwiqv‡Qb|

(Awdm mxj)
¯^vÿi..........................

c`ex .......................
mxj
(cÖ_g †kªYxi wbe©vwn g¨vwR‡óU/
cÖ_g †kÖYxi †M‡R‡UW Awdmvi)