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kk ©e Mðkr{LkkhkÞý Lk{: kk kk ©e økýuþkÞ Lk{: kk kk ykE ©e ¾kuzeÞkh {kíkkÞ Lk{: kk
{ktøkr÷f «Mktøkku
þw¼ rËLk, .............................................
þw¼ rËLk, ..........................................
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kk xnwfku kk
kk økýuþ MÚkkÃkLkk / {tzÃk {wnqoík kk
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MÚk¤ : y{khk rLkðkMk MÚkkLku
kk økeík økhçkk kk
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MÚk¤ : .............................
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kk òLk «MÚkkLk kk
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MÚk¤ : y{khk rLkðkMk MÚkkLkuÚke
kk nMík {u¤kÃk kk
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MÚk¤ : ................................
fkuÞ÷Lku fwtsLk rðLkk Lk [k÷u ¼ðhkLku økwtsLk rðLkk Lk [k÷u,
y{Lku ík{khk rðLkk Lk [k÷u íkku
y{khk Ônk÷k fkfk / {k{k Lkk ÷øLk{kt s÷w÷ s÷w÷Úke ykðòu.......
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kk ©e økwÁðu Lk{: kk kk ©e økýuþkÞ Lk{: kk kk ©e rðLæÞðkrMkLÞu Lk{: kk
{ktøkr÷f «Mktøkku
fw¤Ëuðe ©e rðLæÞðkrMkLke {kíkkSLke yMke{f]ÃkkÚke rþðrþðkLke Mkkûke{kt Ãkrh[ÞLku ÃkrhýÞ{kt Ãk÷xðkLkwt
þw¼ {wnwíko ykÃkLke WÃkrMÚkríkLke Ít¾Lkk, yðMkh Au.....
íkk. ...................................................
kk økýuþ MÚkkÃkLkk kk..........................
kk {tzÃk {wnwíko kk..........................
kk økúnþktrík kk..........................
kk þw¼ MÚk¤ kk..............................................................................................
kk ËþoLkkr¼÷k»ke kk
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kk ©e økýuþkÞ Lk{: kk
Mktðík 2072 ..........................................................
kk yðMkhLkw yktøkýw kk
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kk MLkunkrÄLk kk..................................
kk þw¼ MÚk¤ kk......................................................................................................
Mktðík 2072 ..............................................
kk òLk ykøk{Lk kk.......................
kk nMík {u¤kÃk kk.......................
kk ¼kusLk Mk{kht¼ kk.......................
kk fLÞk rðËkÞ kk.......................
{ktøkr÷f «Mktøkku
kk økýuþ MÚkkÃkLk kk....................
kk {tzÃk {wnwoík kk....................
ykÃk çkLLku / Mknfwxwtçk
ykÃk çkLLku / Mknfwxwtçk
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kk ©e økýuþkÞ Lk{: kk
«ríkfLkk yðMkhkuLke nkh{k¤k
:: Mk÷wýk Mk{whíkk ::...........................................................................
:: yLkku¾w ykýwt ::...........................................................................
:: {ktøkÕÞ {trËh ::..................................................
:: {tøk÷ {ktzðk ::...........................................................................
:: nkUþe÷ku nMík {u¤kÃk ::...........................................................................
:: Mkwh{Þe Mktøkeík MktæÞk ::..................................................
:: «eík Ãkðo {trËh ::..................................................
:: y{ yktøký ::..................................................
:: rLkðurËík ::..................................................
:: MktøkeíkLkwt þkr{Þkýwt ::..................................................
Code 4
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kk ©e økýuþkÞ Lk{: kk
kk {ktøkr÷f «Mktøkku kk
MkkuLkuhe Ãk¤Lkku hýfkh
þw¼rËLk : ...................................................................
Yze huþ{Lke økktX çktÄkþu
MðY[e ¼kusLk
:
:
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9 {tøk÷ {ktzðku 9.............................................................................................
9 y{kYt yktøkýwt 9.............................................................................................
9 þw¼uåAf 9.............................................................................................
9 ykÃkLkk ykþeðkoË yus WÃknkh 9
Code 5