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WvKNi t mvqnvgbMi, Dc‡Rjv t gvaecyi, †Rjv t nweMÄ

‡gvevBjt 01721-636548 (Aa¨ÿ), 01731-027423 (Awdm)

fwZ©i Av‡e`b cÎ

gynZvivg Aa¨ÿ,

Avm& mvjvgy AvjvBKyg Iqv ivngvZzjøvn|

h_vh_ m¤§vb cÖ`k©b c~e©K webxZ wb‡e`b GB †h, Avwg Avcbvi gv`ivmvq ---------- wkÿv e‡l© ---------- ‡kÖwY‡Z fwZ© n‡Z B”QyK| ZvB, cÖ‡qvRbxq Z_¨vw` Avcbvi m`q we‡ePbvi Rb¨ †ck Kijvg:

01| wkÿv_©xi bvg (evsjvq) :  ...................................................................................................

                  (Bs‡iwR‡Z) :  .......................................................................................................

02| wcZvi bvg   (evsjvq) :  .......................................................................................................

                  (Bs‡iwR‡Z) :  .......................................................................................................

                †gvevBj b¤^i  : ........................................................ ‡ckv: .......................................

03| gvZvi bvg    (evsjvq) :  .......................................................................................................

   †gvevBj b¤^i (hw` _v‡K) : ........................................................ ‡ckv: ......................................

04| Rb¥ ZvwiL               : .................................. K_vq : ..........................................................

05| RvZxqZv                 : ......................................................................................................

06| ¯’vqx wVKvbv              : MÖvg: ............................................ WvKNi: ....... ................................

                                    Dc‡Rjv : ........................................ †Rjv : ..............  .....................

07| eZ©gvb wVKvbv           : MÖvg: ............................................ WvKNi: ........................................

                                   Dc‡Rjv : ....................................... †Rjv : ........................................

08| c~‡e© †h cÖwZôv‡b Aa¨qb K‡i‡Q Zvi bvg I wVKvbv : ....................................................................

MÖvg: ........................... WvKNi: ......................... Dc‡Rjv: ............................ †Rjv: ....................

09| QvocÎ bs .... ............  Bm¨yi ZvwiL t ........................ †h †kÖwY‡Z fwZ© n‡Z B”QyK :  .....................

10| †K›`ªxq cixÿv cv‡ki weeiY :

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Awffve‡Ki ¯^vÿi                                                                     wkÿv_©xi ¯^vÿi

Aa¨‡ÿi Aby‡gv`b