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cgvmc 110-002
fvm©b-01
Aby‡gvw`Z t 17/04/2014 wLªt
dig bs t cgvmc 110-002, fvm©b-01, ZvwiL----------------
ewikvj cjøx we y¨r mwgwZ-2 G WªvBfvi c‡` c¨v‡bjf~w³ / wb‡qvM jv‡fi Rb¨ Av‡e`b dig
( mswkøó ¯’vb cÖv_x©‡K ¯n‡ Í c~iY Ki‡Z n‡e )
wmwbqi †Rbv‡ij g¨v‡bRvi / †Rbv‡ij g¨v‡bRvi
ewikvj cjøx we`y¨r mwgwZ-2
K v‡WU K‡jR, ewikvj|
01. wb‡qvM weÁwß bs ................................................ 03. c‡`i aiY t ..................
02. Av‡e`bK…Z c‡`i bvg
( weÁw߇Z †h fv‡e D‡jøL Av‡Q )
.................................................... .....................................................
04. weÁvc‡bi m~Î / cwÎKvi bvg 05. cÖKvkbvi ZvwiL
.............................................. ......................................... .........................................................
06. Av‡e`bKvixi c~Y© bvg (evsjvq) ( eo nv‡Zi Aÿ‡i Bs‡iRx‡Z ) 07. Rb¥ ZvwiL ( GmGmwm cixÿvi mb` / wbeÜb Abyhvqx)
....................................................... ........./........./............ (w`b/gvm/eQi)
08. gvZvi bvg 09. eqm ( ---------- wLªt Zvwi‡L )
....................................................... ....................................
10. wcZvi bvg 11. ag©
........................................................ ...............................
12. RvZxqZv 13. wbR †Rjv
........................................................ 15. ˆeevwnK Ae ’v
14. †Uwj‡dvb / gy‡Vv †dvb b¤i (wUK () w`b)
16. †Kvb †KvUvq myweav cÖvc¨ (e‡·i wfZi Lvwj As‡k wUK () w`b ) t
gwnjv
gyw³‡hv×v/knx` gyw
³‡hv×vi cyÎ
-Kb¨v
gyw³‡hv×v/knx` gyw
³‡hv×vi cyÎ
-Kb¨vi cyÎ-Kb¨v
GwZg I kvixwiK cÖwZewÜ
DcRvwZ Avbmvi I MÖvg cÖwZiÿv Ab¨vb¨
17. ’vqx wVKvbv t
................................. ................................... ............................. .............................
K. MÖvg/moK/evox L. WvKNi M. Dc‡Rjv / _vbv N. †Rjv
18. †h wVKvbvq cÖv_x© cÖ‡ek cÎ / wb‡qvM cÎ (wb‡qvM cvIqvi †ÿ‡Î cÖ‡hvR¨) †c‡Z B”QzK t
................................. ................................... ............................. .............................
K. MÖvg/moK/evox L. WvKNi M. Dc‡Rjv / _vbv N. †Rjv
.......................................................... .............................................................. ........................
19. †cvóvj AW©vi/e¨vsK Wªvd&U/‡c-AW©vi b¤^i 20. †cvóvj AW©vi/e¨vsK Wªvd&U/‡c-AW©vi Gi g~j¨ 21. Bmy¨i ZvwiL
Page 1of 4
cvm‡cvU© mvB‡Ri GK
Kwc Qwe G N‡i
AvBKv/AvVv w ‡q
jvwM‡q Qwei Dci 1g
†kÖYxi †M‡R‡UW
Kg©KZ©v Øviv mZ¨vwqZ
weevwnZ AweevwnZ
22. cÖv_x©i wkÿvMZ †hvM¨Zvi weeiY (weÁvc‡bi kZ©vbyhvqx c~iY Ki‡Z n‡e) t
DËxY© cixÿvi bvg wkÿv cÖwZôv‡bi bvg
wmwRwcG / wefvM / †kÖYx
mvwU©wd‡KU / wWMÖx AR©‡bi eQi
wmwRwcG †¯‹j cÖvß wefvM/ †kÖYx/ †MÖW
---------- †kÖYx
GmGmwm / mggvb
GBPGmwm/mggvb
¯œvZK
23. AwfÁZvi weeiY ( mb` Øviv mgw_©Z n‡Z n‡e ) t
24. cÖv³b I eZ©gvb PvKzixi KvjvbyµwgK weeiY (ïaygvÎ cÖ‡hvR¨ †ÿ‡Î) t
wb‡qvMKvix KZ©„c‡ÿi bvg I wVKvbv PvKzixi / c‡`i bvg I †eZbµg ‡hvM`v‡bi ZvwiL PvKzix cwiZ¨v‡Mi ZvwiL
25. cÖv_x© m¤ú‡K© ÁvZ yÕRb `vwqZ¡kxj e¨w³i cwiPq (AvZ¥xq e¨ZxZ) t
bvg, c`ex / †ckv, wVKvbv, †Uwj‡dvb / gy‡Vv †dvb b¤i Ges B-‡gBj wVKvbv (hw` _v‡K)
01|
02|
26. cjøx we`y¨r mwgwZ‡Z Kg©iZ wefvMxq cÖv_x©‡`i Rb¨ (cwem wb‡`©wkKv 300-14 Abyhvqx wb‡¤œi Z_¨ cÖ‡`q n‡e ) t
Kg©iZ cwem
Gi bvg
c‡`i bvg
eZ©gvb c‡` †gvU
PvKzixKvj
cÖ‡hvR¨ Avewk¨K mKj cÖwkÿ‡Y
DËxY© wK bv (nuv/bv) Reve nuv n‡j
mb` mshy³ Ki‡Z n‡e|
cwem Kg©Pvix PvKzix wewa Abyhvqx
†Kvb `Û cÖ Ë n‡j `‡Ûi ZvwiL I
`‡Ûi weeiY (¸iæ`Û/jNy`Û)
Avwg A½xKvi KiwQ †h, GKRb cÖv_x© wn‡m‡e Dc‡i ewY©Z mKj Z_¨vw` ¯n‡¯Í wjwce× K‡iwQ Zv Avgvi ÁvZmv‡i mwVK| hw`
Av‡e`bc‡Î †Kvb Z_¨ †Mvcb A_ev fzj wKsev AmZ¨ Z_¨ cÖ vb K‡i _vwK A_ev wb‡qvM weÁwßi mKj kZ© c~iY Kiv nqwb e‡j
cieZx©‡Z cÖgvwbZ nq, Zvn‡j evcwe‡evW©/ cwem KZ©„c‡ÿi wbKU Av‡e`bK…Z c‡` wb‡qv‡Mi †ÿ‡Î A‡hvM¨ e‡j we‡ewPZ n‡ev Ges
Avgvi weiæ‡× evcwe‡ev KZ©„cÿ AvBbvbyM e¨e ’v MÖnY Ki‡j Avwg Zv gvb‡Z eva¨ _vK‡ev| wjwLZ cixÿvq DËxY© n‡q hw` Avwg
†gŠwLZ cixÿvi Rb¨ we‡ewPZ nB, †m‡ÿ‡Î †gŠwLZ cixÿvq ¯vÿvrKvi cÖ v‡bi mgq KZ©„c‡ÿi wbKU Avgvi mKj wkÿvMZ †hvM¨Zv,
RvZxqZv mb` Ges AwfÁZv mb` Gi 02 ( yB) †mU AweKj cÖwZwjwc 1g †kÖYxi †M‡R‡UW Kg©KZ©v KZ©„K mZ¨vwqZ c~e©K mieivn
Ki‡Z Ges g~j mb` mg~n cÖ k©Y Ki‡Z eva¨ _vK‡ev|
................................... .....................................................
ZvwiL Av‡e`bKvixi ¯vÿi
wet`ªt- miKvix / Avav-miKvix / ¯vqËkvwmZ ms ’vq ev cjøx we y¨r mwgwZ‡Z Kg©iZ cÖv_x©‡`i‡K h_vh_ KZ©„c‡ÿi gva¨‡g Av‡e`b
Ki‡Z n‡e|
cgvmc 110-002
Page 2 of 4
ewikvj cjøx we y¨r mwgwZ-2
K¨v‡WU K‡jR, ewikvj|
wjwLZ (GgwmwKD) / wjwLZ (iPbvg~jK) / †gŠwLK mvÿvrKvi cixÿvi
( Awdm KZ©„K c~iYxq )
cÖv_x©i †ivj b¤i t .........................................................................
cixÿvi ZvwiL t .........................................................................
cixÿvi mgq t .........................................................................
cixÿv †K‡› ªi bvg t .........................................................................
cixÿv †K‡› ªi wVKvbv t .........................................................................
wb‡qvMKvix KZ©„cÿ ev Zvi g‡bvbxZ cÖwZwbwai ¯vÿi t .........................................
(cÖv_x© / Av‡e`bKvix KZ…©K c~iYxq )
c‡`i bvg t ........................................................................
cÖv_x©i bvg .........................................................................................................
cÖv_x© †h wVKvbvq cÖ‡ekcÎ †c‡Z B”QzK ...................................................................
......................................................................................................................
......................................................................................................................
......................................................................................................................
......................................................................................................................
......................................................................................................................
Page 3 of 4
GLv‡b cvm‡cvU©
mvB‡Ri GK Kwc Qwe
1g †kÖYxi †M‡R‡UW
Kg©KZ©v Øviv mZ¨vwqZ
K‡i ó¨vcjvi wcb w ‡q
AvUwK‡q w ‡Z n‡e|
cÖ‡ek cÎ
cÖv_x© / Av‡e`bKvixi cÖwZ mvaviY wb‡`©kvejx
01| cixÿvi w`b Aek¨B cÖ‡ekcÎwU mv‡_ Avb‡Z n‡e| cÖ‡ek cÎ Qvov cixÿvq Ask MÖnY Ki‡Z †`qv n‡e bv|
02| wba©vwiZ mg‡qi AšÍZt 15 (c‡bi) wgwbU c~‡e© cÖv_x©‡K Avmb MÖnY Ki‡Z n‡e| cÖkœcÎ †`qvi 30.00 wgwbU ci †Kvb
cixÿv_x©‡K cixÿv K‡ÿ / †K‡› ª cÖ‡ek Ki‡Z †`qv n‡e bv| cixÿv †kl nIqvi c~‡e© cixÿv Kÿ Z vM Kiv hv‡e bv|
†Kvb Kvi‡Y cwi`k©‡Ki AbygwZ wb‡q GKevi cixÿv Kÿ Z¨vM Ki‡j cybivq cixÿv K‡ÿ cÖ‡ek Ki‡Z †`qv n‡e bv|
03| DËicÎ c~i‡Yi Rb¨ ej‡cb e¨envi Ki‡Z n‡e| †cwÝj e¨envi Kiv hv‡e bv|
04| cixÿv K‡ÿ †Kvb e¨vM, eBcÎ, †jLvhy³ ev mv`v KvMR Ges gy‡Vv †dvb I K v‡giv Rvbv m¤ú~Y© wbwl×| Z‡e cixÿvi n‡j
mvaviY K¨vjKz‡jUi e¨envi Kiv hv‡e, mvBw›UwdK K¨vjKz‡jUi e¨envi Kiv hv‡e bv|
05| PvKzixi Av‡e`b c‡Îi m‡½ wgj †i‡L nvwRiv ZvwjKv, DËi cÎ Ges Ab¨vb¨ KvMR c‡Î cixÿv_x©i ¯vÿi GK I Awfbœ
n‡Z n‡e|
06| cixÿv †k‡l cixÿv_x©‡K wbR Avm‡b Ae ’vb K‡i Aek¨B cÖkœcÎmn DËicÎwU cwi`k©‡Ki wbKU Rgv w`‡Z n‡e|
07| DwjøwLZ wbqgvejx f½ Ki‡j A_ev cixÿv K‡ÿ †Kvbiæc A‡kvfb AvPiY Ki‡j KZ©e¨iZ cwi`k©K D³ cixÿv_x©‡K
cixÿv †K› ª †_‡K ewn¯‹vi Ki‡Z cvi‡eb| †ÿÎwe‡k‡l cwi`k©K †Mvcbxqfv‡e D³ cixÿv_x©i †ivj b¤i evsjv‡`k cjøx
we`y¨Zvqb †evW© KZ©„c‡ÿi wbKU Rgv †`‡eb Ges KZ©„cÿ KZ©„K cÖ‡qvRb †ev‡a Zvi weiæ‡× AvBbvbyM e¨e¯’v MÖnY Kiv
n‡e|
---------------------------
Page 4 of 4
cgvmc 110-002
fvm©b-01
Aby‡gvw`Z t 17/04/2014 wLªt
dig bs t cgvmc 110-002, fvm©b-01, ZvwiL----------------
ewikvj cjøx we`y¨r mwgwZ-2 G Awdm mnvqK c‡` c¨v‡bjf~w³ / wb‡qvM jv‡fi Rb¨ Av‡e`b dig
( mswkøó ¯’vb cÖv_x©‡K ¯n‡ Í c~iY Ki‡Z n‡e )
wmwbqi †Rbv‡ij g¨v‡bRvi / †Rbv‡ij g¨v‡bRvi
ewikvj cjøx we`y¨r mwgwZ-2
K v‡WU K‡jR, ewikvj|
01. wb‡qvM weÁwß bs ................................................ 03. c‡`i aiY t ..................
02. Av‡e`bK…Z c‡`i bvg
( weÁw߇Z †h fv‡e D‡jøL Av‡Q )
.................................................... .....................................................
04. weÁvc‡bi m~Î / cwÎKvi bvg 05. cÖKvkbvi ZvwiL
.............................................. ......................................... .........................................................
06. Av‡e`bKvixi c~Y© bvg (evsjvq) ( eo nv‡Zi Aÿ‡i Bs‡iRx‡Z ) 07. Rb¥ ZvwiL ( GmGmwm cixÿvi mb` / wbeÜb Abyhvqx)
....................................................... ........./........./............ (w`b/gvm/eQi)
08. gvZvi bvg 09. eqm ( ---------- wLªt Zvwi‡L )
....................................................... ....................................
10. wcZvi bvg 11. ag©
........................................................ ...............................
12. RvZxqZv 13. wbR †Rjv
........................................................ 15. ˆeevwnK Ae ’v
14. †Uwj‡dvb / gy‡Vv †dvb b¤i (wUK () w`b)
16. †Kvb †KvUvq myweav cÖvc¨ (e‡·i wfZi Lvwj As‡k wUK () w`b ) t
gwnjv
gyw³‡hv×v/knx` gyw³‡hv×vi cyÎ-Kb¨v
gyw³‡hv×v/knx` gyw
³‡hv×vi cyÎ
-Kb¨vi cyÎ-Kb¨v
GwZg I kvixwiK cÖwZewÜ
DcRvwZ Avbmvi I MÖvg cÖwZiÿv Ab¨vb¨
17. ’vqx wVKvbv t
................................. ................................... ............................. .............................
K. MÖvg/moK/evox L. WvKNi M. Dc‡Rjv / _vbv N. †Rjv
18. †h wVKvbvq cÖv_x© cÖ‡ek cÎ / wb‡qvM cÎ (wb‡qvM cvIqvi †ÿ‡Î cÖ‡hvR¨) †c‡Z B”QzK t
................................. ................................... ............................. .............................
K. MÖvg/moK/evox L. WvKNi M. Dc‡Rjv / _vbv N. †Rjv
.......................................................... .............................................................. ........................
19. †cvóvj AW©vi/e¨vsK Wªvd&U/‡c-AW©vi b¤^i 20. †cvóvj AW©vi/e¨vsK Wªvd&U/‡c-AW©vi Gi g~j¨ 21. Bmy¨i ZvwiL
cvm‡cvU© mvB‡Ri GK
Kwc Qwe G N‡i
AvBKv/AvVv w ‡q
jvwM‡q Qwei Dci 1g
†kÖYxi †M‡R‡UW
Kg©KZ©v Øviv mZ¨vwqZ
weevwnZ AweevwnZ
22. cÖv_x©i wkÿvMZ †hvM¨Zvi weeiY (weÁvc‡bi kZ©vbyhvqx c~iY Ki‡Z n‡e) t
DËxY© cixÿvi bvg wkÿv cÖwZôv‡bi bvg
wmwRwcG / wefvM / †kÖYx
mvwU©wd‡KU / wWMÖx AR©‡bi eQi
wmwRwcG †¯‹j cÖvß wefvM/ †kÖYx/ †MÖW
---------- †kÖYx
GmGmwm / mggvb
GBPGmwm/mggvb
¯œvZK
23. AwfÁZvi weeiY ( mb` Øviv mgw_©Z n‡Z n‡e ) t
24. cÖv³b I eZ©gvb PvKzixi KvjvbyµwgK weeiY (ïaygvÎ cÖ‡hvR¨ †ÿ‡Î) t
wb‡qvMKvix KZ©„c‡ÿi bvg I wVKvbv PvKzixi / c‡`i bvg I †eZbµg ‡hvM`v‡bi ZvwiL PvKzix cwiZ¨v‡Mi ZvwiL
25. cÖv_x© m¤ú‡K© ÁvZ yÕRb `vwqZ¡kxj e¨w³i cwiPq (AvZ¥xq e¨ZxZ) t
bvg, c`ex / †ckv, wVKvbv, †Uwj‡dvb / gy‡Vv †dvb b¤i Ges B-‡gBj wVKvbv (hw` _v‡K)
01|
02|
26. cjøx we`y¨r mwgwZ‡Z Kg©iZ wefvMxq cÖv_x©‡`i Rb¨ (cwem wb‡`©wkKv 300-14 Abyhvqx wb‡¤œi Z_¨ cÖ‡`q n‡e ) t
Kg©iZ cwem
Gi bvg
c‡`i bvg
eZ©gvb c‡` †gvU
PvKzixKvj
cÖ‡hvR¨ Avewk¨K mKj cÖwkÿ‡Y
DËxY© wK bv (nuv/bv) Reve nuv n‡j
mb` mshy³ Ki‡Z n‡e|
cwem Kg©Pvix PvKzix wewa Abyhvqx
†Kvb `Û cÖ Ë n‡j `‡Ûi ZvwiL I
`‡Ûi weeiY (¸iæ`Û/jNy`Û)
Avwg A½xKvi KiwQ †h, GKRb cÖv_x© wn‡m‡e Dc‡i ewY©Z mKj Z_¨vw` ¯n‡¯Í wjwce× K‡iwQ Zv Avgvi ÁvZmv‡i mwVK| hw`
Av‡e`bc‡Î †Kvb Z_¨ †Mvcb A_ev fzj wKsev AmZ¨ Z_¨ cÖ vb K‡i _vwK A_ev wb‡qvM weÁwßi mKj kZ© c~iY Kiv nqwb e‡j
cieZx©‡Z cÖgvwbZ nq, Zvn‡j evcwe‡evW©/ cwem KZ©„c‡ÿi wbKU Av‡e`bK…Z c‡` wb‡qv‡Mi †ÿ‡Î A‡hvM¨ e‡j we‡ewPZ n‡ev Ges
Avgvi weiæ‡× evcwe‡ev KZ©„cÿ AvBbvbyM e¨e ’v MÖnY Ki‡j Avwg Zv gvb‡Z eva¨ _vK‡ev| wjwLZ cixÿvq DËxY© n‡q hw` Avwg
†gŠwLZ cixÿvi Rb¨ we‡ewPZ nB, †m‡ÿ‡Î †gŠwLZ cixÿvq ¯vÿvrKvi cÖ v‡bi mgq KZ©„c‡ÿi wbKU Avgvi mKj wkÿvMZ †hvM¨Zv,
RvZxqZv mb` Ges AwfÁZv mb` Gi 02 ( yB) †mU AweKj cÖwZwjwc 1g †kÖYxi †M‡R‡UW Kg©KZ©v KZ©„K mZ¨vwqZ c~e©K mieivn
Ki‡Z Ges g~j mb` mg~n cÖ k©Y Ki‡Z eva¨ _vK‡ev|
................................... .....................................................
ZvwiL Av‡e`bKvixi ¯vÿi
wet`ªt- miKvix / Avav-miKvix / ¯vqËkvwmZ ms ’vq ev cjøx we y¨r mwgwZ‡Z Kg©iZ cÖv_x©‡`i‡K h_vh_ KZ©„c‡ÿi gva¨‡g Av‡e`b
Ki‡Z n‡e|
cgvmc 110-002
Page 2 of 4
ewikvj cjøx we y¨r mwgwZ-2
K¨v‡WU K‡jR, ewikvj|
wjwLZ (GgwmwKD) / wjwLZ (iPbvg~jK) / †gŠwLK mvÿvrKvi cixÿvi
( Awdm KZ©„K c~iYxq )
cÖv_x©i †ivj b¤i t .........................................................................
cixÿvi ZvwiL t .........................................................................
cixÿvi mgq t .........................................................................
cixÿv †K‡› ªi bvg t .........................................................................
cixÿv †K‡› ªi wVKvbv t .........................................................................
wb‡qvMKvix KZ©„cÿ ev Zvi g‡bvbxZ cÖwZwbwai ¯vÿi t .........................................
(cÖv_x© / Av‡e`bKvix KZ…©K c~iYxq )
c‡`i bvg t ........................................................................
cÖv_x©i bvg .........................................................................................................
cÖv_x© †h wVKvbvq cÖ‡ekcÎ †c‡Z B”QzK ...................................................................
......................................................................................................................
......................................................................................................................
......................................................................................................................
......................................................................................................................
......................................................................................................................
Page 3 of 4
GLv‡b cvm‡cvU©
mvB‡Ri GK Kwc Qwe
1g †kÖYxi †M‡R‡UW
Kg©KZ©v Øviv mZ¨vwqZ
K‡i ó¨vcjvi wcb w ‡q
AvUwK‡q w ‡Z n‡e|
cÖ‡ek cÎ
cÖv_x© / Av‡e`bKvixi cÖwZ mvaviY wb‡`©kvejx
01| cixÿvi w`b Aek¨B cÖ‡ekcÎwU mv‡_ Avb‡Z n‡e| cÖ‡ek cÎ Qvov cixÿvq Ask MÖnY Ki‡Z †`qv n‡e bv|
02| wba©vwiZ mg‡qi AšÍZt 15 (c‡bi) wgwbU c~‡e© cÖv_x©‡K Avmb MÖnY Ki‡Z n‡e| cÖkœcÎ †`qvi 30.00 wgwbU ci †Kvb
cixÿv_x©‡K cixÿv K‡ÿ / †K‡› ª cÖ‡ek Ki‡Z †`qv n‡e bv| cixÿv †kl nIqvi c~‡e© cixÿv Kÿ Z vM Kiv hv‡e bv|
†Kvb Kvi‡Y cwi`k©‡Ki AbygwZ wb‡q GKevi cixÿv Kÿ Z¨vM Ki‡j cybivq cixÿv K‡ÿ cÖ‡ek Ki‡Z †`qv n‡e bv|
03| DËicÎ c~i‡Yi Rb¨ ej‡cb e¨envi Ki‡Z n‡e| †cwÝj e¨envi Kiv hv‡e bv|
04| cixÿv K‡ÿ †Kvb e¨vM, eBcÎ, †jLvhy³ ev mv`v KvMR Ges gy‡Vv †dvb I K v‡giv Rvbv m¤ú~Y© wbwl×| Z‡e cixÿvi n‡j
mvaviY K¨vjKz‡jUi e¨envi Kiv hv‡e, mvBw›UwdK K¨vjKz‡jUi e¨envi Kiv hv‡e bv|
05| PvKzixi Av‡e`b c‡Îi m‡½ wgj †i‡L nvwRiv ZvwjKv, DËi cÎ Ges Ab¨vb¨ KvMR c‡Î cixÿv_x©i ¯vÿi GK I Awfbœ
n‡Z n‡e|
06| cixÿv †k‡l cixÿv_x©‡K wbR Avm‡b Ae ’vb K‡i Aek¨B cÖkœcÎmn DËicÎwU cwi`k©‡Ki wbKU Rgv w`‡Z n‡e|
07| DwjøwLZ wbqgvejx f½ Ki‡j A_ev cixÿv K‡ÿ †Kvbiæc A‡kvfb AvPiY Ki‡j KZ©e¨iZ cwi`k©K D³ cixÿv_x©‡K
cixÿv †K› ª †_‡K ewn¯‹vi Ki‡Z cvi‡eb| †ÿÎwe‡k‡l cwi`k©K †Mvcbxqfv‡e D³ cixÿv_x©i †ivj b¤i evsjv‡`k cjøx
we`y¨Zvqb †evW© KZ©„c‡ÿi wbKU Rgv †`‡eb Ges KZ©„cÿ KZ©„K cÖ‡qvRb †ev‡a Zvi weiæ‡× AvBbvbyM e¨e¯’v MÖnY Kiv
n‡e|
---------------------------
Page 4 of 4
cgvmc 110-002
fvm©b-01
Aby‡gvw`Z t 17/04/2014 wLªt
dig bs t cgvmc 110-002, fvm©b-01, ZvwiL----------------
ewikvj cjøx we`y¨r mwgwZ-2 G wbivcËv cÖnix c‡` c¨v‡bjf~w³ / wb‡qvM jv‡fi Rb¨ Av‡e`b dig
( mswkøó ¯’vb cÖv_x©‡K ¯n‡ Í c~iY Ki‡Z n‡e )
wmwbqi †Rbv‡ij g¨v‡bRvi / †Rbv‡ij g¨v‡bRvi
ewikvj cjøx we`y¨r mwgwZ-2
K v‡WU K‡jR, ewikvj|
01. wb‡qvM weÁwß bs ................................................ 03. c‡`i aiY t ..................
02. Av‡e`bK…Z c‡`i bvg
( weÁw߇Z †h fv‡e D‡jøL Av‡Q )
.................................................... .....................................................
04. weÁvc‡bi m~Î / cwÎKvi bvg 05. cÖKvkbvi ZvwiL
.............................................. ......................................... ................................................
06. Av‡e`bKvixi c~Y© bvg (evsjvq) ( eo nv‡Zi Aÿ‡i Bs‡iRx‡Z ) 07. Rb¥ ZvwiL ( GmGmwm cixÿvi mb`)
....................................................... ........./........./............ (w`b/gvm/eQi)
08. gvZvi bvg 09. eqm ( ---------- wLªt Zvwi‡L )
....................................................... ....................................
10. wcZvi bvg 11. ag©
........................................................ ...............................
12. RvZxqZv 13. wbR †Rjv
........................................................ 15. ˆeevwnK Ae ’v
14. †Uwj‡dvb / gy‡Vv †dvb b¤i (wUK () w`b)
16. †Kvb †KvUvq myweav cÖvc¨ (e‡·i wfZi Lvwj As‡k wUK () w`b ) t
gwnjv
gyw³‡hv×v/knx` gyw
³‡hv×vi cyÎ
-Kb¨v
gyw³‡hv×v/knx` gyw
³‡hv×vi cyÎ
-Kb¨vi cyÎ-Kb¨v
GwZg I kvixwiK cÖwZewÜ
DcRvwZ Avbmvi I MÖvg cÖwZiÿv Ab¨vb¨
17. ’vqx wVKvbv t
................................. ................................... ............................. .............................
K. MÖvg/moK/evox L. WvKNi M. Dc‡Rjv / _vbv N. †Rjv
18. †h wVKvbvq cÖv_x© cÖ‡ek cÎ / wb‡qvM cÎ (wb‡qvM cvIqvi †ÿ‡Î cÖ‡hvR¨) †c‡Z B”QzK t
................................. ................................... ............................. .............................
K. MÖvg/moK/evox L. WvKNi M. Dc‡Rjv / _vbv N. †Rjv
.......................................................... .............................................................. ........................
19. †cvóvj AW©vi/e¨vsK Wªvd&U/‡c-AW©vi b¤^i 20. †cvóvj AW©vi/e¨vsK Wªvd&U/‡c-AW©vi Gi g~j¨ 21. Bmy¨i ZvwiL
cvm‡cvU© mvB‡Ri GK
Kwc Qwe G N‡i
AvBKv/AvVv w ‡q
jvwM‡q Qwei Dci 1g
†kÖYxi †M‡R‡UW
Kg©KZ©v Øviv mZ¨vwqZ
weevwnZ AweevwnZ
22. cÖv_x©i wkÿvMZ †hvM¨Zvi weeiY (weÁvc‡bi kZ©vbyhvqx c~iY Ki‡Z n‡e) t
DËxY© cixÿvi bvg wkÿv cÖwZôv‡bi bvg
wmwRwcG / wefvM / †kÖYx
mvwU©wd‡KU / wWMÖx AR©‡bi eQi
wmwRwcG †¯‹j cÖvß wefvM/ †kÖYx/ †MÖW
---------- †kÖYx
GmGmwm / mggvb
GBPGmwm/mggvb
¯œvZK
23. AwfÁZvi weeiY ( mb` Øviv mgw_©Z n‡Z n‡e ) t
24. cÖv³b I eZ©gvb PvKzixi KvjvbyµwgK weeiY (ïaygvÎ cÖ‡hvR¨ †ÿ‡Î) t
wb‡qvMKvix KZ©„c‡ÿi bvg I wVKvbv PvKzixi / c‡`i bvg I †eZbµg ‡hvM`v‡bi ZvwiL PvKzix cwiZ¨v‡Mi ZvwiL
25. cÖv_x© m¤ú‡K© ÁvZ yÕRb `vwqZ¡kxj e¨w³i cwiPq (AvZ¥xq e¨ZxZ) t
bvg, c`ex / †ckv, wVKvbv, †Uwj‡dvb / gy‡Vv †dvb b¤i Ges B-‡gBj wVKvbv (hw` _v‡K)
01|
02|
26. cjøx we`y¨r mwgwZ‡Z Kg©iZ wefvMxq cÖv_x©‡`i Rb¨ (cwem wb‡`©wkKv 300-14 Abyhvqx wb‡¤œi Z_¨ cÖ‡`q n‡e ) t
Kg©iZ cwem
Gi bvg
c‡`i bvg
eZ©gvb c‡` †gvU
PvKzixKvj
cÖ‡hvR¨ Avewk¨K mKj cÖwkÿ‡Y
DËxY© wK bv (nuv/bv) Reve nuv n‡j
mb` mshy³ Ki‡Z n‡e|
cwem Kg©Pvix PvKzix wewa Abyhvqx
†Kvb `Û cÖ Ë n‡j `‡Ûi ZvwiL I
`‡Ûi weeiY (¸iæ`Û/jNy`Û)
Avwg A½xKvi KiwQ †h, GKRb cÖv_x© wn‡m‡e Dc‡i ewY©Z mKj Z_¨vw` ¯n‡¯Í wjwce× K‡iwQ Zv Avgvi ÁvZmv‡i mwVK| hw`
Av‡e`bc‡Î †Kvb Z_¨ †Mvcb A_ev fzj wKsev AmZ¨ Z_¨ cÖ vb K‡i _vwK A_ev wb‡qvM weÁwßi mKj kZ© c~iY Kiv nqwb e‡j
cieZx©‡Z cÖgvwbZ nq, Zvn‡j evcwe‡evW©/ cwem KZ©„c‡ÿi wbKU Av‡e`bK…Z c‡` wb‡qv‡Mi †ÿ‡Î A‡hvM¨ e‡j we‡ewPZ n‡ev Ges
Avgvi weiæ‡× evcwe‡ev KZ©„cÿ AvBbvbyM e¨e ’v MÖnY Ki‡j Avwg Zv gvb‡Z eva¨ _vK‡ev| wjwLZ cixÿvq DËxY© n‡q hw` Avwg
†gŠwLZ cixÿvi Rb¨ we‡ewPZ nB, †m‡ÿ‡Î †gŠwLZ cixÿvq ¯vÿvrKvi cÖ v‡bi mgq KZ©„c‡ÿi wbKU Avgvi mKj wkÿvMZ †hvM¨Zv,
RvZxqZv mb` Ges AwfÁZv mb` Gi 02 ( yB) †mU AweKj cÖwZwjwc 1g †kÖYxi †M‡R‡UW Kg©KZ©v KZ©„K mZ¨vwqZ c~e©K mieivn
Ki‡Z Ges g~j mb` mg~n cÖ k©Y Ki‡Z eva¨ _vK‡ev|
................................... .....................................................
ZvwiL Av‡e`bKvixi ¯vÿi
wet`ªt- miKvix / Avav-miKvix / ¯vqËkvwmZ ms ’vq ev cjøx we y¨r mwgwZ‡Z Kg©iZ cÖv_x©‡`i‡K h_vh_ KZ©„c‡ÿi gva¨‡g Av‡e`b
Ki‡Z n‡e|
cgvmc 110-002
Page 2 of 4
ewikvj cjøx we y¨r mwgwZ-2
K¨v‡WU K‡jR, ewikvj|
wjwLZ (GgwmwKD) / wjwLZ (iPbvg~jK) / †gŠwLK mvÿvrKvi cixÿvi
( Awdm KZ©„K c~iYxq )
cÖv_x©i †ivj b¤i t .........................................................................
cixÿvi ZvwiL t .........................................................................
cixÿvi mgq t .........................................................................
cixÿv †K‡› ªi bvg t .........................................................................
cixÿv †K‡› ªi wVKvbv t .........................................................................
wb‡qvMKvix KZ©„cÿ ev Zvi g‡bvbxZ cÖwZwbwai ¯vÿi t .........................................
(cÖv_x© / Av‡e`bKvix KZ…©K c~iYxq )
c‡`i bvg t ........................................................................
cÖv_x©i bvg .........................................................................................................
cÖv_x© †h wVKvbvq cÖ‡ekcÎ †c‡Z B”QzK ...................................................................
......................................................................................................................
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Page 3 of 4
GLv‡b cvm‡cvU©
mvB‡Ri GK Kwc Qwe
1g †kÖYxi †M‡R‡UW
Kg©KZ©v Øviv mZ¨vwqZ
K‡i ó¨vcjvi wcb w ‡q
AvUwK‡q w ‡Z n‡e|
cÖ‡ek cÎ
cÖv_x© / Av‡e`bKvixi cÖwZ mvaviY wb‡`©kvejx
01| cixÿvi w`b Aek¨B cÖ‡ekcÎwU mv‡_ Avb‡Z n‡e| cÖ‡ek cÎ Qvov cixÿvq Ask MÖnY Ki‡Z †`qv n‡e bv|
02| wba©vwiZ mg‡qi AšÍZt 15 (c‡bi) wgwbU c~‡e© cÖv_x©‡K Avmb MÖnY Ki‡Z n‡e| cÖkœcÎ †`qvi 30.00 wgwbU ci †Kvb
cixÿv_x©‡K cixÿv K‡ÿ / †K‡› ª cÖ‡ek Ki‡Z †`qv n‡e bv| cixÿv †kl nIqvi c~‡e© cixÿv Kÿ Z vM Kiv hv‡e bv|
†Kvb Kvi‡Y cwi`k©‡Ki AbygwZ wb‡q GKevi cixÿv Kÿ Z¨vM Ki‡j cybivq cixÿv K‡ÿ cÖ‡ek Ki‡Z †`qv n‡e bv|
03| DËicÎ c~i‡Yi Rb¨ ej‡cb e¨envi Ki‡Z n‡e| †cwÝj e¨envi Kiv hv‡e bv|
04| cixÿv K‡ÿ †Kvb e¨vM, eBcÎ, †jLvhy³ ev mv`v KvMR Ges gy‡Vv †dvb I K v‡giv Rvbv m¤ú~Y© wbwl×| Z‡e cixÿvi n‡j
mvaviY K¨vjKz‡jUi e¨envi Kiv hv‡e, mvBw›UwdK K¨vjKz‡jUi e¨envi Kiv hv‡e bv|
05| PvKzixi Av‡e`b c‡Îi m‡½ wgj †i‡L nvwRiv ZvwjKv, DËi cÎ Ges Ab¨vb¨ KvMR c‡Î cixÿv_x©i ¯vÿi GK I Awfbœ
n‡Z n‡e|
06| cixÿv †k‡l cixÿv_x©‡K wbR Avm‡b Ae ’vb K‡i Aek¨B cÖkœcÎmn DËicÎwU cwi`k©‡Ki wbKU Rgv w`‡Z n‡e|
07| DwjøwLZ wbqgvejx f½ Ki‡j A_ev cixÿv K‡ÿ †Kvbiæc A‡kvfb AvPiY Ki‡j KZ©e¨iZ cwi`k©K D³ cixÿv_x©‡K
cixÿv †K› ª †_‡K ewn¯‹vi Ki‡Z cvi‡eb| †ÿÎwe‡k‡l cwi`k©K †Mvcbxqfv‡e D³ cixÿv_x©i †ivj b¤i evsjv‡`k cjøx
we`y¨Zvqb †evW© KZ©„c‡ÿi wbKU Rgv †`‡eb Ges KZ©„cÿ KZ©„K cÖ‡qvRb †ev‡a Zvi weiæ‡× AvBbvbyM e¨e¯’v MÖnY Kiv
n‡e|
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