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palakaMnaI BaravayaacaI
maaihtI
p~laoKkacao pUNa- naaMva:______________________________________________
javaLpasacyaa KuNaosah pUNa- p%ta :_________________________________________
____________________________________________________________
____________________________________________________________
____________________________________________________________
ipna kaoD :_______ faona
: ________ f^@sa :______
[-–maola :________
p~laoKkacao sqaLaSaI naato : _____________________________
sqaLacao pUNa- naava : _______________________________________
sqaLacao vaastvya : _________________________________
janmatarIK : __________ ]McaI (
fUT va [Mcaat ):__________
jaat : ______ paoTjaat / paoTSaaKaa :______
gaao~ / dovak :__________
maMgaL : _____caYmaa : ______laonsa : ______ r@tgaT :_________
rasa :_____ naxa~ :_______ carNa : ______gaNa :_____ naaD :
_____
iSaxaNa :______________________________________
__________________________________________
__________________________________________
naaokrI / svatM~ vyavasaaya
:_______________ maa.p`a. :____________pasapaoT- Aaho /
naahI
naaokrI Asalyaasa - KajagaI /
sarkarI / inamasarkarI.
kMpnaIcao naava :____________________________________
naaokrI vyavasaayaacao izkaNa va hu_a :___________________________
vyavasaaya Asalyaasa %yaacao sva$p :_________________________________________________
__________________________________________
sqaLacaI [tr maaihtI ( rMga ,vyai@tma%va ,baaMQaa ,SaOxaiNak ,kiryar ,CMd
,imaLvalaolao
p`aivaNya yaabaabatcaa tpSaIla )____________________________________
_________________________________________
_________________________________________
_________________________________________
sqaLacao vaastvya prdoSaat Asalyaasa %yaa saMbaMQaI
Kulaasaovaar maaihtI ( vhIsaa kaoNa%yaa sva$pacaa ? ga`InakaD- Aaho ka ? Baartat kQaI yaoNaar ?
iktI idvasa vaastvya ? itkDo kayama
vaastvya krNaar ka ? [.sava- tpSaIla.)
_________________________________________
_________________________________________
_________________________________________
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p`qamavar / p`qamavaQaU / GaTsfaoTIt / ivaQaUr /ivaQavaa
ivaQaUr / ivaQavaa Asalyaasa ivavaah kQaI Jaalaa ? inaQana kQaI ? karNa :
GaTsfaoTIt Asalyaasa ivavaah kQaI /
GaTsfaoT kQaI va tpSaIlavaar karNa :
_________________________________________
_________________________________________
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Ap%ya Aaho ka ? ___Asalyaasa
iktI ? ____%yaaMcao vaya va iSaxaNa
[tr tpSaIlavaar maaihtI
_________________________________________
_________________________________________
p`qama ptI / p%naIcao pUNa-
naaMva va p%ta :_____________________________
_________________________________________
vyMaga Aaho / naahI :_________________________________
Asalyaasa %yaacao sva$p ; janmat: kI ApGaatanao ,
p`maaNa iktI [.sava- tpSaIla.
_________________________________________
_________________________________________
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kaOTuMibak maaihtI
sqaLacao Aa[-,
vaDIla va sa##yaa BaavaMDaMcaI (iSaxaNa, naaokrI, ivavaahIt ,AivavaahIt, vaastvya [.) tpSaIlavaar maaihtI
_________________________________________
_________________________________________
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rahtI jaagaa svat:caI Aaho
ka ?_________________________________
_________________________________________________
[tr naatovaa[-kaMcaI qaaoD@yaat maaihtI( kaka, maamaa, Aa%yaa ,maavaSaI ,AajaI ,Aajaaobaa [%yaadI)
_________________________________________
_________________________________________
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AiQak maaihtIsaazI naatovaa[-kaMcaa p%ta va %yaaMcao
sqaLaSaI naato
_________________________________________
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ivaSaoYa kaOTuMibak paSva-BaUmaI vaa
[tr kahI mah%vaacao
_________________________________________
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________________________________________
Apoixat sqaL ksao hvao
iSaxaNa (pdvaI ,iSaxaNa SaaKaa [)
:______________________________
_________________________________________
_________________________________________
naaokrI vyavasaaya :________________________________________
_________________________________________
_________________________________________
vayaaogaT :__________ ]McaI:_______
prdoSaatIla caalaola/naahI________ pi~ka phavayaacaI
Aaho ka ?_________
maMgaL caalaola ka ?____ caYmaa
caalaola ka ?_____laonsa caalatIla ka?______
svajaatIya hvao ka ?___________
svajaatIya hvao Asalyaasa Apoixat paoTSaaKa
/ paoTjaatI
____________________
AaMtrjaatIya ivavaahacaI tyaarI Aaho ka ?____________________________
Asalyaasa Apoixat jaatI :____________________________________
CMd, AavaDI inavaDI
va [tr Kasa Apoxaa :____________________________
_________________________________________
_________________________________________
_________________________________________
GaTsfaoTIt / ivaQavaa
/ ivaQaUr caalaola ka ?
_______saap%ya caalaola
ka ?_________
vyaMgaacao sqaL caalaola ka ?____________________________________
kaoNa%yaa sva$pacao vyaMga caalaola,
%yaabaabatcaa tpSaIla :______________________
_________________________________________
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palakaMcaI sahI va tarIK
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