Staff-Driver .pdf - Ministry of Minority Affairs

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File No.A-12024/1/2014-Estt. Government of India Ministry of Minority Affairs Establishment Section Floor. Paryavaran Bhawan. CGO Complex, Lodhi Road. New Delhi-110003 Dated: .. ;1 August, 2015 OFFICE MEMORANDUM Sub: Filling up of the post of Staff Car Driver in the Ministry of Minority Affairs on deputation or absorption basis failing which by direct recruitment. It is proposed to fill up 1 (one) post of Staff Car Driver in Pay Band-I Rs. 5200- 20200 plus Grade Pay Rs. 1900/- in the Ministry of Minority Affairs in New Delhi on deputation or absorption basis, failing which by direct recruitment. Details of the post, eligibility conditions and method of recruitment thereof are given in Annexure-I. 2. For absorption basis, willing and eligible MTS of other Ministries will forward their application through proper channel as per the proforma given in Annexure-II along with the copies of their valid Driving Licence. certificate of experience and educational certificates duly attested by an officer not below the rank of Under Secretary or equivalent. Vigilance Clearance and Integrity Certificate. For direct recruitment, eligible candidates will submit their application as per the proforma given in Annexure-III along with the self attested copies of their valid Driving Licence, certificate of experience and educational certificates. Deputation or re-employment for Ex-serviceme n . willing and eligible Armed Forces personnel due to retire or who are to be transferred to reserve within a period of one year and having the requisite experience and qualifications, will forward their application through proper channel as per the proforma given in Annexure-II along with the copies of their valid Driving Licence, certificate of experience and educational certificates duly attested by an officer of the level of Under Secretary or equivalent, Vigilance Clearance and Integrity Certificate. The application with requisite documents may he forwarded/submitted to the Under Secretary (Estt). Ministry of Minority Affairs. 11' 1 ' Floor, Paryavaran Bhawan, CGO Complex, New Delhi 110003 within 45 days from the date of publication of this advertisement in the Employment News. 2. On appointment to the post, the pay and all other terms and conditions of the appointment will be regulated in accordance with the provisions of the relevant rules and regulations. 3 ..page..2/-

Transcript of Staff-Driver .pdf - Ministry of Minority Affairs

File No.A-12024/1/2014-Estt. Government of India

Ministry of Minority Affairs Establishment Section

Floor. Paryavaran Bhawan. CGO Complex, Lodhi Road.

New Delhi-110003 Dated: ..;1 August, 2015

OFFICE MEMORANDUM

Sub: Filling up of the post of Staff Car Driver in the Ministry of Minority Affairs on deputation or absorption basis failing which by direct recruitment.

It is proposed to fill up 1 (one) post of Staff Car Driver in Pay Band-I Rs. 5200-20200 plus Grade Pay Rs. 1900/- in the Ministry of Minority Affairs in New Delhi on deputation or absorption basis, failing which by direct recruitment. Details of the post, eligibility conditions and method of recruitment thereof are given in Annexure-I.

2. For absorption basis, willing and eligible MTS of other Ministries will forward their application through proper channel as per the proforma given in Annexure-II along with the copies of their valid Driving Licence. certificate of experience and educational certificates duly attested by an officer not below the rank of Under Secretary or equivalent. Vigilance Clearance and Integrity Certificate.

For direct recruitment, eligible candidates will submit their application as per the proforma given in Annexure-III along with the self attested copies of their valid Driving Licence, certificate of experience and educational certificates.

Deputation or re-employment for Ex-serviceme n . willing and eligible Armed Forces personnel due to retire or who are to be transferred to reserve within a period of one year and having the requisite experience and qualifications, will forward their application through proper channel as per the proforma given in Annexure-II along with the copies of their valid Driving Licence, certificate of experience and educational certificates duly attested by an officer of the level of Under Secretary or equivalent, Vigilance Clearance and Integrity Certificate.

The application with requisite documents may he forwarded/submitted to the Under Secretary (Estt). Ministry of Minority Affairs. 11' 1 ' Floor, Paryavaran Bhawan, CGO Complex, New Delhi 110003 within 45 days from the date of publication of this advertisement in the Employment News.

2. On appointment to the post, the pay and all other terms and conditions of the appointment will be regulated in accordance with the provisions of the relevant rules and regulations.

3

..page..2/-

ingh )

4. The Ministries are requested that applications of only such eligible and willing MTS may be forwarded whose services can be spared immediately on their selection. Candidates once selected will not be allowed to withdraw their candidature subsequently. Applications received after expiry of the prescribed period and/or found to be incomplete in any manner, may not be considered for selection. No advance copy of the application shall be entertained.

Under Secretary to the Governm t of India

To All Ministries / Departments under Government of India (As per the standard list)

Copy to:

I. The Editor (Advertisement), Employment News, East Block IV, Level V, R.K. Puram, New Delhi - 110 066 with the request to publish the aforesaid advertisement bilingually (in Hindi and English versions) in the forthcoming issue of the Employment News and an intimation regarding publication of the advertisement along with necessary bills towards cost of the advertisement may be forwarded to this Ministry for payment.

2. Director (NIC), Ministry of Minority Affairs with the request to up load the advertisement on the web-site of the Ministry stating that the period of 45 days period for recei •t of application will count from the date of publication of advertisement in the Emp nt News.

Under Secretary to the Government of India

ANNEXURE-I

Details of the post, eligibility conditions and method of recruitment for the post of Staff Car Driver in Ministry of Minority Affairs

Name of the post Staff Car Driver

General Central Service Group-C, Non-Gazetted, Non-Ministerial Pay Band-1, Rs.5200-20200 plus Grade Pay Rs.1900/- plus other allowances admissible as per Central Government Rules in force from time to time One (1)

Deputation or absorption failing which by direct recruitment.

For Ex-Servicemen - Deputation or re-employment.

Absorption: Regular Multi Tasking Staff (MTS) in the Central Government Ministries on the basis of a driving test to assess the competence to drive motor cars failing which regular Multi Tasking Staff in Central Government Ministries who fulfill the necessary qualifications required for direct recruits:-

Direct Recruitment: Persons

(i) possessing a valid driving licence for motor cars; (ii) Experience of driving a motor car for at least three years;

and (iii) Pass in 10 th Standard.

Desirable: (i) Three years service as Home Guard or Civil Volunteers.

Note: The qualification regarding experience is relaxable at the discretion of the Competent Authority in the case of candidates belonging to the SchedUled Castes or the Scheduled Tribes if at any stage of selection, the Competent Authority is of the opinion that sufficient number of candidates with requisite experience are not likely to be available to fill up the vacancy reserved for them.

Age limit for direct recruits: Not exceeding 25 years. (Relaxable for Government servants up to 40 years in accordance with the instructions or orders issued by the Central Government) Note 1: The crucial date for determining the age-limit shall be the closing date for receipt of applications from candidates in

3.

Classification of post

Pay Band & Grade Pay

Number of post(s)

Method of Recruitment

Eligibility

ingh) Under Secretary to the Government of India

India (and not the closing date prescribed for those in Assam, Meghalaya, Arunachal Pradesh, Mizoram, Manipur, Nagaland, Tripura, Sikkim, Ladakh Division or Jammu and Kashmir State, Lahaul and Spiti District and Pangi sub-division of Chamba District of Himachal Pradesh, Andaman and Nicobar Islands and Lakshadweep). Note 2: In the case of recruitment made through the Employment Exchange, the crucial date for determining the age limit shall be the last date up to which the Employment Exchange is asked to submit the names.

For Ex-Servicemen. Deputation or re-employment The Armed Forces personnel due to retire or who are to be transferred to reserve within a period of one year and having the requisite experience and qualifications prescribed shall also be considered. Such persons shall be given deputation terms upto the date on which they are due for release from the Armed Forces; thereafter they may be continued on re-employment. (The period of deputation including the period of deputation in another ex-cadre post held immediately preceding this appointment in the same or some other organization or department of the Central Government shall ordinarily not exceed three years)

ANNEXUREY

BIO-DATAJ CURRICULUM VITAE PROFORMA

1.Name and Address

(in Block Letters)

2 Date of Birth (in Christian era)

3.i) Date of entry into service

ii) Date of retirement under

Central/State Government Rules

4.Educational Qualifications

5. Whether Educational and

other qualifications required for

the post are satisfied. (If any

qualification has been treated

as equivalent to the one

prescribed in the Rules, state

the authority for the same)

Qualifications/ Experience required as

mentioned in the advertisement/ vacancy circular

Qualifications/ experience possessed by the officer

Essential

A) Qualification

B) Experience

Desirable

Essential

A) Qualification

B) Experience

Desirable A) Qualification

A) Qualification 8) Experience

B) Experience

5.1 Note: This column needs to be amplified to indicate Essential and Desirable Qualifications as

mentioned in the RRs by the Administrative Ministry/Department/Office at the time of issue of Circular and issue of Advertisement in the Employment News. 5.2

In the case of Degree and Post Graduate Qualifications Elective/ main subjects and subsidiary subjects may be indicated by the candidate.

6. Please state clearly whether in the light of entries

made by you above, you meet the requisite

Essential Qualifications and work experience of the post.

6.1 Note: Borrowing Departments are to provide their specific comments/ views confirming the

relevant Essential Qualification/ Work experience possessed by the Candidate (as indicated in the Rio-data) with reference to the post applied.

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7. Details of Employment, in chronological order. Enclose a separate sheet duly authenticated by your

signature, if the space below is insufficient.

Office/Institution Post held on

regular basis From To *Pay Band and Grade

Pay/Pay Scale of the

post held on regular

basis

Nature of

Duties (in

detail)

highlighting

experience

required for

the post

applied for

.... mportant: Pay-band and Grade Pay granted under ACP/MACP are personal to the officer and

therefore, should not be mentioned . Only Pay Band and Grade Pay/ Pay scale of the post held on regular basis to be mentioned. Details of ACP/MACP with present Pay Band and Grade Pay where such

benefits have been drawn by the Candidate, may be indicated as below;

Office/Institution Pay , Pay Band, and Grade Pay

drawn under ACP / MACP Scheme

From To

8.Nature of present employment i.e. Ad-

hoc or Temporary or Quasi-Permanent

or Permanent

9.In case the present employment is held on deputation/contract basis, please state-

a) The date of initial

appointment b) Period of appointment

on deputation/contract c) Name of the parent

office/organization to

which the applicant

belongs.

d) Name of the

post and Pay of the post held in

substantive

capacity in the

parent

organisation

9.1 Note: In case of Officers already on deputation, the applications of such officers should be forwarded by the parent cadre/ Department along with Cadre Clearance, Vigilance Clearance and Integrity certificate. 9.2 Note: Information under Column 9(c) & (d) above must be given in all cases where a person is holding a post on deputation outside the cadre/ organization but still maintaining a lien in his parent cadre/ organisation

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,,,.,. If any post held on Deputation in the

past by the applicant, date of return

' from the last deputation and other details.

11.Additional details about present employment:

Please state whether working under

(indicate the name of your employer

against the relevant column)

a) Central Government b) State Government c) Autonomous Organization d) Government Undertaking e) Universities

f) Others •

12. Please state whether you are

working in the same Department and

are in the feeder grade or feeder to feeder grade.

13. Are you in Revised Scale of Pay? If

yes, give the date from which the

revision took place and also indicate the pre-revised scale

14.Total emoluments per month now drawn

Basis Pay in the PB Grade Pay I Total Emoluments

15. In case the applicant belongs to an Organisation which is not following the Central Government

Pay-scales, the latest salary slip issued by the Organisation showing the following details may be enclosed.

Basic Pay with Scale of

Pay and rate of

increment

Dearness Pay/interim

relief /other Allowances

etc., (with break-up

details)

Total Emoluments

16.A Additional information, if any, relevant to the

post you applied for in support of your suitability for the post.

(This among other things may provide information with

regard to (i) additional academic qualifications (ii)

•1,-06fessional training and (iii) work experience over and

above prescribed in the Vacancy

Circular/Advertisement)

(Note: Enclose a separate sheet, if the space is insufficient)

16.6 Achievements:

The candidates are requested to indicate information

with regard to;

(i) Research publications and reports and special

projects

(ii) Awards/Scholarships/Official Appreciation

(iii) Affiliation with the professional

bodies/institutions/societies and;

(iv) Patents registered in own name or achieved for the

organization

(v) Any research/ innovative measure involving official

recognition vi) any other information.

(Note: Enclose a separate sheet if the space is

insufficient)

17. Please state whether you are applying for

deputation (1STC)/Absorption/Re-employment Basis.#

(Officers under Central/State Governments are only

eligible for "Absorption". Candidates of non-

Government Organizations are eligible only for Short

Term Contract)

# (The option of 'STC' / 'Absorption'/'Re-employment'

are available only if the vacancy circular specially

mentioned recruitment by "STC" or "Absorption" or

"Re-employment").

18. Whether belongs to SC/ST

I have carefully gone through the vacancy circular/advertisement and I am well aware that the

information furnished in the Curriculum Vitae duly supported by the documents in respect of Essential

Qualification/ Work Experience submitted by me will also be assessed by the Selection Committee at the

time of selection for the post. The information/ details provided by me are correct and true to the best

of my knowledge and no material fact having a bearing on my selection has been suppressed/ withheld.

(Signature of the candidate)

Address

Date

-5--

Certification by the Employer/ Cadre Controlling Authority

The information/ details provided in the above application by the applicant are true and

correct as per the facts available on records. He/she possesses educational qualifications and experience mentioned in

the vacancy Circular. If selected, he/she will be relieved immediately. 2. Also certified that;

i)There is no vigilance or disciplinary case pending/ contemplated against Shri/Smt.

ii) His/ Her integrity is certified.

iii)His/ Her CR Dossier in original is enclosed/photocopies of the ACRs for the last 5 years duly

attested by an officer of the rank of Under Secretary of the Govt. of India or above are enclosed..

iv)No major/ minor penalty has been imposed on him/ her during the last 10 years Or A list of

major/ minor penalties imposed on him/ her during the last 10 years is enclosed. (as the case may be)

Countersigned

(Employer/ Cadre Controlling Authority with Seal)

r

Annexure-III

PROFORMA

APPLICATION FOR THE POST OF STAFF CAR DRIVER

Paste a recent

Passport

size

photograph

1. Name in block letters : _________________________

2. Father’s Name : _________________________

3. Address (with contact number, if any:-

(i) Permanent Address : _________________________

(ii) Correspondence Address : _________________________

4. Date of Birth(in words and figures : _________________________

5. Nationality : _________________________

6. Educational Qualification : _________________________

7. Number, date and validity of period of driving : _________________________

licence (enclose a copy of the Licence)

8. Whether belong to SC/ST/OBC : _________________________

8. Experience: Give details of experience of driving

(Motor Car), if any:-

(i) Name of Employer/Organization : _________________________

(ii) Address of the Office : _________________________

(iii) Duration : _________________________

9. The information furnished above is true to the best of my knowledge and belief and in

case anything is found to have been suppressed or incorrectly furnished by me, I shall be

liable for the same.

Date:______________ (Signature of the Applicant)

Place: _____________

4)10 40 - -12024 / 1 / 2014- 9410

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vgZrk@dk;Z vuqHko ¼tSlk ck;ksMkVk esa mYys[k fd;k x;k gS½ dh iqf’V djrs gq, viuh fof”k’V

fVIif.k;ka@er çnku djsaA

7- jkstxkj dk dkyØe ds vuqlkj fooj.kA ;fn uhps fn;k x;k LFkku vi;kZIr gks rks vius

gLrk{kj ls fof/kor çekf.kr djrs gq, vyx “khV layXu djsaA

dk;kZy;@laLFkku fu;fer

vk/kkj ij

/kkfjr in

ls rd *fu;fer vk/kkj ij

/kkfjr in dk

osru cSaM vkSj

xzsM

osru@osrueku

drZO;ksa dk

Lo:Ik

¼vkosnu fd,

x,½ in ds

fy, vko”;d

vuqHko dk

fo”ks’k mYys[k

djrs gq,

foLrkjiwoZd

C;kSjk

*egRoiw.kZ % ,lhih@,e,lhih ds v/khu çnÙk osru cSaM vkSj xzsM osru vf/kdkjh ds fy, O;fDrxr

gksrs gSa vkSj blfy, mudk mYys[k u fd;k tk,A dsoy fu;fer vk/kkj ij /kkfjr in dk osru

cSaM vkSj xzsM osru@osrueku dk mYYks[k fd;k tk,A ,lhih@,e,lhih dk fooj.k] tgka vH;FkhZ

}kjk ,sls ykHk fy, x, gSa] ekStwnk osru cSaM vkSj xsM osru ds lkFk uhps fn, vuqlkj fn;k tk

ldrk gS(

dk;kZy;@laLFkku ,lhih@,e,lhih

;kstuk ds v/khu

vkgfjr osru] osru cSaM

vkSj xzsM osru

ls rd

8- orZeku jkstxkj dk Lo:Ik

vFkkZr~ rnFkZ ;k vLFkk;h ;k

LFkk;hoÙk ;k LFkk;h

9- ;fn orZeku jkstxkj

çfrfu;qfDr@lafonk vk/kkj ij

gS rks d`Ik;k mYys[k djsa &

d½ vkjafHkd fu;qfDr dh

rkjh[k

[k½

çfrfu;qfDr@lafonk

ij fu;qfDr dh

vof/k

x½ ewy

dk;kZy;@laxBu dk

uke ftlls vkosnd

lacaf/kr gS

?k½ ewy laxBu esa

LFkk;h :Ik ls /kkfjr

in dk uke vkSj osru

9-1 fVIi.kh% tks vf/kdkjh igys ls gh çfrfu;qfDr

ij gSa rks ,sls vf/kdkfj;ksa ds vkosnu dSMj

fDy;jsal] lrdZrk fDy;jsal vkSj lR;fu’Bk

çek.k&i= ds lkFk ewy laoxZ@foHkkx }kjk vxzsf’kr

fd, tkus pkfga,A

9-2 fVIi.kh% Åij dkWye 9¼x½ vkSj ¼?k½ ds v/khu

lwpuk lHkh ekeyksa esa nh tk, tgka dksbZ O;fDr

laoxZ@laxBu ls ckgj çfrfu;qfDr vk/kkj ij

fdlh in ij gks ijarq ewy laoxZ@laxBu esa mldk

vHkh fy;u gksA

10- ;fn vkosnd foxr esa fdlh in ij

çfrfu;qfDr ij jgs gksa rks vafre çfrfu;qfDr ls

okil vkus dh rkjh[k vkSj vU; fooj.kA

11- orZkeku jkstxkj ds ckjs esa vfrfjDr fooj.k%

d`Ik;k crk,a fd fuEufyf[kr esa ls fdlds v/khu

dk;Zjr gSa ¼laxr dkWye esa ls vius fu;ksDrk ds

uke dk mYys[k djsa½

d½ dsaæ ljdkj

[k½ jkT; ljdkj

x½ LOkk;r laxBu

?k½ ljdkjh m|e

³½ fo”ofo|ky;

p½ vU;

12- d`Ik;k crk,a fd D;k vki mlh foHkkx esa dk;Z

dj jgs gSa vkSj QhMj xzsM esa gSa vFkok QhMj ls

QhMj xzsM esa gSaA

13- D;k vki la”kksf/kr osrueku esa gSa\ ;fn gka rks

og rkjh[k crk,a ftldks osrueku la”kksf/kr gqvk

vkSj la”kks/kuiwoZ osrueku Hkh crk,aA

14- vc vkgfjr dqy ekfld ifjyfC/k;ka

osru cSaM esa ewy osru

xsM osru dqy ifjyfC/k;ka

15- ;fn vkosnd fdlh ,sls laxBu ls gS tks dsaæ ljdkj ds osrueku ugha viuk jgk gS] rks

fuEufyf[kr fooj.k n”kkZrs gq, laxBu }kjk tkjh vafre osru fLyi layXu dh tk,A

osrueku ds lkFk ewy osru

vkSj okf’kZd osruof) dh nj

eagxkbZ osru@varfje

jkgr@vU; HkÙks vkfn

¼vyx&vyx fooj.k ds lkFk½

dqy ifjyfC/k;ka

16-d vkids }kjk vkosnu fd, x, in ds fy,

viuh mi;qDrrk ds leFkZu esa vfrfjDr lwpuk]

;fn dksbZ gksA

¼blesa vU; ckrksa ds lkFk&lkFk buds ckjs esa Hkh

lwpuk çnku dh tk, ¼i½ vfrfjDr “kSf{kd vgZrk,a

¼ii½ O;kolkf;d çf”k{k.k vkSj ¼iii½ fjfDr

ifji=@foKkiu esa fu/kkZfjr ds vfrfjDr dk;Z

vuqHko½

¼fVIi.kh% ;fn LFkku vi;kZIr gks rks vyx ls “khV

layXu djsa½

16-[k miyfC/k;ka

vH;fFkZ;ksa ls vuqjks/k gS fd os fuEufyf[kr ds ckjs

esa lwpuk nsa(

¼i½ “kks/k çdk”ku vkSj fjiksVsZa rFkk fo”ks’k

ifj;kstuk,a

¼ii½ iqjLdkj@Nk=o`fÙk@ljdkjh ç”kalk &i=

¼iii½ O;kolkf;d fudk;ksa@laLFkkuksa@lkslkbfV;ksa ds

lkFk lac)rk vkSj(

¼iv½ vius uke esa ntZ vFkok laxBu ds fy, çkIr

isVsaV

¼v½ dksbZ “kks/k@uo&çorZudkjh mik; ftls

ljdkjh ekU;rk feyh gks ¼vi½ vU; dksbZ lwpukA

¼fVIi.kh% ;fn LFkku vi;kZIr gks rks vyx ls “khV

layXu djsa½

17- d`Ik;k crk,a fd D;k vki çfrfu;qfDr

¼vkbZ,lVhlh½@vkesyu@iqujksZtxkj vk/kkj ij

vkosnu dj jgs gSaA #¼**vkesyu** ds fy, dsoy

dsaæ@jkT; ljdkjksa ds vf/kdkjh ik= gSaA

xSj&ljdkjh laxBuksa ds vH;FkhZ dsoy vYikof/k

lafonk ds fy, ik= gSa½

#¼*vYikof/k lafonk@*vkesyu*@*iqujksZtxkj* dk

fodYi dsoy rHkh miyC/k gksxk tc fjfDr ifji=

esa *vYikof/k lafonk* ;k *vkesyu* ;k *iqujksZtxkj*

}kjk HkrhZ dk fo”ks’k :Ik ls mYys[k fd;k x;k

gks½A

18- D;k vuqlwfpr tkfr&tu&tkfr ls lacaf/k gSaA

eSaus fjfDr ifji=@foKkiu lko/kkuhiwoZd i<+ fy;k gS vkSj eq>s vPNh rjg Kkr gS fd esjs

}kjk vfuok;Z vgZrk@dk;Z vuqHko ds ckjs esa nLrkostksa ds lkFk thouo`Ùk esa nh xbZ lwpuk bl in

ds p;u ds le; p;u lfefr }kjk ewY;kafdr dh tk,xhA esjs }kjk nh xbZ lwpuk vkSj C;kSjs esjh

tkudkjh ds vuqlkj lgh vkSj lR; gSa vkSj dksbZ Hkh egRoiw.kZ rF;k ftldk esjs p;u ij çHkko

iM+s] nck;k@jksdk ugha x;k gSA

¼vH;FkhZ ds gLrk{kj½

irk ________________

________________

fnukad ________________

fu;ksDrk@laoxZ fu;a=.k çkf/kdkjh }kjk çek.ku

vkosnd }kjk mi;qZDr vkosnu esa nh xbZ [email protected] fjdkWMksZa esa miyC/k rF;ksa ds

vuqlkj lR; ,oa lgh gSaA blds ikl fjfDr ifji= esa mfYyf[kr “kSf{kd vgZrk vkSj vuqHko gSA

;fn budk p;u gks tkrk gS] rks bUgsa rRdky dk;ZeqDr dj fn;k tk,xkA

2- ;g Hkh çekf.kr fd;k tkrk gS fd(

i½ Jh@Jherh _______ ds fo:) lrdZrk vFkok vuq”kklfud ekeyk yafcr@fopkjk/khu

ugha gSA

ii½ budk lR;fu’Bk çekf.kr gSA

iii½ buds ewy xksiuh; fjiksVZ Mksft;j layXu gS@fiNys ikap o’kksZa dh ,lhvkj dh QksVks çfr;ka

Hkkjr ljdkj esa voj lfpo ;k blls Åij ds vf/kdkjh }kjk fof/kor :Ik ls lR;kfir

djokdj layXu gSaA

iv½ fiNys 10 o’kksZa ds nkSjku buij dksbZ cM+h@NksVh “kkfLr vf/kjksfir ugha dh xbZ gSa vFkok

fiNys 10 o’kksZa ds nkSjku buij dksbZ vf/kjksfir cM+h@NksVh “kkfLr;ksa dh lwph layXu gSaA

¼tSlk Hkh ekeyk gks½

çfrgLrk{kfjr

________________ ¼eksgj ds lkFk fu;ksDrk@laoxZ fu;a=.k vf/kdkjh½

gky dk ikliksVZ

vkdkj dk QksVks

fpidk,a

vuqyXud&III

çi=

LVkQ dkj MªkbZoj in ds fy, vkosnu

1- Li’V v{kjksa esa uke : ______________________

2- firk dk uke : ______________________

3- irk ¼laidZ la[;k ds lkFk ;fn dksbZ gS%&

¼i½ LFkk;h irk : ______________________

¼ii½ i=kpkj dk irk : ______________________

4- tUe frFk ¼”kCnksa ,oa vadksa esa½ : ______________________

5- jk’Vªh;rk : ______________________

6- “kS{kf.kd vgZZrk : ______________________

7- MªkbZfoax ykbZlsal dk uacj] fnukad rFkk : ______________________

oS/krk vof/k ¼ykbZlsal dh çfr layXu djsa½

8- D;k v0tk0@v0t0tk0@v0fi0o0 ls lacaf/kr gS : ______________________

9- vuqHko% ¼eksVj dkj½ MªkbZfoax ds vuqHko dk fooj.k

çLrqr djsa] ;fn dksbZ gS rks%&

¼i½ fu;ksDrk@laxBu dk uke : ______________________

¼ii½ dk;kZy; dk irk : ______________________

¼iii½ vof/k : ______________________

10- Åij çLrqr dh xbZ lwpuk esjh loksZÙke tkudkjh vkSj fo”okl ds vuqlkj lgh gS rFkk ;fn

dksbZ ckr fNikbZ xbZ gS vFkok xyr çLrqr dh xbZ gS] rks mlds fy, eSa mÙkjnk;h gw¡xkA

fnukad% _____________ ¼vkosnd dk gLrk{kj½

LFkku% _____________