gfj;k.

kk ljdkj
Je foHkkx
vf/klwpuk

fnukaad 04 tuojh] 2017

ua0 6@75@2016&1ySc] gfj;k.kk jkT; ds jkT;iky izlUurk iwoZd “gfj;k.kk

flfydksfll iquZokl uhfr” dks izLrqr djrs gSa tks fd Hk;kud O;olk;tfur QsQM+ksa
dh fcekjh ^^flfydksfll** ls ihfM+r Jfedksa ds bZykt] eqvkotk] iquZokl rFkk fofHkUu
dY;k.kdkjh lqfo/kk,a lqfuf'pr djsxhA
gfj;k.kk flyhdksfll iquZokl uhfr
Hkwfedk
flfydksfll ,d rjg dh O;olk;tfur QsQM+ksa dh fcekjh gSa] tks fd
crystalline silica dh /kwy esa dk;Z djus ds nkSjku lkal ysus ls gksrh gSA blesa fof'k"V :i
ls QsaQMksa esa lwtu vk tkrh gS ,oa rFkk QsQM+ksa ds Hkkxksa esa xkaBnkj ?kko cu tkrs gSa
vkSj bl fcekjh dks pneumoconiosis dh Js.kh esa j[kk x;k gSA
flfydksfll ds y{k.k

 Vh0ch0 ls lEcU/k
 lkal dk Qwyuk
 Fkdku gksuk
 Hkw[k u yxuk
 Nkrh esa nnZ] lw[kh [kkalh
 lkal ysus esa vojks/k
 vUrr% e`R;qA
 flfydksfll ,d ykbykt QsQM+ksa dh chekjh gS tks fd
flfydksfll izo`Rrd dk;Z LFkyksa tSls fd LVksu dzs'kj] dks;yk vk/kkfjr rki
fo|qr la;a=] fuekZ.kk/khu LFky ,oa [kkuksa ij gks ldrh gSA fo'o Lrj ij bl
fcekjh ls cpko o [kRe djus ds lHkh iz;klksa ds ckotwn flfydksfll ls izR;sd
o"kZ yk[kksa Jfed blls izHkkfor gksrs gSa rFkk gtkjksa yksxksa dh e`R;q gks tkrh gSA
;g fcekjh ihfM+r O;fDr ds 'kjhj esa yxkrkj c<+rh gS vkSj LFkkbZ :i ls
fodykaxrk iSnk dj ldrh gS] blds ckotwn flydksfl nqfu;k esa izeq[k
O;kolfk;d LokLF; chekfj;ksa esa ls ,d cuh gqbZ gSA
gfj;k.kk izns'k esa flfydksfll] dkj[kkuk vf/kfu;e] 1948 rFkk
Hkou ,oa vU; lfUuekZ.k deZdkj ¼jkstxkj vkSj 'krksZa dk fofu;eu lsok½
vf/kfu;e] 1966 ds vUrZxr vf/klwfpr chekjh gSA
y{;
izxfr'khy izns'k gfj;k.kk }kjk flfydksfll ihfM+rksa ds bZykt] eqvkotk]
iquZokl ds fy;s ,d ,dhd`r uhfr ^^gfj;k.kk flfydksfll iquZokl uhfr** cukbZ xbZ gSA
;g uhfr flfydksfll ihfM+r Jfed] tks fd lkekftd o vkfFkZd :i ls detksj gSa
muds bZykt] eqvkotk] iquZokl rFkk fofHkUu dY;k.kdkjh lqfo/kk,a lqfuf'pr djsxhA
gfj;k.kk flyhdksfll iquZokl uhfr dh ifjikyuk ds rjhds uhps n'kkZ;s x;s gSa %&
ik=rk
 ftl Jfed dks flfydksfll Mk;Xukslhl cksMZ izefkf.kr djsxk og bl
uhfr ds vUrxZr ik= gksxkA

 ;g uhfr dsoy dkj[kkuksa rFkk fuekZ.k LFkyksa ij dk;Z djus okys Jfedksa
ij ykxw gksxhA
iquZokl ,oa vU; dY;k.kdkjh igyw
d½ bZykt
tc Hkh dksbZ lafanX/k ekeyk flfydksfll Mk;Xuksfll cksMZ }kjk izekf.kr fd;k
tkrk gS] rks ml Jfed dks bZykt gsrq vLirky Hkstk tk;sxkA tks Jfed
 deZpkjh jkT; chek vf/kfu;e] 1948 ds vUrxZr iathd`r gksxk mls bZykt gsrq
bZ0,l0vkbZ0 vLirky Hkstk tk;sxk vkSj tks Jfed] deZpkjh jkT; chek
vf/kfu;e] 1948 ds vUrxZr iathd`r ugha gS rks mls tkap iM+rky] eqQr bZykt]
rFkk nokbZ;ksa ds fy;s jkT; ljdkj ds LokLF; foHkkx ds ftyk vLirkyksa vFkok
fpfdLrk egkfo|ky;ksa esa Hkstk tk;sxkA ;fn flfydksfll ihfM+r Jfed ds
bZykt ds fy;s dksbZ nokbZ] tkap ;k midj.k LokLF; foHkkx ds ikl miyC/k
ugha gS rks LokLF; foHkkx mldks cktkj ls [kjhn ldrk gS rFkk ml jkf'k dh
izfriwfrZ Je foHkkx }kjk dh tk;sxhA
[k½ eqvkotk
tks Jfed deZpkjh jkT; chek vf/kfu;e] 1948 ds vUrxZr iathd`r gS] mldks
bl vf/kfu;e ds izko/kkuksa ds vUrxZr eqvkotk fn;k tk;sxk rFkk tks blds
vUrxZr iathd`r ugha gS] mldks dkexkj {kfriwfrZ vf/kfu;e] 1923 ds izko/kkuksa
ds vUrxZr eqvkotk fn;k tk;sxkA
x½ dY;k.kdkjh ;kstuk,a
Ø-l- dY;k.kdkjh ;kstuk dk lgk;rk jkf'k Ikk=rk dh 'krsZa
uke
(i) iquokZl lgk;rk  igpku i=
flfydksfll Mk;Xuksfll
cksMZ }kjk izekf.kr gksus  eqR;q izek.k&i=
mijkUr ,d eq'r 5 yk[k ;fn e`R;q iquZokl
:0 dh lgk;rk jkf'kA lgk;rk izkIr gksus
ls igys gqbZ gks
flfydksfll Mk;Xuksfll rksA
cksMZ }kjk izekf.kr gksus
mijkUr ;fn fdlh Jfed
dh e`R;q gks tkrh gS vkSj
mls iquZokl lgk;rk izkIr
ugh gqbZ gks rks] iquZokl
lgk;rk mlds %&
 fo/kok@fo/kqj vxj
Jfed 'kknh'kqnk FkkA
vFkok
  thfor ekrk@firk esa
ls ,d] ;fn Jfed
'kknh'kqnk ugha FkkA
dks ns; gksxhA
(ii) e`R;q mijkUr lgk;rk 1 yk[k :0 dh jkf'k  e`rd dk igpku
flfydksfll ihfM+r Jfed i=
dh e`R;q mijkUr mlds %&  e`R;q izek.k i=
 fo/kok@fo/kqj
vFkok
 ukekafdr fd;s gq;s
O;fDr dks] ;fn e`rd
'kkfn'kqnk ugha FkkA
dks ns; gksxhA
(iii) vafre laLdkj lgk;rk jkf'k 15 gtkj :0 dh jkf'k  e`rd dk igpku
e`rd Jfed ds vaR;sf"V i=
muq"Bkuksa ds fy;sA
(iv) flfydksfll iquZokl 4]000 :0 dh jkf'k izfr  igpku i=
ekg  bZykt lEcU/kh
iSa'ku
lHkh nLrkost
ILO }kjk flfydksfll
oxhZd`r ¼,½]¼ch½ ¼lh½ Js.kh
ds Jfedksa ds fy;s] tcrd
og thfor gSA
(v) ikfjokfjd iSa'ku 3500@& :0 dh jkf'k izfr  igpku i=
ekg  Jfed dk e`R;q
izek.k i=
Jfed dh flfydksfll ls
e`R;q mijkUr mlds%&
 thfor fo/kok@fo/kqj
vFkok
 thfor ekrk@firk
;fn Jfed 'kknh'kqnk
ugha gS rks]
dks ns; gksxh
(vi) cPpksa dh f'k{kk ds fy;s 5000@& ls 12000@&:0  igpku i=
foRrh; lgk;rk dh jkf'k izfr o"kZ  fiNyh d{kk dk
d{kk 1 ls lukrdksRrj rd ifj.kke
 d{kk 1 &5 5000@&  vxyh d{kk esa
d{kk 6&8 6000@& nkf[kys dk izek.k
d{kk 9&10 8000@& i=
d{kk 11&12 10000@&  nks yM+dksa rFkk
vkbZ0Vh0vkbZ0 12000@& rhu yM+fd;ksa rd
fMIiyksek@ muds tUe Øekad
Lukrd@ ds fujsis{kkuqlkj
LukrdksRrj ns; gksxkA
(vii) yM+dh dh 'kknh gsrq 51]000@&:0 dh jkf'k  igpku i=
dU;knku lgk;rk rhu yM+fd;ksa rd ns;  ljiap@okMZ eSEcj
}kjk izekf.kr 'kknh
dk fueU=.k i=A
 rhu yMfd;ksa rd
ns;A
(viii) yM+dksa dh 'kknh gsrq 11]000@&:0 dh jkf'k  igpku i=
fofRr; lgk;rk nks yM+dksa rd ns;  ljiap@okMZ
eSEcj }kjk
izekf.kr 'kknh
dk fueU=.k
i=A
 nks yM+dksa rd
ns;

?k½ dY;k.kdkjh ;kstukvksa ds fy;s dks"k

bl uhfr dks vey esa ykus rFkk dY;k.kdkjh ;kstukvksa ds foRr ds fy;s vyx
ls ,d dks"k cuk;k tk;sxk] ftlesa 70izfr'kr vuqnku gfj;k.kk Je dY;k.k cksMZ
rFkk 30izfr'kr vuqnku gfj;k.kk Hkou ,oa vU; lfUuekZ.k deZxkj dY;k.k cksMZ
}kjk fn;k tk;sxkA bl dks"k esa jkf'k tek djus dk fu'p; iz'kklfud foHkkx ds
vuqeksnu mijkUr Je vk;qDr] }kjk fy;k tk;sxkA
M-½ dk;kZUo;u ,oa fu"iknu
bl uhfr ls lEcfU/kr lHkh dk;ksZa dk dk;kZUo;u ,oa fu"iknu gfj;k.kk Je
dY;k.k cksMZ }kjk fd;k tk;sxk rFkk gfj;k.kk Je dY;k.k cksMZ] flfydksfll
Mk;Xuksfll cksMZ }kjk izekf.kr flfydksfll fifM+r Jfed] dks igpku i=
tkjh djsxkA
bl uhfr ds rgr dY;k.kdkjh ;kstukvksa gsrq vkosnuksa dk fuiVkjk gfj;k.kk Je
dY;k.k cksMZ }kjk fd;k tk;sxkA bu dY;k.kdkjh ;kstukvksa ij rFkk vU; [kpksZa
ds O;; dh eatwjh gsrq Je vk;qDr] gfj;k.kk tks fd dY;k.k vk;qDr Hkh gSa] l{ke
izkf/kdkjh gksaxsA flfydksfll ihfM+r Jfedksa dks fn;s tkus okys ykHk dk fjdkMZ
gfj;k.kk Je dY;k.k cksMZ }kjk j[kk tk;sxkA
p½ vkosnu izfØ;k
flfydksfll ihfM+r Jfed] dY;k.kdkjh ;kstukvksa ds rgr lgk;rk jkf'k izkIr
djus gsrqs vkosnu fu/kkZfjr izksQkekZ esa ¼vuqyXud i ls viii½ vius {ks= ds lgk;d
funs'kd] vkS|ksfxd LokLF;] Je foHkkx ds ikl tek djok;sxkA ftls lgk;d
funs'kd vkS0 Lok0 tkap iM+rky ds ckn Je vk;qDr&lg&dY;k.k vk;qDr]
gfj;k.kk ds dk;kZy; dks izsf"kr djsxkA vkosnu i= dks foHkkx dh oSolkbZV
hrylabour.gov.in ls MkÅuyksM fd;k tk ldrk gSA
N½ tkx:drk
flfydksfll lEcfU/kr fcekjh dh tkx:drk ds fy;s Jfedksa dks le;&le;
ij fu;fer ijke'kZ fn;k tk;sxkA bldks lqfuf'pr djus ds fy;s deZpkjh jkT;
chek LokLF; laj{k.k@lkekU; vLirky@fpfdRlk egkfo|k; ds fpfdRldksa@xSj
ljdkjh laxBu rFkk lkekftd dk;Zdrkvksa ds leUo; ls iwjs izns'k esa foLr`r
tkx:drk dk;ZØe fu;fer rkSj ij fd;s tk;saxsaA Je foHkkx }kjk bl chekjh
ds xEHkhj ifj.kke] tYnh vkSj le; ij irk yxus ds ykHk rFkk lkFk gh
gfj;k.kk flfydksfll iquZokl uhfr ds O;kid izpkj vkSj izlkj gsrq
v[kckj@foKkiu@jsfM;k ftaxy@nwjn'kZu dk;ZØe@uqDdM+ ukVd@ukVd'kkyk
bR;kfn rFkk vU; izpkj ek/;eksa ls izpkfjr djuk lqfuf'pr fd;k tk;sxkA
fot; o/kZu
fnukad% 27-12-2016 vfrfjDr eq[; lfpo] gfj;k.kk ljdkj
Je foHkkxA
i`’Bkadu dzekad%6@75@2016&1Je fnukad % 04-01-2017-

,d izfr fu;U=d] eqnz.k rFkk ys[ku lkexzh foHkkx] gfj;k.kk] p.Mhx<+

dks Hkstdj vuqjks/k fd;k tkrk gS fd d`i;k mijksDr vf/klwpuk rFkk lkFk esa lyXu
izksQksZeksa dks gfj;k.kk ljdkj ds vlk/kkj.k jkti= esa izdkf'kr djds bldh eqfnzr 30
izfr;ka bl foHkkx dks Hksth tk;sA

v/kh{kd Je]
d`rs% vfrfjDr eq[; lfpo] gfj;k.kk ljdkj
Je foHkkxA

i`"Bu dzekad%6@75@2016&1Je fnukad 04-01-2017

bldh ,d izfr Je vk;qDr gfj;k.kk] p.Mhx<+ dks lwpukFkZ ,oa vko';d
dk;Zokgh gsrq Hksth tkrh gSA

v/kh{kd Je]
d`rs% vfrfjDr eq[; lfpo] gfj;k.kk ljdkj
Je foHkkxA
 vuqyXud & I
flfydkWlhl ls ihfMr O;fDr dk fooj.k
(igpku la[;k_________)
fnukad :_________

uke: _____________________________________________________
flfydkWlhl
izHkkfor O;fDr dk
vk;q: ________ fyax: _______ QksVks

vk/kkj la[;k:_______________ ernkrk igpku la[;k: _________________

jkT; deZpkjh chek la[;k: __________________________________________________

firk dk uke: _____________________________________________________________

orZeku irk: _________________________________________________________________

______________________________________________________________________________

LFkkbZ irk: _________________________________________________________________

______________________________________________________________________________

flyhdklhl izekf.kr djus dh frfFk: _____________________________________

flyhdklhl chekjh dh Js.kh: __________________________________________

bZykt 'kq: gksus dh frfFk: _____________________________________ __________

vLirky dk irk: ______________________________________________________

______________________________________________________________________________

cSad [kkrs dk C;kSjk:

[kkrk la[;k: _________________________________________________________

cSad dk uke o 'kk[kk: _________________IFSC Code:________________________

ifjokj dk fooj.k:
Ø-l- ifjokj ds lnL; dk vk;q lhfydklhl izHkkfor
uke O;fDr ls lEcU/k

ikfjokfjd lnL;ksa ds
QksVks

ukekafdr O;fDr dk C;kSjk ¼ifr ;k iRuh@thfor ekrk&firk esa ls ,d½

Ø-l- ukekafdr O;fDr dk uke lhfydklhl izHkkfor vk;q

O;fDr ls lEcU/k

ukekafdr O;fDr
dh QksVks

vk/kkj la[;k:_______________ ernkrk igpku la[;k: _________________

[kkrk la[;k: _________________________________________________________

cSad dk uke o 'kk[kk: _________________ IFSC Code:________________________

__________________________________________________________________________________
__________________________________________________________________________

LFkku%
fnukad%

vkosnd ds gLrk{kj mi funs'kd@lgk;d funs'kd]

@vaxwBs dk fu'kku vkS|ksfxd LokLF;
 vuqca/k - II
iquokZl lgk;rk ds fy;s vkosnu i=

1- izkFkhZ dk uke

2- vk;q--------------------------------fyax---------------------------eksckbZy ua

3- vk/kkj ua --------------------------------------------------------oksVj vkbZ-Mh ua -----------------------------------------

--

4- deZpkjh thou chek ua ------------------------------------

5- firk@ifr dk uke -------------------------------------------

6- fjgk;lh irk%&

i=kpkj irk----------------------------------------------------------------------------------------------------------------------------

------------------------------------------------------------------------------------------orZeku irk------------------------------------

-------------------------------------------------------------------------------------------------------------------------------------------

7- flyhdksfll igpku fnukad ---------------------------------------------------------------------------------------

8- flyhdksfll dh fLFkfr -----------------------------------------------------------------------------------------------------

9- bykt pyus dh frfFk -----------------------------------------------------------------------------------------------------

10- vLirky dk uke tgka ij bZykt py jgk gS -----------------------------------------------------------

----------------------------------------------------------------------------------------------------

11- flfydksfll ls ihfM+r Jfed dh cSad fLFkfr

[kkrk ua ------------------cSad o czkp dk uke --------------------vkbZ,Q,llhdksM--------------------

tek fd;s x;s nLrkost

 ¼d½ igpku i= dh izfr
¼[k½ vk/kkj dkMZ o oksVj dkMZ dh izfr
¼x½ cSad ikl cqd
¼?k½ esfMdy fjdkMZ
esjs }kjk mij nh xbZ lwpuk lR; gS A
LFkku%
fnukad%
izkFkhZ ds gLrk{kj
 vuqyXud - III

vfUre laLdkj lgk;rk ds fy;s vkosnu

1- izkFkhZ dk uke---------------------------------------------------------------------------
2- irk---------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------eksckbZy ua ----------------
--------------------------------
3- izkFkhZ dk vk/kkj ua ------------------------------------------------------------- igpku i=------------------------------
4- ihfM+r Jfed ds lkFk laaca/k ---------------------------------------------------------------------------------------------------
5- ihfM+r Jfed dk uke o irk -----------------------------------------------------------------------------------------------
6- igpku i= uacj -------------------------------------------------------------------------------------------------------------------------
7- e`R;q dk izd`fr -------------------------------------------------------------------------
8- [kkrk ua -----------------------------------------------------------------cSad dk uke o czkap --------------------------------
-----------------------------------------------------------------------------------------------vkbZ,Q,llh dksM----------------------
9- fn;s x;s nLrkostks dh lwph %
d- e`R;q izek.k i= @ Jfed dh iksLVekVZe fjiksVZ
[k- flfydksfll dk igpku dkMZ

esjs }kjk mijfyf[kr nh xbZ lwpuk lR; gS

LFkku % izkFkhZ ds gLrk{kj

fnukad
 vuqyXud - IV

ikfjokfjd iSa’ku ds vkosnu

Photograph of
the applicant

1- izkFkhZ dk uke---------------------------------------------------------------------------
2- irk---------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------eksckbZy ua ----------------
--------------------------------
3- izkFkhZ dk vk/kkj ua ------------------------------------------------------------- igpku i=-------------------------------
--------------
4- ihfM+r Jfed ds lkFk laaca/k ---------------------------------------------------------------------------------------------------
-------------
5- ihfM+r Jfed dk uke o irk ------------------------------------------------------------------------------------------------
------------
6- igpku i= uacj -------------------------------------------------------------------------------------------------------------------------
-----------
7- lhfydksfll ls ihfM+r Jfed dh e`R;q dh frfFk---------------------------------------------------------------
----------
8- [kkrk ua ----------------------------------cSad dk uke o czkap ---------------------------------------------------------------
vkbZ,Q,llh dksM-------------------------------------------------
9- fn;s x;s nLrkostks dh lwph %
d- e`rd Jfed dk igpku i=
[k- e`R;q izek.k i=
x- e`rd Jfed ds lkFk laca/k dk izek.k i=
 ?k+ cSad dh ikl cqd
M- vk/kkj dkMZ o igpku i= dh izfr

esjs }kjk mijfyf[kr nh xbZ lwpuk lR; gS

LFkku % izkFkhZ ds gLrk{kj

fnukad
 vuqyXud - V
iquokZl iSU’ku ds fy;s vkosnu i=

1- izkFkhZ dk uke -----------------------------------------------------------------------------------------------------------------------

2- vk;q--------------------------------iq:"k@efgyk---------------------------eksckbZy ua ---------------------------------

3- vk/kkj ua --------------------------------------------------------oksVj vkbZ-Mh ua -----------------------------------------

4- deZpkjh thou chek ua ------------------------------------

5- firk@ifr dk uke -------------------------------------------

6- fjgk;lh irk%&

i=kpkj irk----------------------------------------------------------------------------------------------------------------------------

---------------------------------------------------------------------------------------------------------------------------------------------------

---------------orZeku irk---------------------------------------------------------------------------------------------------------------

---------------------------------------------------------------------------------------------------------------------------------------------------

7- flyhdksfll igpku fnukad -----------------------------------------------------------------------------------------

8- flyhdksfll dh fLFkfr -----------------------------------------------------------------------------------------------------

9- bykt pyus dh frfFk -------------------------------------------------------------------------------------------------------

10- vLirky dk uke tgka ij bZykt py jgk gS -----------------------------------------------------------

---------------------------------------------------------------------------------------------------------------------------------------------------

11- flfydksfll ls ihfM+r Jfed dh cSad fLFkfr

[kkrk ua -------------------------------------------------------------------cSad o czkp dk uke ------------------------

----------------------------------------------------------------------------------vkbZ,Q,llhdksM--------------------------------
 tek fd;s x;s nLrkost
¼d½ igpku i= dh izfr
¼[k½ vk/kkj dkMZ o oksVj dkMZ dh izfr
¼x½ cSad ikl cqd
¼?k½ esfMdy fjdkMZ
esjs }kjk mij nh xbZ lwpuk lR; gS A
LFkku%
fnukad%
izkFkhZ ds gLrk{kj
 vuqyXud -VI

fookg lgk;rk ds fy;s vkosnu

1- izkFkhZ dk uke ¼Jfed@e`rd Jfed ds ikfjokfjd lnL; ½

2- izkFkhZ dk vk/kkj ua ------------------------------------------oksVj vkbZ-Mh--------------------------------

3- ihfM+r Jfed ls laca/k ¼;fn ikfjokfjd lnL; vkosnu dj jgk gS½ -------

4- irk-------------------------------------------------------------------------------------------------------------------------------------------------------------------------

----------------------------------------------------------------------------------------------------------------------

5- igpku i= ua --------------------------------------------------------------------------------------------------------------------------------------------------

6- lhfydkWlhl ls izHkkfor Jfed dh e`R;q dh frfFk -------------------------------------------------------------------------------

7- iq=@iq=h ds fookg lgk;rk ds fy;s vkosnu------------------------------------------------------------------------------------------

¼d½ tUe frfFk iq=@iq=h ftldh 'kknh gksuh gS ------------------------------------------------------------------------------

¼[k½ uke iq= @iq=h ftldh 'kknh gksuh gS ------------------------------------------------------------------------------------------

¼x½ D;k vki }kjk nwljs iq=@iq=h ds fookg dh lgk;rk ds fy;s vkosnu fd;k gS ] ;fn

gka rks iw.kZ fooj.k nsa%

¼?k½ fookg dh frfFk o le;---------------------------------------------------------------------------------------------------------------

¼M½ nqYgk o nqYgu ds firk dk irk ---------------------------------------------------------------------------------------------------------

-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------

¼p½ fookg lfVZfQdsV dh frfFk o ua ---------------------------------------------------------------------------------------------------

8- izkFkhZ dk [kkrk ua ----------------------------------------------------cSd

a dk uke o czkap -------------------------------------------------

------------------------------------------------------------------------------------- vkbZ,Q,llh dksM---------------------------------------------------

9- tek fd;s x;s nLrkost

¼d½ igpku i=

¼[k½ Jfed dk e`R;q izek.k&i= ;fn Jfed thfor ugha gS

 ¼x½ 'kknh dk fuea=.k dkMZ ljiap@okMZ esacj }kjk lR;kfir

¼?k½ tUe izek.k i= dh izfr] iq=@iq+= ftldh 'kknh gS

¼M+½ cSad ikl cqd

¼p½ vk/kkj o oksVj vkbZ-Mh dh izfr

esjs }kjk mij nh xbZ lwpuk lR; gS

LFkku

fnukad

izkFkhZ ds gLrk{kj
 vuqyXud -VII
'kSf{kf.kd lgk;rk ds fy;s vkosnu

1- izkFkhZ dk uke ¼Jfed@ e`rd Jfed ds ikfjokfjd lnL; ½---------------------------------------

-----------------------------------------------------------------------------------------------------------

2- izkFkhZ dk vk/kkj uacj ------------------------------------------igpku i= -----------------------

3- e`rd Jfed ds lkFk laca/k ¼;fn ikfjokfjd lnL; us vkosnu fd;k gS ½----------------
-------------------------------------------------------------------------------------------------------------

4- irk ------------------------------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------

5- igpku i= uacj ¼flyhdksfll½----------------------------------------------------------------------------------------------

-----

6- flyhdkfll ls ihfM+r Jfed dh e`R;q dh frfFk -------------------------------------------

7- 'kS{kf.kd lgk;rk ds fy;s iq=@iq=h }kjk fd;k x;k vkonsu-------------------¼d½ tUe
frfFk iq=@iq=h ----------------------------------------------------------------------------¼[k½ uke iq=@iq=h --------

----------------------------------------------------------------------------------D;k dHkh vki }kjk igys 'kS{kf.kd

lgk;rk ds fy;s vkosnu fd;k gS ;fn gka rks lwpuk nsa ------------------------------------------------

---------------------------------------------------------------------------------------------------------------------------------------------------------

----------¼x½ fdl d{kk dh lgk;r ds fy;s vkosnu fd;k gS ---------------------------------- ¼?k½

Ldwy o dkyst dk uke o irk-------------------------------------------------------------

 8- izkFkhZ dk [kkrk ua --------------------------------------------------------------------------------------------czkap dk uke--
----------------------------------------------------------vkbZ,Q,llhdksM-----------

9- izLrqr fd;s x;s nLrkost %

d- igpku i=

[k- e`R;q izek.k i= ;fn Jfed thfor ugha gS rks

x- Ldwy o dkyst }kjk fn;k x;k nkf[kyk izek.k i= dh lR;kfir izfr

?k- tUe izek.k i= dk lfVZfQdsV

M+ cSad dh ikl cqd

p- vk/kkj dkMZ o igpku i= dh izfr

esjs }kjk mijfyf[kr nh xbZ lwpuk lR; gS

LFkku % izkFkhZ ds gLrk{kj

fnukad %
 vuqyXud & VIII

e`R;q mijkar lgk;rk ds fy;s vkosnu

1. vkosnd dk uke:____________________________________________________
2. irk__________________________________________________________________

_____________________________________________nwjHkk"k la[;k _____________

3. vk/kkj la[;k: _______________ ernkrk igpku la[;k: _________________

2. e`rd Jfed ds lkFk lEcU/k:___________________________________________

3. e`rd Jfed dk uke o irk:______________________________

4 igpku la[;k :

7. e`R;q dk dkj.k ¼fooj.k lfgr½ :

8. izLrqr fd;s tkus okys nLrkost %

d½ Jfed dk e`R;q izek.k i=:
[k½ iagpku i= ¼flfydkWfll½:
x½ e`rd Jfed ds lkFk lEcU/k dk izek.k:

9. cSad [kkrsdkC;kSjk:
[kkrk la[;k: _________________________________________________________

cSaddkuke o 'kk[kk: _________________ IFSC Code:________________________

mijksDr fooj.k esjs Kku o tkudkjh vuqlkj lgh gS A
LFkku:
fnukad : vknsonudrkZdkuke o gLrk{kj
 vf/kd`r i=
ukekafdr O;fDr dk C;kSjk ¼;fn Jfed 'kknh'kqnk gS rks ifr ;k iRuh½
;fn Jfed vfookfgr gS rks thfor ekrk&firk esa ls ,d
eSa vius ,rn }kjk---------------------------------------------------------------------vius vf/kdkfjd vkfJr
dks vf/kd`r djrk gS tks esjh e`R;q mijkar lHkh izdkj ds ykHk dk vf/kdkj j[ksxk A

Ukkekafdr O;fDr dk flfydksfll ls Ukkekafdr O;fDr dh cSad [kkrs dk fooj.k

uke xzLr ihfM+r Jfed vk;q
dk laca/k

Ukkekafdr O;fDr dh QksVks

LFkku %
fnukad%
Jfed ds gLrk{kj
irk