xUizj FHij ts gf l

mftho cjahs gfhd zg

l :
ifgl

ifbahgJl

Passport size

01 kDjhu bga

02 jfgdh / fzt bga

03 kDjhu Ul Kft

04 khefuh/efuh/ng%uh
kly nfhl /thL/ tlhu/
Cuh v

05 khefuh/ efuh/ ng%uh/

tlhu / Cuh bga

06 cjahs akd nfhU

ika v, bga/ yhr

07 f jF

08 wj nj kW ailj
taJl

09 tF ( tUth Jiw bgw *jh.t/jh.g./..t/.t/.t

rh rhWl)

10 kDjhu Ul Kft
(rhWl) thfhs milahs
mil ef (m) FLg mil
ef (m) t uJ (m) Mjh
mil ef
11 kDjhu tF lF
akd nfhU mftho
ikaF cs u
12 kDjhu FLgntW ahnuD
muR/csh Wtd /jah
Jiw Wtdf g
cshuh? iyba mjfhd
rhW izfgl ntL

13 kDjhu w f jFf
(rhj izfgl ntL)

14 Ukz iy Ukzkhdt/jit/Mjutw jit/

fztuh iflglt

15 ju jFf(Extra Curricular
activities)

15( kDjhu Loco Motor Disability i.e., M/iy

a) partially orthopaedically differently
abled persons
M v mj tu / rjj
(rhWl rkf)

16 kDjhu FLg tUkhd

17 w Ff

l :

eh :

kDjhu ifbahg
 gjidf:-

vGj gof bjUf ntL.

01.07.2017 mW taJ 20 Kj 40-F Uf ntL (jit /
Mjutw jit/ fztdh iflglt / kiythgFd 5 taJ
js / Loco Motor Disability i.e., partially orthopaedically differently abled
persons rgjglt v 3 taJ js).
zgjhu zF ika mU tf ntL.
jit/fztuh iflglt /Loco Motor Disability i.e., partially
orthopaedically differently abled persons rkjglt v ca
tif rhW rkfgl ntL.
FLg cWd muR g iy vgjfhd rhW njitahd
df rkf ntL.
* jhjgl tFd /jhjgl gHFod/f gLjgl
tFd / gLjgl tFd vgjfhd rhW
tlhalUJ bgW rkf ntL

mYtyf cgnahfF kL (For Office Use Only)

fl rhWf izfgLsjh?

taJ (g khW rhj ) : M / iy

FLgdmuR ntiyf iy vgjfhd rhW : M / iy
jit/fztuh iflglt, Loco Motor Disability i.e.,
partially orthopaedically differently abled persons
vgjfhd rhW : M / iy
Ul rhj
w Ff VnjD U

FHij ts l mYty.

zgjhuf UlF mU cs FHij

tsl mYtyfij mD zf.

aFe(k) FGk aFeuf, juk,brid-113

mYtyf zgij jf.