Form No.

19
Order No. 515 (a)
HÁ tcJ¡pÅ lÀÖn
lÀÖn¡mcs³d t]cv ..........................................................................................................................................................
taÂhnemkw .............................................................................................................................................................................
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k_vcPnkvÁmÀ AhÀIÄ¡v

Xm¦fpsS B^oknse _p¡pIÄ ]cntim[n¨v Xmsg¸dbp¶ B[mc¯ns³d Hcp

]IÀ¸v Xcphm³ At]£n¡p¶p.

1. B[mc¯ns³d hnhcw ...........................................................................................................................................

2. FgpXnsImSp¯hcpsS t]cpw hnhchpw ..........................................................................................................

3. AhImis¸«hcpsS t]cpw hnhchpw ...............................................................................................................

4. apXÂ InS¡p¶ tZiw ...........................................................................................................................................

5. apXens³d t]cv ........................................................................................................................................................

6. _p¡pIfn sXcªpt\mt¡ sImÃw .....................................................................................................

7. _p¡pIfn XpSÀ¨bmbn sXcªpt\mt¡p¶ sImÃtamþsImçtfm.....................................

XobXn lÀÖn¡mcs³d H¸v

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