application form hindi2
TRANSCRIPT
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8/7/2019 Application Form Hindi2
1/18
g0 vkosnd1
futh laLFkkvksa dks nks o"khZ; ch0Vh0lh0futh laLFkkvksa dks nks o"khZ; ch0Vh0lh0futh laLFkkvksa dks nks o"khZ; ch0Vh0lh0futh laLFkkvksa dks nks o"khZ; ch0Vh0lh0@,u0Vh0Vh0@,u0Vh0Vh0@,u0Vh0Vh0@,u0Vh0Vh0 izf'k{k.kizf'k{k.kizf'k{k.kizf'k{k.k ikB~;eikB~;eikB~;eikB~;e
lapkyu ds fy, lEc)rk gsrqlapkyu ds fy, lEc)rk gsrqlapkyu ds fy, lEc)rk gsrqlapkyu ds fy, lEc)rk gsrq vkosnu i=vkosnu i=vkosnu i=vkosnu i=
vkosnuvkosnuvkosnuvkosnu djus dhdjus dhdjus dhdjus dh frfFkfrfFkfrfFkfrfFk ----------------------------------------------------------------------------------------------------------------------------------------
1111---- vf/kdr vkosnd dk uke -------------- ------------------ ------------------- ------------------firk dk uke ------------------- ------------------ ----------------
laLFkk@VLV esa inuke ---------------------------------------------------------------------------------------------------------------------------------------------------------
irk ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Qksu ua0 dksM ua0 lfgr-----------------------------------------------------------QSDl ua0-------------------------------------------------------------------------bZ&esy vkbZ-Mh-----------------------------------------------------------------------eksckby ua0 ----------------------------------------------------------------------------
2222---- laLFkk dk uke -------------------------------------------------------------------------------------------------------------------------------------------------------------------------
vaxzsth ds dSfiVy v{kjksa esa -------------------------------------------------------------------------------------------------------------------------------------------
i=kpkj dk irk ----------------------------------------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Qksu ua0 dksM ua0 lfgr-----------------------------------------------------------QSDl ua0-------------------------------------------------------------------------bZ&esy vkbZ-Mh-----------------------------------------------------------------------osc lkbV ua0 -----------------------------------------------------------------------
3333---- dddd---- lkslkbVh@VLV dk ukelkslkbVh@VLV dk ukelkslkbVh@VLV dk ukelkslkbVh@VLV dk uke ---------------------------------------------------------------------------------------------------------------------------------
irk ---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
-----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
Qksu ua0 dksM ua0 lfgr-----------------------------------------------------------QSDl ua0-------------------------------------------------------------------------
bZ&esy vkbZ-Mh-----------------------------------------------------------------------osc lkbV ua0 -----------------------------------------------------------------------ckbZ&ykWt rFkk izcU/k lfefr ds lnL;ksa dh lwph layXu djsa
[k[k[k[k---- lkslkbVh@VlkslkbVh@VlkslkbVh@VlkslkbVh@VLV dsLV dsLV dsLV ds uohuhdj.k dh v|ru fLFkfruohuhdj.k dh v|ru fLFkfruohuhdj.k dh v|ru fLFkfruohuhdj.k dh v|ru fLFkfr ------------------------------------------------------------------------Nk;kizfr
layXu djsa
xxxx---- lkslkbVh@VlkslkbVh@VlkslkbVh@VlkslkbVh@VLVLVLVLV dk VSdk VSdk VSdk VSuuuu(TAN)uEcjuEcjuEcjuEcj ----------------------------------------------------------------------------------------------------
4444---- laLFkklaLFkklaLFkklaLFkkuuuu dk LFkkiuk o"kZdk LFkkiuk o"kZdk LFkkiuk o"kZdk LFkkiuk o"kZ -----------------------------------------------------------------------------------------------------------------------------------------------
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8/7/2019 Application Form Hindi2
2/18
g0 vkosnd2
5555---- v& vkosnu 'kqYd :0 1000@& ,d gtkj ek= dk fooj.kv& vkosnu 'kqYd :0 1000@& ,d gtkj ek= dk fooj.kv& vkosnu 'kqYd :0 1000@& ,d gtkj ek= dk fooj.kv& vkosnu 'kqYd :0 1000@& ,d gtkj ek= dk fooj.k
cSad MkV la[;k --------------- ------------------- -------------------- -----
jk"Vh;dr cSad dk uke --------------- ------------------- -------------------- -----
MkV tkjh dk fnukad -----------------------------------------------------------
c&c&c&c& izf;k 'izf;k 'izf;k 'izf;k 'kqYd :0 50]000@& ipkl gtkj ek= dk fooj.kkqYd :0 50]000@& ipkl gtkj ek= dk fooj.kkqYd :0 50]000@& ipkl gtkj ek= dk fooj.kkqYd :0 50]000@& ipkl gtkj ek= dk fooj.kcSad MkV la[;k --------------- ------------------- -------------------- -----
jk"Vh;dr cSad dk uke --------------- ------------------- -------------------- -----
MkV tkjh dk fnukad -----------------------------------------------------------
vkosnu rFkk izf;k 'kqYd dh jkf'k] iz'kklfud vf/kdkjh]iz'kklfud vf/kdkjh]iz'kklfud vf/kdkjh]iz'kklfud vf/kdkjh] jkT; 'kSf{kd vuqla/kku ,oa izf'k{k.k ifj"kn]jkT; 'kSf{kd vuqla/kku ,oa izf'k{k.k ifj"kn]jkT; 'kSf{kd vuqla/kku ,oa izf'k{k.k ifj"kn]jkT; 'kSf{kd vuqla/kku ,oa izf'k{k.k ifj"kn]m0iz0]m0iz0]m0iz0]m0iz0] y[kuy[kuy[kuy[ku ds i{k esa rFkk y[ku esa ns; gksxhA nksuksa cSad MkV ewy :i esa layXu djsaA
6666---- (i) lEc)rk gsrq vkosfnr ikB~;e dk uke --------------- ------------------- ------------------- ------------------ ------------------ -
(ii) jk"Vh; v/;kid f'k{kk ifj"kn }kjk iznku dh x;h ekU;rk dk fooj.k
ikB~;e dk uke -------------- ------------------ ------------------ ------------------- ------------------ ------------------- ----------------ekU;rk dk i=kad ,ao fnukad --------------------------------------------------------------------------------------------------------------------------
lapkfyr l= --------------- ----------------- ------------------ ------------------- ------------------ ------------------- ---------------
vkoafVr lhVksa dh la[;k -------------------------------------------------------------------------------------------------------------------------
ekU;rk vkns'k dh Nk;kizfr layXu djsa
7777---- ;fn;fn;fn;fn ekU;rkekU;rkekU;rkekU;rk i=i=i=i= esaesaesaesa dksbZ izfrcU/k yxk gS rks mldhdksbZ izfrcU/k yxk gS rks mldhdksbZ izfrcU/k yxk gS rks mldhdksbZ izfrcU/k yxk gS rks mldh iwfrZ dh fLFkfriwfrZ dh fLFkfriwfrZ dh fLFkfriwfrZ dh fLFkfr --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
-------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- di;k fooj.k layXu djsa
8888---- jk"Vh; v/;kid f'k{kk ifj"kn ls ekU;rk izkIr djrs le; tek fd;s x;sjk"Vh; v/;kid f'k{kk ifj"kn ls ekU;rk izkIr djrs le; tek fd;s x;sjk"Vh; v/;kid f'k{kk ifj"kn ls ekU;rk izkIr djrs le; tek fd;s x;sjk"Vh; v/;kid f'k{kk ifj"kn ls ekU;rk izkIr djrs le; tek fd;s x;s
dddd izkHkwr dks"k dk fooj.kizkHkwr dks"k dk fooj.kizkHkwr dks"k dk fooj.kizkHkwr dks"k dk fooj.k :0 ikap yk[k ek= Nk;kizfr layXu djsa:0 ikap yk[k ek= Nk;kizfr layXu djsa:0 ikap yk[k ek= Nk;kizfr layXu djsa:0 ikap yk[k ek= Nk;kizfr layXu djsa
,QMhvkj dk uEcj ,oa fnukad --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
jk"Vh;dr cSad dk uke ----------- -------------- -------------- -------------- ------------ -------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
izkjafHkd fnukad --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
,QMhvkj dh vof/k ----------- -------------- -------------- -------------- ------------ -------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
[k[k[k[k lqjf{kr dks"k dk fooj.klqjf{kr dks"k dk fooj.klqjf{kr dks"k dk fooj.klqjf{kr dks"k dk fooj.k :0 rhu yk[k ek= Nk;kizfr layXu djsa:0 rhu yk[k ek= Nk;kizfr layXu djsa:0 rhu yk[k ek= Nk;kizfr layXu djsa:0 rhu yk[k ek= Nk;kizfr layXu djsa
,QMhvkj dk uEcj ,oa fnukad --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
jk"Vh;dr cSad dk uke ----------- -------------- -------------- -------------- ------------ -------------- -------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
izkjafHkd fnukad --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
,QMhvkj dh vof/k --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
jk"Vh; v/;kid f'k{kk ifj"kn ds fu;ekuqlkj ,QMhvkj esa ca/kd/kkjh dk lk{; lfgrajk"Vh; v/;kid f'k{kk ifj"kn ds fu;ekuqlkj ,QMhvkj esa ca/kd/kkjh dk lk{; lfgrajk"Vh; v/;kid f'k{kk ifj"kn ds fu;ekuqlkj ,QMhvkj esa ca/kd/kkjh dk lk{; lfgrajk"Vh; v/;kid f'k{kk ifj"kn ds fu;ekuqlkj ,QMhvkj esa ca/kd/kkjh dk lk{; lfgra
9999---- laLFkku esa lapkfyr vU;laLFkku esa lapkfyr vU;laLFkku esa lapkfyr vU;laLFkku esa lapkfyr vU; f'k{kd izf'k{k.kf'k{kd izf'k{k.kf'k{kd izf'k{k.kf'k{kd izf'k{k.k ikB~;e dh fLFkfrikB~;e dh fLFkfrikB~;e dh fLFkfrikB~;e dh fLFkfr
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8/7/2019 Application Form Hindi2
3/18
g0 vkosnd3
---- ikB~;e dk ukeikB~;e dk ukeikB~;e dk ukeikB~;e dk uke ekU;rk dkekU;rk dkekU;rk dkekU;rk dk
i=kadi=kadi=kadi=kad fnukadfnukadfnukadfnukad
vuqeU;vuqeU;vuqeU;vuqeU;
lhVksa dhlhVksa dhlhVksa dhlhVksa dh
la[;kla[;kla[;kla[;k
lEc)rklEc)rklEc)rklEc)rk
nsus okyhnsus okyhnsus okyhnsus okyh
laLFkk dklaLFkk dklaLFkk dklaLFkk dk
ukeukeukeuke
lEc)rk dklEc)rk dklEc)rk dklEc)rk dk
i=kad fnukadi=kad fnukadi=kad fnukadi=kad fnukad
ikB~;eikB~;eikB~;eikB~;e
lapkyulapkyulapkyulapkyu
dk l=dk l=dk l=dk l=
12
3
4
5
ekU;rkekU;rkekU;rkekU;rk ,oa lEc)rk,oa lEc)rk,oa lEc)rk,oa lEc)rk i= dh Nk;kizfr layXu djsai= dh Nk;kizfr layXu djsai= dh Nk;kizfr layXu djsai= dh Nk;kizfr layXu djsa
10101010---- laLFkku esa lapkfyrlaLFkku esa lapkfyrlaLFkku esa lapkfyrlaLFkku esa lapkfyr f'k{k.k izf'k{k.kf'k{k.k izf'k{k.kf'k{k.k izf'k{k.kf'k{k.k izf'k{k.k ikB~;e ds vfrfjikB~;e ds vfrfjikB~;e ds vfrfjikB~;e ds vfrfjDrDrDrDr vU; ikB~;evU; ikB~;evU; ikB~;evU; ikB~;e ds lapkyuds lapkyuds lapkyuds lapkyu dh fLFdh fLFdh fLFdh fLFkfkfkfkfrrrr
---- ikB~;e dkikB~;e dkikB~;e dkikB~;e dkukeukeukeuke
ekU;rk nsusekU;rk nsusekU;rk nsusekU;rk nsusokyh laLFkk dkokyh laLFkk dkokyh laLFkk dkokyh laLFkk dk
ukeukeukeuke
ekU;rk dkekU;rk dkekU;rk dkekU;rk dki=kadi=kadi=kadi=kad
fnukadfnukadfnukadfnukad
vuqeU;vuqeU;vuqeU;vuqeU;lhVksalhVksalhVksalhVksa
dhdhdhdh
la[;kla[;kla[;kla[;k
lEc)rk nsuslEc)rk nsuslEc)rk nsuslEc)rk nsusokyh laLFkkokyh laLFkkokyh laLFkkokyh laLFkk
dk ukedk ukedk ukedk uke
lEc)rklEc)rklEc)rklEc)rkdk i=kaddk i=kaddk i=kaddk i=kad
fnukadfnukadfnukadfnukad
ikB~;eikB~;eikB~;eikB~;elapkyulapkyulapkyulapkyu
dk l=dk l=dk l=dk l=
1
2
3
45
ekU;rk ,oa lEc)rk i= dh Nk;kizfr layXu djsaekU;rk ,oa lEc)rk i= dh Nk;kizfr layXu djsaekU;rk ,oa lEc)rk i= dh Nk;kizfr layXu djsaekU;rk ,oa lEc)rk i= dh Nk;kizfr layXu djsa
11111111---- (i) laLFkku gsrq miyC/k dqy Hkwfe dk {ks=Qy oxZeh esalaLFkku gsrq miyC/k dqy Hkwfe dk {ks=Qy oxZeh esalaLFkku gsrq miyC/k dqy Hkwfe dk {ks=Qy oxZeh esalaLFkku gsrq miyC/k dqy Hkwfe dk {ks=Qy oxZeh esa --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
(ii) vkosfnr ikB~;e gsrq miyC/k dqy Hkwfe dk {ks=Qy oxZ ehVj esavkosfnr ikB~;e gsrq miyC/k dqy Hkwfe dk {ks=Qy oxZ ehVj esavkosfnr ikB~;e gsrq miyC/k dqy Hkwfe dk {ks=Qy oxZ ehVj esavkosfnr ikB~;e gsrq miyC/k dqy Hkwfe dk {ks=Qy oxZ ehVj esa ----------------------------------------------------------------------------------------------------------------------------
(iii) D;k HkwfeD;k HkwfeD;k HkwfeD;k Hkwfe laLFkku ds uke gLrkarfjr vkSj iathdr gS] ;fn gka rks vfHkys[k layXu djsalaLFkku ds uke gLrkarfjr vkSj iathdr gS] ;fn gka rks vfHkys[k layXu djsalaLFkku ds uke gLrkarfjr vkSj iathdr gS] ;fn gka rks vfHkys[k layXu djsalaLFkku ds uke gLrkarfjr vkSj iathdr gS] ;fn gka rks vfHkys[k layXu djsa
(iv) orZeku esa Hkwfe fdlds uke lsorZeku esa Hkwfe fdlds uke lsorZeku esa Hkwfe fdlds uke lsorZeku esa Hkwfe fdlds uke ls iathdriathd`riathdriathd`r gSgSgSgS --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
LokfeRo dk jktLo vfHkys[k layXu djsa12121212---- (i) laLFkku gsrq miyC/k dqy fufeZr Hkou dk {ks=Qy oxZ eh esalaLFkku gsrq miyC/k dqy fufeZr Hkou dk {ks=Qy oxZ eh esalaLFkku gsrq miyC/k dqy fufeZr Hkou dk {ks=Qy oxZ eh esalaLFkku gsrq miyC/k dqy fufeZr Hkou dk {ks=Qy oxZ eh esa -------------------------------------------------------------------------------------------------------------------------------------------------------- (ii) vkosfnrvkosfnrvkosfnrvkosfnr
ikB~;e gsrq miyC/k dqy fufeZr Hkou dk {ks=Qy oxZ ehVj esaikB~;e gsrq miyC/k dqy fufeZr Hkou dk {ks=Qy oxZ ehVj esaikB~;e gsrq miyC/k dqy fufeZr Hkou dk {ks=Qy oxZ ehVj esaikB~;e gsrq miyC/k dqy fufeZr Hkou dk {ks=Qy oxZ ehVj esa ------------------------------------------------------------------------
13131313---- fufeZr Hkou dk uD'kkfufeZr Hkou dk uD'kkfufeZr Hkou dk uD'kkfufeZr Hkou dk uD'kk rFkkrFkkrFkkrFkk l{ke vf/kdkjh }kjk vuqeksnl{ke vf/kdkjh }kjk vuqeksnl{ke vf/kdkjh }kjk vuqeksnl{ke vf/kdkjh }kjk vuqeksnu dh fLFkfru dh fLFkfru dh fLFkfru dh fLFkfr------------------------------------------------------------------------------------------------------------------------------------------------ nksuksa dhnksuksa dhnksuksa dhnksuksa dh
Nk;kizfr layXu djsaNk;kizfr layXu djsaNk;kizfr layXu djsaNk;kizfr layXu djsa
14141414---- Hkou ds iw.kZ gksus ds laca/k esa LFkkuh; fudk; ds vuqeksnu i= tkjh gksus dh fLFkfrHkou ds iw.kZ gksus ds laca/k esa LFkkuh; fudk; ds vuqeksnu i= tkjh gksus dh fLFkfrHkou ds iw.kZ gksus ds laca/k esa LFkkuh; fudk; ds vuqeksnu i= tkjh gksus dh fLFkfrHkou ds iw.kZ gksus ds laca/k esa LFkkuh; fudk; ds vuqeksnu i= tkjh gksus dh fLFkfr --------------------------------------------------------------------------------------------------------------------------------------------
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8/7/2019 Application Form Hindi2
4/18
g0 vkosnd4
Nk;kizfr layXu djsa Nk;kizfr layXu djsa Nk;kizfr layXu djsa Nk;kizfr layXu djsa
15151515---- Hkou dks f'k{k.k dk;ZHkou dks f'k{k.k dk;ZHkou dks f'k{k.k dk;ZHkou dks f'k{k.k dk;Z gsrq iz;ksx esa yk, tkus gsrq D;k LFkkuh; fudk; }kjk vuqefr iznku dh tk pqdhgsrq iz;ksx esa yk, tkus gsrq D;k LFkkuh; fudk; }kjk vuqefr iznku dh tk pqdhgsrq iz;ksx esa yk, tkus gsrq D;k LFkkuh; fudk; }kjk vuqefr iznku dh tk pqdhgsrq iz;ksx esa yk, tkus gsrq D;k LFkkuh; fudk; }kjk vuqefr iznku dh tk pqdh
gSgSgSgS------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------ Nk;kizfr layXu djsa Nk;kizfr layXu djsa Nk;kizfr layXu djsa Nk;kizfr layXu djsa
16161616---- D;k Hkwfe ,oa Hkou leLr fooknksa ls eqDr gSaD;k Hkwfe ,oa Hkou leLr fooknksa ls eqDr gSaD;k Hkwfe ,oa Hkou leLr fooknksa ls eqDr gSaD;k Hkwfe ,oa Hkou leLr fooknksa ls eqDr gSa----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
11117777---- miyC/kmiyC/kmiyC/kmiyC/k HkkSfrdHkkSfrdHkkSfrdHkkSfrd lalk/kuksalalk/kuksalalk/kuksalalk/kuksa dk fooj.kdk fooj.kdk fooj.kdk fooj.k---- fooj.kfooj.kfooj.kfooj.k d{kd{kd{kd{k
uauauaua0000
yEckbZyEckbZyEckbZyEckbZ
eheheheh---- esaesaesaesa
pkSM+kbZpkSM+kbZpkSM+kbZpkSM+kbZ
eheheheh---- esaesaesaesa
dqydqydqydqy {ks={ks={ks={ks=QyQyQyQy
oxZoxZoxZoxZ eh0 esaeh0 esaeh0 esaeh0 esa
1111 2222 3333 4444 5555 6666
1 f'k{k.k d{k
f'k{k.k d{k
2 cgqmn~ns'kh; gky
3 iqLrdky; ,oa okpuky;4 bZVh@vkbZlhVh ds fy, lalk/ku dsUnz
5 euksfoKku lalk/ku dsUnz
6 dyk rFkk f'kYi lalk/ku dsUnz
7 LokLF; vkSkj 'kkjhfjd f'k{kk lalk/ku dsUnz
8 foKku vkSj xf.kr lalk/ku dsUnz
9 izkpk;Z d{k
10 dk;kyZ; d{k
11 LVkQ :e
12 LVksj :e
LVksj :e
13 ckfydkvksa dk dkeu :e
14 dSUVhu
15 vfrfFk d{k
16 ckyd@ckfydk gsrq vyx&vyx izlk/ku lqfo/kk
17 okgu [kM+k djus dk LFkku
18 yku] ckxokuh ds f;kdykiksa vkfn ds fy, [kqyk
LFkku
19 LVksj :e
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8/7/2019 Application Form Hindi2
5/18
g0 vkosnd5
20 [ksy dk eSnku
11118888---- deZpkfj;ksa gsrq vkokl O;oLFkk gS vFkok ughadeZpkfj;ksa gsrq vkokl O;oLFkk gS vFkok ughadeZpkfj;ksa gsrq vkokl O;oLFkk gS vFkok ughadeZpkfj;ksa gsrq vkokl O;oLFkk gS vFkok ugha ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
--------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
11119999---- (i) Hkou dk fuekZ.k us'kuy fcfYMax dksM&2005 ds vuqlkj fd;k x;k gS vFkok ughaHkou dk fuekZ.k us'kuy fcfYMax dksM&2005 ds vuqlkj fd;k x;k gS vFkok ughaHkou dk fuekZ.k us'kuy fcfYMax dksM&2005 ds vuqlkj fd;k x;k gS vFkok ughaHkou dk fuekZ.k us'kuy fcfYMax dksM&2005 ds vuqlkj fd;k x;k gS vFkok ugha------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
;fn gka rks l{ke vf/kdkjh }kjk fuxZr izek.k i= layXu djsaA
(ii) D;k laLFkku es vfXu lqj{kk lEcfU/kr fu;eksa dk ikyu gks jgk gS vFkok ughaD;k laLFkku es vfXu lqj{kk lEcfU/kr fu;eksa dk ikyu gks jgk gS vFkok ughaD;k laLFkku es vfXu lqj{kk lEcfU/kr fu;eksa dk ikyu gks jgk gS vFkok ughaD;k laLFkku es vfXu lqj{kk lEcfU/kr fu;eksa dk ikyu gks jgk gS vFkok ugha ;fn gka rks;fn gka rks;fn gka rks;fn gka rks
fooj.k nsfooj.k nsfooj.k nsfooj.k nsaaaa --------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ---
20202020---- laLFkku esa Hkou o QuhZpkj fof'k"V vko';drkvksa okys O;fDr;ksa fodykaxksa ds vuqdwylaLFkku esa Hkou o QuhZpkj fof'k"V vko';drkvksa okys O;fDr;ksa fodykaxksa ds vuqdwylaLFkku esa Hkou o QuhZpkj fof'k"V vko';drkvksa okys O;fDr;ksa fodykaxksa ds vuqdwylaLFkku esa Hkou o QuhZpkj fof'k"V vko';drkvksa okys O;fDr;ksa fodykaxksa ds vuqdwy gS vFkok ughagS vFkok ughagS vFkok ughagS vFkok ugha
;fn gksa rks;fn gksa rks;fn gksa rks;fn gksa rks fooj.k nsafooj.k nsafooj.k nsafooj.k nsa------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
22221111---- Nk=@Nk=kvksaNk=@Nk=kvksaNk=@Nk=kvksaNk=@Nk=kvksa gsrqgsrqgsrqgsrq Nk=koklNk=koklNk=koklNk=kokl dk fooj.kdk fooj.kdk fooj.kdk fooj.k
Nk=Nk=Nk=Nk= Nk=kvksaNk=kvksaNk=kvksaNk=kvksa
dejksa dh la[;k
dejksa dh eki & oxZ eh0 esa
izlk/kuksa dh la[;k
Nk=kokl dk dqy {ks=Qy
22222222---- Nk=@Nk=kvksaNk=@Nk=kvksaNk=@Nk=kvksaNk=@Nk=kvksa ,oa LVkQ gsrq miyC/k,oa LVkQ gsrq miyC/k,oa LVkQ gsrq miyC/k,oa LVkQ gsrq miyC/k dk"Bksidj.kdk"Bksidj.kdk"Bksidj.kdk"Bksidj.k dk fooj.kdk fooj.kdk fooj.kdk fooj.k
LVkQLVkQLVkQLVkQ gsrqgsrqgsrqgsrq Nk=@Nk=kvksaNk=@Nk=kvksaNk=@Nk=kvksaNk=@Nk=kvksa gsrgsrqgsrgsrq
dqflZ;ksa dh la[;k
estksa dh la[;k
22223333---- laLFkku esa okaNuh; lqfo/kklaLFkku esa okaNuh; lqfo/kklaLFkku esa okaNuh; lqfo/kklaLFkku esa okaNuh; lqfo/kkvksavksavksavksa dk fooj.kdk fooj.kdk fooj.kdk fooj.k
---- fooj.kfooj.kfooj.kfooj.k miyC/krkmiyC/krkmiyC/krkmiyC/krk
1 lHkh ekSle esa iagqp ekxZ
2 'kq) is;ty
3 tujsVj
4 izkpk;Z vkokl
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8/7/2019 Application Form Hindi2
6/18
g0 vkosnd6
5 QksVkdkih e'khu
6 ladk; lnL;ksa ds vkokl dh O;oLFkk
7 vfrfFk d{k
8 laLFkku ds pkjksa vksj ckm.Mhoky
22224444---- (i)---- vkosfnr ikB~;e gsrqvkosfnr ikB~;e gsrqvkosfnr ikB~;e gsrqvkosfnr ikB~;e gsrq dk;Zjr 'kS{kf.kddk;Zjr 'kS{kf.kddk;Zjr 'kS{kf.kddk;Zjr 'kS{kf.kd ladk; lnL;ksa dk fooj.kladk; lnL;ksa dk fooj.kladk; lnL;ksa dk fooj.kladk; lnL;ksa dk fooj.k- uke inuke osru e 'kSf{kd
;ksX;rk
vuqHko fu;qfDr
frfFk
iw.kZdkfyd@
va'kdkfyd
(ii) dk;Zjr f'k{k.ksRrj deZpkfj;ksa dk fooj.kdk;Zjr f'k{k.ksRrj deZpkfj;ksa dk fooj.kdk;Zjr f'k{k.ksRrj deZpkfj;ksa dk fooj.kdk;Zjr f'k{k.ksRrj deZpkfj;ksa dk fooj.k
- uke inuke osru e 'kSf{kd
;ksX;rk
vuqHko fu;qfDr
frfFk
iw.kZdkfyd@
va'kdkfyd
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22225555---- v&v&v&v& vkosfnr ikB~;e ds vfrfjDr laLFkkvkosfnr ikB~;e ds vfrfjDr laLFkkvkosfnr ikB~;e ds vfrfjDr laLFkkvkosfnr ikB~;e ds vfrfjDr laLFkkuuuu esa pyk;s tk jgsesa pyk;s tk jgsesa pyk;s tk jgsesa pyk;s tk jgs f'k{kd izf'k{k.k dk;Zef'k{kd izf'k{k.k dk;Zef'k{kd izf'k{k.k dk;Zef'k{kd izf'k{k.k dk;Ze ikB~;e dkikB~;e dkikB~;e dkikB~;e dkuke vafdr djsauke vafdr djsauke vafdr djsauke vafdr djsa---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- dsdsdsds lEcU/k esa &lEcU/k esa &lEcU/k esa &lEcU/k esa &
(i) 'kS{kf.kd'kS{kf.kd'kS{kf.kd'kS{kf.kd ladk; lnL;ksa dk fooj.kladk; lnL;ksa dk fooj.kladk; lnL;ksa dk fooj.kladk; lnL;ksa dk fooj.k
- uke inuke osru e 'kSf{kd
;ksX;rk
vuqHko fu;qfDr
frfFk
iw.kZdkfyd@
va'kdkfyd
(ii) dk;Zjr f'k{k.ksRrj deZpkfj;ksa dk fooj.kdk;Zjr f'k{k.ksRrj deZpkfj;ksa dk fooj.kdk;Zjr f'k{k.ksRrj deZpkfj;ksa dk fooj.kdk;Zjr f'k{k.ksRrj deZpkfj;ksa dk fooj.k
- uke inuke osru e 'kSf{kd
;ksX;rk
vuqHko fu;qfDr
frfFk
iw.kZdkfyd@
va'kdkfyd
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22226666---- c& vkosfnr ikB~;e ds vfrfjDr laLFkkc& vkosfnr ikB~;e ds vfrfjDr laLFkkc& vkosfnr ikB~;e ds vfrfjDr laLFkkc& vkosfnr ikB~;e ds vfrfjDr laLFkkuuuu esa pyk;s tk jgs f'k{kd izf'k{k.k dk;Ze ikB~;e dkesa pyk;s tk jgs f'k{kd izf'k{k.k dk;Ze ikB~;e dkesa pyk;s tk jgs f'k{kd izf'k{k.k dk;Ze ikB~;e dkesa pyk;s tk jgs f'k{kd izf'k{k.k dk;Ze ikB~;e dkuke vafdr djsauke vafdr djsauke vafdr djsauke vafdr djsa---------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------- ds lEcU/k esa & ds lEcU/k esa & ds lEcU/k esa & ds lEcU/k esa &
(i) 'kS{kf.kd ladk; lnL;ksa dk fooj.k'kS{kf.kd ladk; lnL;ksa dk fooj.k'kS{kf.kd ladk; lnL;ksa dk fooj.k'kS{kf.kd ladk; lnL;ksa dk fooj.k
- uke inuke osru e 'kSf{kd
;ksX;rk
vuqHko fu;qfDr
frfFk
iw.kZdkfyd@
va'kdkfyd
(ii) dk;Zjr f'k{k.ksRrj deZpkfj;ksa dk fooj.kdk;Zjr f'k{k.ksRrj deZpkfj;ksa dk fooj.kdk;Zjr f'k{k.ksRrj deZpkfj;ksa dk fooj.kdk;Zjr f'k{k.ksRrj deZpkfj;ksa dk fooj.k
- uke inuke osru e 'kSf{kd
;ksX;rk
vuqHko fu;qfDr
frfFk
iw.kZdkfyd@
va'kdkfyd
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22227777---- v& f'k{kd izf'k{k.k dk;Ze ds vfrfjDrv& f'k{kd izf'k{k.k dk;Ze ds vfrfjDrv& f'k{kd izf'k{k.k dk;Ze ds vfrfjDrv& f'k{kd izf'k{k.k dk;Ze ds vfrfjDr laLFkklaLFkklaLFkklaLFkkuuuu esa pyk;s tk jgsesa pyk;s tk jgsesa pyk;s tk jgsesa pyk;s tk jgs vU; 'kSf{kdvU; 'kSf{kdvU; 'kSf{kdvU; 'kSf{kd ikB~;eikB~;eikB~;eikB~;eksa dsksa dsksa dsksa ds lEcU/k esalEcU/k esalEcU/k esalEcU/k esa
&&&& ikB~;e dk ukeikB~;e dk ukeikB~;e dk ukeikB~;e dk uke --------------------------------------------------------------------------------------------------------------------------------(i) 'kS{kf.kd ladk; lnL;ksa dk fooj.k'kS{kf.kd ladk; lnL;ksa dk fooj.k'kS{kf.kd ladk; lnL;ksa dk fooj.k'kS{kf.kd ladk; lnL;ksa dk fooj.k
- uke inuke osru e 'kSf{kd
;ksX;rk
vuqHko fu;qfDr
frfFk
iw.kZdkfyd@
va'kdkfyd
(ii) dk;Zjr f'k{k.ksdk;Zjr f'k{k.ksdk;Zjr f'k{k.ksdk;Zjr f'k{k.ksRrj deZpkfj;ksa dk fooj.kRrj deZpkfj;ksa dk fooj.kRrj deZpkfj;ksa dk fooj.kRrj deZpkfj;ksa dk fooj.k
- uke inuke osru e 'kSf{kd
;ksX;rk
vuqHko fu;qfDr
frfFk
iw.kZdkfyd@
va'kdkfyd
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22228888---- c& f'k{kd izf'k{k.k dk;Ze ds vfrfjDr laLFkku ec& f'k{kd izf'k{k.k dk;Ze ds vfrfjDr laLFkku ec& f'k{kd izf'k{k.k dk;Ze ds vfrfjDr laLFkku ec& f'k{kd izf'k{k.k dk;Ze ds vfrfjDr laLFkku esa pyk;s tk jgs vU; 'kSf{kd ikB~;eksa ds lEcU/k esasa pyk;s tk jgs vU; 'kSf{kd ikB~;eksa ds lEcU/k esasa pyk;s tk jgs vU; 'kSf{kd ikB~;eksa ds lEcU/k esasa pyk;s tk jgs vU; 'kSf{kd ikB~;eksa ds lEcU/k esa
& ikB~;e dk uke& ikB~;e dk uke& ikB~;e dk uke& ikB~;e dk uke --------------------------------------------------------------------------------------------------------------------------------(i) 'kS{kf.kd ladk; lnL;ksa dk fooj.k'kS{kf.kd ladk; lnL;ksa dk fooj.k'kS{kf.kd ladk; lnL;ksa dk fooj.k'kS{kf.kd ladk; lnL;ksa dk fooj.k
- uke inuke osru e 'kSf{kd
;ksX;rk
vuqHko fu;qfDr
frfFk
iw.kZdkfyd@
va'kdkfyd
(ii) dk;Zjr f'k{k.ksRrj deZpkfj;ksa dk fooj.kdk;Zjr f'k{k.ksRrj deZpkfj;ksa dk fooj.kdk;Zjr f'k{k.ksRrj deZpkfj;ksa dk fooj.kdk;Zjr f'k{k.ksRrj deZpkfj;ksa dk fooj.k
- uke inuke osru e 'kSf{kd
;ksX;rk
vuqHko fu;qfDr
frfFk
iw.kZdkfyd@
va'kdkfyd
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22229999---- iqLrdky;k/;{kiqLrdky;k/;{kiqLrdky;k/;{kiqLrdky;k/;{k lfgr iqLrdky; ds leLr LVkQlfgr iqLrdky; ds leLr LVkQlfgr iqLrdky; ds leLr LVkQlfgr iqLrdky; ds leLr LVkQ dk fooj.kdk fooj.kdk fooj.kdk fooj.k
- uke inuke osru e 'kSf{kd;ksX;rk
vuqHko fu;qfDrfrfFk
iw.kZdkfyd@va'kdkfyd
30303030---- [ksy[ksy[ksy[ksy midj.kksamidj.kksamidj.kksamidj.kksa dhdhdhdh fooj.kfooj.kfooj.kfooj.k ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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31313131---- ifjpkyuifjpkyuifjpkyuifjpkyu dks"k dks"k dks"k dks"k Operational Funds dh miyC/krkdh miyC/krkdh miyC/krkdh miyC/krk
- cSad dk uke [kkrk la[;k uxn ,QMhvkj dqy /kujkf'k
33332222---- dEI;wVjdEI;wVjdEI;wVjdEI;wVj lqfo/kkvksa dk fooj.klqfo/kkvksa dk fooj.klqfo/kkvksa dk fooj.klqfo/kkvksa dk fooj.k- fooj.k miyC/krk
1 dEI;qVj dh la[;k
2 gkMZos;j dk fooj.k
3 ysu@oSu dh la[;k
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4 yhxy lkWVos;j
5 fizaVj
6 baVjusV
33333333---- iqLrdkyh; lqfo/kkvksaiqLrdkyh; lqfo/kkvksaiqLrdkyh; lqfo/kkvksaiqLrdkyh; lqfo/kkvksa dk fooj.kdk fooj.kdk fooj.kdk fooj.k
- fooj.k miyC/krk@la[;k1 iqLrdsa] tuZy vkSj if=dk,a
2 cPpksa dh iqLrdsa
3 JO;&n'; lkexzh&Vhoh] vks,pih] MhohMh Iys;j
4 JO;&n'; lgk;d lkexzh&ohfM;ks JO;Vsi] LykbMsa] fQYesa
5 v/;kiu lgk;d lkexzh pkVZ] rLohjsa
6 fodklkRed ewY;kadu iM+rky lwfp;ka vkSj ekiu lk/ku
34343434---- v/;kiu&vf/kxe lkexzh vkSj lgk;d lkexzh dk fooj.kv/;kiu&vf/kxe lkexzh vkSj lgk;d lkexzh dk fooj.kv/;kiu&vf/kxe lkexzh vkSj lgk;d lkexzh dk fooj.kv/;kiu&vf/kxe lkexzh vkSj lgk;d lkexzh dk fooj.k ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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35353535---- laxhr ok|;a=ksalaxhr ok|;a=ksalaxhr ok|;a=ksalaxhr ok|;a=ksa dk fooj.kdk fooj.kdk fooj.kdk fooj.k ----------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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33336666---- foRrh; lalk/ku& vk;foRrh; lalk/ku& vk;foRrh; lalk/ku& vk;foRrh; lalk/ku& vk; ,oa,oa,oa,oa O;;O;;O;;O;; dk fooj.kdk fooj.kdk fooj.kdk fooj.k ------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------------
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jftLVMZ pkVZM ,dkm.VsUV }kjk izekf.kr izfr layXu djsa
33337777---- laLFkklaLFkklaLFkklaLFkkuuuu ds lehi izkFkfed fo|ky; tgka izf'k{k.kkfFkZ;ks a dk iz;ksxkRed izf'k{k.k djk;k tk ldrk gSAds lehi izkFkfed fo|ky; tgka izf'k{k.kkfFkZ;ks a dk iz;ksxkRed izf'k{k.k djk;k tk ldrk gSAds lehi izkFkfed fo|ky; tgka izf'k{k.kkfFkZ;ks a dk iz;ksxkRed izf'k{k.k djk;k tk ldrk gSAds lehi izkFkfed fo|ky; tgka izf'k{k.kkfFkZ;ks a dk iz;ksxkRed izf'k{k.k djk;k tk ldrk gSA
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----lalalala---- izkFkfed fo|ky; dk ukeizkFkfed fo|ky; dk ukeizkFkfed fo|ky; dk ukeizkFkfed fo|ky; dk uke CykdCykdCykdCykd dk ukedk ukedk ukedk uke laLFkk ls nwjhlaLFkk ls nwjhlaLFkk ls nwjhlaLFkk ls nwjh
33338888---- jk"Vh; v/;kid f'k{kk ifj"kn ls ch0Vh0lh0@,u0Vh0Vh0 ikB~;e dh ekU;rk izkfIr gsrq izsf"kr vkosnujk"Vh; v/;kid f'k{kk ifj"kn ls ch0Vh0lh0@,u0Vh0Vh0 ikB~;e dh ekU;rk izkfIr gsrq izsf"kr vkosnujk"Vh; v/;kid f'k{kk ifj"kn ls ch0Vh0lh0@,u0Vh0Vh0 ikB~;e dh ekU;rk izkfIr gsrq izsf"kr vkosnujk"Vh; v/;kid f'k{kk ifj"kn ls ch0Vh0lh0@,u0Vh0Vh0 ikB~;e dh ekU;rk izkfIr gsrq izsf"kr vkosnu
i=i=i=i= lHkh layXudksalHkh layXudksalHkh layXudksalHkh layXudksa lfgrlfgrlfgrlfgr layXulayXulayXulayXu djsaAdjsaAdjsaAdjsaA
33339999---- vkosnd laLFkk }kjk fu/kkZfjrvkosnd laLFkk }kjk fu/kkZfjrvkosnd laLFkk }kjk fu/kkZfjrvkosnd laLFkk }kjk fu/kkZfjr layXulayXulayXulayXu izk:iizk:iizk:iizk:i ij :0 100@& ds ukWu twfM'k;y LVkEi isij ij 'kiFkij :0 100@& ds ukWu twfM'k;y LVkEi isij ij 'kiFkij :0 100@& ds ukWu twfM'k;y LVkEi isij ij 'kiFkij :0 100@& ds ukWu twfM'k;y LVkEi isij ij 'kiFk
i= izLrqri= izLrqri= izLrqri= izLrqr djsaAdjsaAdjsaAdjsaA
44440000---- laLFkku }kjk izfr izf'k{k.kkFkhZ ls fy;s tkus okys izLrkfor 'kqYdksa dk enokj fooj.klaLFkku }kjk izfr izf'k{k.kkFkhZ ls fy;s tkus okys izLrkfor 'kqYdksa dk enokj fooj.klaLFkku }kjk izfr izf'k{k.kkFkhZ ls fy;s tkus okys izLrkfor 'kqYdksa dk enokj fooj.klaLFkku }kjk izfr izf'k{k.kkFkhZ ls fy;s tkus okys izLrkfor 'kqYdksa dk enokj fooj.k &&&&
1111---- f'k{k.k 'kqYdf'k{k.k 'kqYdf'k{k.k 'kqYdf'k{k.k 'kqYd
2222---- fodkl 'kqYdfodkl 'kqYdfodkl 'kqYdfodkl 'kqYd
3333---- --------------------------------------------------------------------------------------------------------
4444---- --------------------------------------------------------------------------------------------------------------------
5555---- --------------------------------------------------------------------------------------------------------------------
6666---- ----------------------------------------------------------------------------------------------------
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41414141---- izLrkfor 'kqYd dk O;; laLFkku }kjk fdl izdkj ls fd;k tk;sxkizLrkfor 'kqYd dk O;; laLFkku }kjk fdl izdkj ls fd;k tk;sxkizLrkfor 'kqYd dk O;; laLFkku }kjk fdl izdkj ls fd;k tk;sxkizLrkfor 'kqYd dk O;; laLFkku }kjk fdl izdkj ls fd;k tk;sxkA O;; dh enksa dks vkSfpR; lfgrA O;; dh enksa dks vkSfpR; lfgrA O;; dh enksa dks vkSfpR; lfgrA O;; dh enksa dks vkSfpR; lfgr
iznf'kZr fd;k tk,Aiznf'kZr fd;k tk,Aiznf'kZr fd;k tk,Aiznf'kZr fd;k tk,A
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eSa ?kks"k.kk djrh@djrk gWawfd vkosnu i= esa fn;s x;s fooj.kksa dks eSaus i fy;k gSA
blesa fn;s x;s leLr fooj.k esjh tkudkjh esa iw.kZr% lR; gSA lEc)rk gsrq fujh{k.k ds le; ifjlj
dh ohfM;ksxzkQh dh O;oLFkk laLFkk }kjk djk nh tk;sxhA
vkosnd ds gLrk{kjinuke
eqgj
irk
lEidZ uEcj &
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(Format of affidavit to be given on Rs. 100 Non-Judicial stamp paper duly attested by Oath
Commissioner / Notary Public)
AFFIDAVIT
I, .......................... Son of ,,,,,,,,,,,,,,,,,,,,,,,,,,,,, and .......................... of (name of theCollege) .aged about ............. years, resident of ..........................................................................
am the authorized signatory of the application form seeking grant of affiliation for conducting a
course in Teacher Education titled as Elementary Teacher Education titled ...............................
with intake of ...........................................
2. That I have read and understood the contents of the application and the same are true
and correct on the basis on my personal knowledge and on the basis of records of the
institution.
3. That the ........................................................................... college is in possession of land as
per the following description: -
3.1 Total Area (in Sq. Mtr.)
3.2 Address:
Village
Post Office
Teh. & Distt.
State
Bounded by
North:
South:
East:
West:
Registered in the office of: ...................................on ..........................................
4. That out of the above mentioned land, the institution is in possession of minimum 2500
Sq. mts. (two thousand five hundred square meters) of exclusive well demarcated land for the
initial intake of fifty students out of which 1500 sq mts (one thousand five hundred square
meters) shall be the built up area and the remaining space for lawns, playfields etc.
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5. That the land is exclusively meant for running the education institution. The entire land
earmarked for the purpose of running the desired course is duly registered in the name of the
Institution through the Society/Trust running the Institution.
6. In connection with the application for grant of affiliation of BTC Course with 50 Intake
the applicant hereby undertake to comply with the following: -
(i) That the Management has seen, studied and understood the norms and conditions
stipulated by the NCTE for grant of recognition and those of State Government for
grant of affiliation to the programme proposed. If the State Government or a body
or a person authorized by it, at the time of inspection, finds any deviation from the
prescribed norms/standards, we will accept any unfavorable decision resulting
thereof.
(ii) That infrastructural, instructional and other facilities will be provided as per the
NCTE/State Government norms, standards and guidelines prescribed from time to
time.
(iii) That admission of students, satisfying the eligibility conditions will be made as per
the State Government policy.
(iv) That there shall be reservation of seats for SC/ST/OBC/handicapped etc. as per
the Policy of State Government.
(v) That admission to the Course will be made only after the affiliation is granted by
the State Government.(vi) That the supporting and other staff will be appointed as per the guidelines of the
State Government.
(vii) That the tuition and other fees will be charged at rates prescribed by the State
Government and shall not charged donations, capitation fees, etc. from the
students.
(viii) That the academic and other staff of the institution shall be paid such salary as
may be prescribed by the State Government from time to time.
(ix) That the Management shall discharge the statutory obligations relating to provident
fund, pension, gratuity etc. in respect of all its employees.
(x) That the Management will make adequate funds available for providing satisfactory
facilities and for proper programme implementation.
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(xi) That the accounts of the institution will be properly maintained and audited
annually by the audit authorities or a Chartered Accountant, and will be open for
inspection.
(xii) That the Management will strictly follow all conditions and norms prescribed by
NCTE / State Government from time to time, conduct the programme in all
earnestness, and submit itself to inspection by the State Government or a body or
a person authorized by it as required at any time.
(xiii) That the institution will provide a conducive atmosphere for academic and extra
curricular activities and will prevent any mental and physical harassment of
teachers and trainees.
(xiv) In the event of non-compliance by the ..................................... Society/Trust with
regard to the norms and standards and any other condition laid down/prescribed
by the State Government from time to time. The State Government or a body or a
person authorized by it will be free to inspect at any time and take all necessary
measures for effecting withdrawal of its recognition for permission, without
consideration of any other issue, and that all liabilities arising out of such a
withdrawal would solely be that of the Institution/Management.
(xv) That the Management will not cause or allow discontinuation of the Course in any
year or for any batch, and that where compelled, it will seek the concurrence of
NCTE/State Government for discontinuation on the completion of the year/batch.(xvi) That the course for which the affiliation is applied for is solely on self-financed
basis and we shall not claim any financial grant or assistance from the State
Government.
I do hereby swear that my declaration under Paras (i) to (xvi) are true and correct and
that it conceals nothing and that no part of this is false. In case the contents of affidavit are
found to be incorrect or false, I shall be liable for action under the relevant provision of the
Indian penal code and other relevant laws
(Signature of the authorized designated
authority giving undertaking along with
his/her official and position office seal)
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Place
Date
vkosnu i= ds lkFk layXu djvkosnu i= ds lkFk layXu djvkosnu i= ds lkFk layXu djvkosnu i= ds lkFk layXu djus okys izi=us okys izi=us okys izi=us okys izi=
1- vkosnu i= rhu izfr;ksa esa iw.kZr% Hkjs gksus pkfg,A
2- :0 100@& ds ukWu twfM'k;y LVkEi isij ij 'kiFk i= A
3- Hkwfe ls lEcfU/kr LokfeRo dk vfHkys[kA
4- ekU;rk vkosnu ds le; tek fd;s x;s izkHkwr ,oa lqjf{kr dks"k ds ,QMhvkj dh Nk;kizfrA
5- lkslkbVh@VLV ds uohuhdj.k dh Nk;kizfrA
6- laLFkk@VLV ds ckbZ ykWt ,oa izcU/k lfefr dh lwph dh Nk;kizfrA
7- jk"Vh; v/;kid f'k{kk ifj"kn }kjk fuxZr ekU;rk izi= dh Nk;k izfrA
8- fufeZr Hkou ds uD'ks dh l{ke vf/kdkjh }kjk vuqeksfnr izfr
9- ekU;rk vkns'k esa mYyf[kr izfrcU/kksa dh iwfrZ dh v|ru fLFkfr
10- laLFkk esa f'k{kd izf'k{k.k ikB~;e ds vfrfjDr lapkfyr ikB~;eksa dk fooj.k
11- fofHkUu lapkfyr ikB~;eksa esa dk;Zjr f'k{kd@f'k{k.ksRrj deZpkfj;ksa dh lwphA
12- fufeZr Hkou us'kuy fcfYMax dksM 2005 ds vuqlkj gS vFkok ugha dk l{ke vf/kdkjh }kjk fuxZr izek.k
i=A
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