24
Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; cjtp Kfhikahsu; 70>B.Mu;. tpN[tu;j;jd khtj;ij nfhOk;G 10. ____________________________________________________________ cupikf;Nfhupf;if ,y :- Njrpa Msilahs ml;il ,y. :- Njjp :- mf;u`hu fhg;GWjp ed;ikfis kPsspj; mf;u`hu fhg;GWjp ed;ikfis kPsspj; mf;u`hu fhg;GWjp ed;ikfis kPsspj; mf;u`hu fhg;GWjp ed;ikfis kPsspj;jy; jy; jy; jy; cq;fshy; mDg;gpitf;fg;gl;l cupikf;Nfhupf;if tpz;zg;gk; njhlu;ghf. cq;fs; cupikf;Nfhupf;if njhlu;ghf mtrpakhd eltbf;iffis vLg;gjw;F vk;ik ,ayr;nra;tjw;nfd ,f;fbjk; fpilf;fg;ngw;w NjjpapypUe;J Kg;gJ (30) ehl;fspDs; gpd;tUk; Mtzq;fisr; rku;g;gpf;fTk;. NkNyAs;s jftiy ePq;fs; vkf;F mDg;gpitf;Fk;NghJ xt;nthU gpd;dpizg;gpYk; NkNy Fwpg;gplg;gl;l cq;fs; Njrpa Msilahs ml;il ,yf;fj;ijAk; cupikf;Nfhupf;if ,yf;fj;ijAk; $wTk;> my;yJ ,f;fbjj;ij ,izf;fTk;. nrk;ikahd Mtzq;fisr; rku;g;gpg;gjd;%yk; cq;fs; cupikf;Nfhupf;ifiar; nrYj;Jtjpyhd jhkjj;ij jtpu;f;fKbAk;. ____________________________________________________________ njhiyNgrp ,y. : 0114-873901-5 kpd;dQ;ry; : [email protected] ,izak; : www.nitf.lk njhiyefy; : 0112-333893

Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; Claim form (tamil).pdf · Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; cjtp Kfhikahsu; 70>B.Mu;. tpN[tu;j;jd khtj;ij nfhOk;G 10. _____ cupikf;Nfhupf;if

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Page 1: Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; Claim form (tamil).pdf · Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; cjtp Kfhikahsu; 70>B.Mu;. tpN[tu;j;jd khtj;ij nfhOk;G 10. _____ cupikf;Nfhupf;if

Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;

cjtp Kfhikahsu;

70>B.Mu;. tpN[tu;j;jd khtj;ij

nfhOk;G 10.

____________________________________________________________

cupikf;Nfhupf;if ,y :-

Njrpa Msilahs ml;il ,y. :-

Njjp :-

mf;u`hu fhg;GWjp ed;ikfis kPsspj;mf;u`hu fhg;GWjp ed;ikfis kPsspj;mf;u`hu fhg;GWjp ed;ikfis kPsspj;mf;u`hu fhg;GWjp ed;ikfis kPsspj;jy; jy; jy; jy;

cq;fshy; mDg;gpitf;fg;gl;l cupikf;Nfhupf;if tpz;zg;gk; njhlu;ghf.

cq;fs; cupikf;Nfhupf;if njhlu;ghf mtrpakhd eltbf;iffis vLg;gjw;F

vk;ik ,ayr;nra;tjw;nfd ,f;fbjk; fpilf;fg;ngw;w NjjpapypUe;J Kg;gJ (30)

ehl;fspDs; gpd;tUk; Mtzq;fisr; rku;g;gpf;fTk;. NkNyAs;s jftiy

ePq;fs; vkf;F mDg;gpitf;Fk;NghJ xt;nthU gpd;dpizg;gpYk; NkNy

Fwpg;gplg;gl;l cq;fs; Njrpa Msilahs ml;il ,yf;fj;ijAk;

cupikf;Nfhupf;if ,yf;fj;ijAk; $wTk;> my;yJ ,f;fbjj;ij ,izf;fTk;.

nrk;ikahd Mtzq;fisr; rku;g;gpg;gjd;%yk; cq;fs; cupikf;Nfhupf;ifiar;

nrYj;Jtjpyhd jhkjj;ij jtpu;f;fKbAk;.

____________________________________________________________

njhiyNgrp ,y. : 0114-873901-5

kpd;dQ;ry; : [email protected] ,izak; : www.nitf.lk

njhiyefy; : 0112-333893

Page 2: Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; Claim form (tamil).pdf · Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; cjtp Kfhikahsu; 70>B.Mu;. tpN[tu;j;jd khtj;ij nfhOk;G 10. _____ cupikf;Nfhupf;if

2

Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;

cjtp Kfhikahsu;

70>B.Mu;. tpN[tu;j;jd khtj;ij

nfhOk;G 10.

____________________________________________________________

cupikf;Nfhupf;if ,y :-

Njrpa Msilahs ml;il ,y. :-

Njjp :-

mf;umf;umf;umf;u`hu fhg;GWjp ed;ikfis kPsspj;jy; `hu fhg;GWjp ed;ikfis kPsspj;jy; `hu fhg;GWjp ed;ikfis kPsspj;jy; `hu fhg;GWjp ed;ikfis kPsspj;jy;

cq;fshy; mDg;gpitf;fg;gl;l ………………. Me; Njjpa cupikf;Nfhupf;if

tpz;zg;gk; njhlu;ghf.

mf;u`hu ed;ikfisg; ngw;Wf;nfhs;tjw;F cq;fshy; rku;g;gpf;fg;gl;l

tpz;zg;gk; gpd;tUk; fhuzq;fSf;fhf epuhfupf;fg;gl;Ls;snjdf; ftiyAld;

njuptpf;fpd;Nwhk;.

cjtp KfhikahsUf;fhf (mf;u`hu)

Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;

____________________________________________________________

njhiyNgrp ,y. : 0114-873901-5

kpd;dQ;ry; : [email protected] ,izak; : www.nitf.lk

njhiyefy; : 0112-333893

Page 3: Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; Claim form (tamil).pdf · Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; cjtp Kfhikahsu; 70>B.Mu;. tpN[tu;j;jd khtj;ij nfhOk;G 10. _____ cupikf;Nfhupf;if

3

Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;

kUj;Jt kw;Wk; kUj;Jtkidf; fl;lzq;fSf;fhd cupikf;Nfhupf;if

tpz;zg;gk; (mf;u`hu)

tpz;zg;gfhuupd; Njrpa Msilahs ml;il ,yf;fk; (epow;glg;gpujpnahd;iw ,izf;fTk;)

1. tpz;zg;gfhuu;gw;wpa jfty;:-

1.1 KOg;ngau; (rpq;fsj;jpy;): tz./jpU./jpUkjp/nry;tp ………………….

KjnyOj;Jf;fSld; ngau; (Mq;fpyj;jpy;): tz./jpU./jpUkjp/nry;tp

………………………….

1.2 jdpg;gl;l Kftup (rpq;fsj;jpy;): …………………………………………..

jdpg;gl;l Kftup (Mq;fpyj;jpy;): …………………………………………..

1.3 gpwe;j Njjp: ………………………………………………………………….

1.4 njhiyNgrp ,y: mYtyfKiw: …………….. jdpg;gl;lJ: ………….

2. ePq;fs; njhopYf;fku;j;jg;gl;Ls;s epWtdj;jpd; ngaUk; KftupAk;:

……………………………………………………………………………………….

……………………………………………………………………………………….

3. tho;f;ifj;Jizgw;wpa jfty;:

3.1 Njrpa Msilahs ml;il ,yf;fk;:

3.2 ngau;:- …………………………………………………………………………..

3.3 Ntiyj;jyj;jpd; ngaUk; KftupAk;: ………………………………………

Page 4: Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; Claim form (tamil).pdf · Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; cjtp Kfhikahsu; 70>B.Mu;. tpN[tu;j;jd khtj;ij nfhOk;G 10. _____ cupikf;Nfhupf;if

4

4. vtUf;Ff; fhg;GWjp ed;ikfs; cupikNfhug;gLfpd;wd: cq;fSf;F

my;yJ cq;fs; tho;f;ifj;Jizf;F

my;yntdpy;> Fwpg;gPLnra;ag;gl;l $l;by;

(�)vdf; Fwpg;gplTk;.

4.1 gps;isfSf;fhf � jha;f;fhf � jfg;gDf;fhf �

4.2.1 mtuJ/mtsJ ngau;: ……………………………………………………...

4.2.2 mtu; my;yJ mts; gpwe;j Njjp: …………………………………………

5. tq;fpf; fzf;Ffs; njhlu;ghd jfty;:

5.1 tq;fpf;fzf;fpy; Njhd;Wfpd;wthwhf cq;fs; ngau;: …………………..

5.2 fzf;fpy.:

5.3 tq;fpapd; ngau;: ………………………. tq;fpf; fpis: …………………

6. ,t;Tupikf;Nfhupf;if tpz;zg;gk; njhlu;ghd nryTfs; rdhjpgjp

epjpaj;jplkpUe;J my;yJ NtNwNjDk; epjpaj;jplkpUe;J Ntz;lg;gl;bUg;gpd;

my;yJ mjdhy; nrYj;jg;gl;bUg;gpd;> tpguq;fisj; juTk;:

6.1 epWtdj;jpd; ngaUk; KftupAk;: ………………………………………….

6.2 kPsspf;fg;gl;l njhif:…………………………………….

6.3 nrYj;jg;gl;l njhif: …………………………………………

cupikf;Nfhupf;if ,y./Fwpg;gPl;by.

7. tpz;zg;gfhuupd; ntspg;gLj;Jif:

* NkNyAs;s jfty; cz;ikahdJk; rupahdJk; vd ,j;jhy;

rhd;Wg;gLj;Jfpd;Nwd; vd;gJld;> NkNy 6Mk; ge;jpf;fika>

vdJ tho;f;ifj;JizNah my;yJ ehNdh NtNwNjDk;

Page 5: Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; Claim form (tamil).pdf · Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; cjtp Kfhikahsu; 70>B.Mu;. tpN[tu;j;jd khtj;ij nfhOk;G 10. _____ cupikf;Nfhupf;if

5

epWtdj;Jf;F VNjDk; cupikf;Nfhupf;ifiar; nra;atpy;iy

my;yJ NtNwNjDk; Kiwapy; VNjDk; cupikf;Nfhupf;ifiar;

nra;atpy;iy.

Njjp: ………………………. ………………………..

tpz;zg;gfhuupd; ifnahg;gk;

8. epWtdj; jiytupd; rhd;wpjo;:

Nkw;gb jpU./jpUkjp ………………………………. vd;gtupd; fhg;GWjp

cupikf;Nfhupf;if> mtrpakhd eltbf;iff;fhf ,j;Jld;

mDg;gpitf;fg;gLfpd;wJ. NkNyAs;s jfty;> mtuJ/mtsJ Ms;rhu;

Nfhg;gpd;gb cz;ikahdJk; rupahdJk; vdr; rhd;Wg;gLj;Jfpd;Nwd;.

fhg;GWjpnra;ag;gl;ltu; ve;j kUj;Jtkidapy; rpfpr;ir ngw;whNuh me;j

kUj;Jtkidia mtu;/mts; tpl;LePq;fpa khjj;Jf;F Neu;Kw;Nghe;j

khjj;Jf;fhd cjTnjhiffs; mwtplg;gl;Ls;sdntd;gJld;> FtPd;];

tPjpf; fpisapYs;s kf;fs; tq;fpapy; Ngzg;gl;l Njrpa fhg;GWjp

ek;gpf;ifg;nghWg;G epjpaj;jpd; fzf;fpyf;fk; 033-2-001-2-2467951 vd;gjw;F

tuTitf;fg;gl;LKs;sd.

ifnahg;gk; -

ngau; -

gjtpg;ngau; -

(mYtyfKiwahd ,yr;rpid fl;lhakhdJ)

9. Nehahspapd; jdpj;Jt kUj;Jtupdhy; (MNyhrf itj;jpau;) mWit

kUj;Jtupdhy; epug;gg;gLjy; Ntz;Lk; (Nehahsp jdpahu;

kUj;Jtkidnahd;wpy; cs;NehahspahftpUe;jpUg;gpd; kl;LNk

epug;gg;gLjy; Ntz;Lk;).

Page 6: Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; Claim form (tamil).pdf · Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; cjtp Kfhikahsu; 70>B.Mu;. tpN[tu;j;jd khtj;ij nfhOk;G 10. _____ cupikf;Nfhupf;if

6

tpz;zg;gj;ij epug;Gtjw;fhd mwpTWj;jy;fs;tpz;zg;gj;ij epug;Gtjw;fhd mwpTWj;jy;fs;tpz;zg;gj;ij epug;Gtjw;fhd mwpTWj;jy;fs;tpz;zg;gj;ij epug;Gtjw;fhd mwpTWj;jy;fs;

,t;tpz;zg;gk;> ,Ujak; njhlu;ghd rj;jpurpfpr;irfs;> kfg;NgWfs; vd;gd

njhlu;ghf kUj;Jtkidnahd;wpy; thl;by; jq;fpapUf;Fk; xU Nehahsp

njhlu;gpYk;> kw;Wk; Gw;WNehahspfs;> rpWePuf Nehahspfs; vd;Nghu;

njhlu;gpYk;> %f;Ff;fz;zhbfSf;Fkhd cupikf;Nfhupf;iffSf;F

kl;LNkahFk;. (gfpuq;f mYtynuhUtupd; kuzj;jpd; my;yJ tpgj;jpd;

tplaj;jpy;> mj;jifa rk;gtk; vOj;jpy; mwptpf;fg;gLjy; Ntz;Lk;. mj;jifa

cupikf;Nfhupf;iff;fhfj; jdpNtwhd tpz;zg;gnkhd;W toq;fg;gLk;).

1. cupikf;Nfhupf;if tpz;zg;gkhdJ> kUj;Jtkidia tpl;LePq;fpa

gpd;du; 90 ehl;fspDs; Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpaj;Jf;Fr;

rku;g;gpf;fg;gLjy; Ntz;Lk;.

2. Mtzq;fspd; vy;yh epow;glg;gpujpfSk;> rku;g;gpf;fg;gLk;NghJ> epWtdj;

jiytupdhy; ifnahg;gkplg;gLjy; Ntz;Lk;.

• gpwg;Gr; rhd;wpjo;

• tpthfr; rhd;wpjo;

• Neha;epUza ml;il.

3. fztd;> kidtp Mfpa ,UtUk; gfpuq;f

Nritahsu;fshftpUf;Fkplj;J> cupikf;Nfhupf;if tpz;zg;gk;

NehahspapdhNyNa mDg;gpitf;fg;gLjy; Ntz;Lk;. Xu; cWg;gpdupd;

gps;isfs; njhlu;gpyhd cupikf;Nfhupf;iffs; xU

tho;f;ifj;Jizapdhy; kl;LNk mDg;gpitf;fg;gLjy; Ntz;Lk;.

4. jq;fpthOeu;fs; njhlu;gpyhd cupikf;Nfhupf;iffis

mDg;gpitf;Fk;NghJ> gpd;tUk; Mtzq;fspd; epow;glg;gpujpfs;

mj;jifa tpz;zg;gj;Jld; Nru;j;jDg;gg;gLjy; Ntz;Lk;:-

Page 7: Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; Claim form (tamil).pdf · Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; cjtp Kfhikahsu; 70>B.Mu;. tpN[tu;j;jd khtj;ij nfhOk;G 10. _____ cupikf;Nfhupf;if

7

4.1 tho;f;ifj;Jizf;fhf> tpthfr; rhd;wpjopd;

epow;glg;gpujpnahd;W@

4.2 gps;isfSf;fhf> gpwg;Gr;rhd;wpjopd; epow;glg;gpujpnahd;W@

(gps;isahdJ 21 taJf;Ff; Fiwe;jtuhfTk; jpUkzQ;

nra;ahjtuhfTk; Ntiyaw;wtuhfTk; ,Uj;jy; Ntz;Lk;).

fhg;GWjp nra;ag;gl;ltu; jpUkzQ;nra;ahjtuhftpUg;gpd;> fhg;GWjp

nra;ag;gl;ltupd; jha;f;fhfTk; jfg;gDf;fhfTk; (jha;/jfg;gd; 70

taJf;Ff; Fiwe;jtu;fshf ,Uj;jy; Ntz;Lk;):-

• fhg;GWjp nra;ag;gl;ltupd; gpwg;Gr; rhd;wpjopd; gpujpnahd;W@

• jhapd;/jfg;gdpd; gpwg;Gr; rhd;wpjopdJ my;yJ Njrpa

Msilahs ml;ilapdJ epow;glg;gpujpfs;@

• fhg;GWjpnra;ag;gl;ltu; tpthfQ;nra;ahjtnud;w me;j];Jj;

njhlu;ghf epWtdj; jiytuplkpUe;jhd fbjnkhd;W@

• fhg;GWjpnra;ag;gl;ltupd; jhAk; jfg;gDk; mtupy;

jq;fptho;Nthuhf cs;sdnud;Wk;> mtu;fs;

tUkhdnkjidAk; ciof;ftpy;iynad;Wk; $Wfpd;wJk;>

gpuNjr nrayhsupdhy; fPnohg;gkplg;gl;lJk;> ,iaghd

,lg;gug;gpd; fpuhkNrit mYtyupdhyhdJkhd

rhd;wpjnohd;W.

5. fhg;GWjpnra;ag;gl;ltu;> cupikf;Nfhupf;iff;fhf Ntz;LNfhs;tpLf;fg;gLk;

fUkk; njhlu;ghf NtNwNjDk; epWtdj;jplkpUe;J fhg;GWjp

ed;ikfisg; ngw;wpUe;J> ,g;NghJ ,e;epWtdj;jplkpUe;Jk; ed;ikfisg;

ngWtjw;F cl;fUJkplj;J> toq;fg;gl;l vy;yhr;

rpl;ilfspdJk;/gw;Wr;rPl;Lf;fspdJk; rhd;Wg;gLj;jg;gl;l

epow;glg;gpujpfSld;Nru;j;J> nrYj;jg;gl;l njhifiar; Rl;bf;fhl;b>

mj;jifa NtNwNjDk; epWtdj;jplkpUe;jhd fbjnkhd;iw mtu;

rku;g;gpj;jy; Ntz;Lk;.

Page 8: Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; Claim form (tamil).pdf · Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; cjtp Kfhikahsu; 70>B.Mu;. tpN[tu;j;jd khtj;ij nfhOk;G 10. _____ cupikf;Nfhupf;if

8

6. cupaKiwapy; epug;gg;gl;l tpz;zg;gj;Jld;Nru;j;J gpd;tUk; Mtzq;fs;

rku;g;gpf;fg;glNtz;Lk;:-

6.1 kUj;Jtkidapy; jq;fpapUj;jy;/,Ujak; njhlu;ghd

rj;jpurpfpr;ir/Gw;WNeha; Kjypatw;wpd; tplaj;jpy;-

• Neha;epUza ml;ilapd; %yg;gpujp my;yJ

rhd;Wg;gLj;jg;gl;l gpujp@ (ngaUk;> kUj;Jtkidapy;

mDkjpf;fg;gl;l NjjpAk; kUj;JtkidapypUe;J mDg;gp

itf;fg;gl;l NjjpAk;> rpfpr;ir vt;itj;jpauplkpUe;J

ngwg;gl;lNjh mt;itj;jpaupd; ifnahg;gKk;

,yr;rpidAk;)@

• jdpahu; kUj;Jtkidnahd;wpd; tplaj;jpy;> gzitg;Gg;

gw;Wr;rPl;Lf;fspd; %yg;gpujpfSk;> nrYj;jg;gl;l

nfhLg;gdTfspd; gw;Wr;rPl;Lf;fSk;> ,Wjpr;rpl;ilAk;@

• ngau;fSk; NjjpfSk; khw;wg;gl;l %yg;gpujpfs; my;yJ ngau;fSk; NjjpfSk; khw;wg;gl;l %yg;gpujpfs; my;yJ ngau;fSk; NjjpfSk; khw;wg;gl;l %yg;gpujpfs; my;yJ ngau;fSk; NjjpfSk; khw;wg;gl;l %yg;gpujpfs; my;yJ

epow;glg;gpujpfs; Vw;Wf;nfhs;sg;glyhfhJ@epow;glg;gpujpfs; Vw;Wf;nfhs;sg;glyhfhJ@epow;glg;gpujpfs; Vw;Wf;nfhs;sg;glyhfhJ@epow;glg;gpujpfs; Vw;Wf;nfhs;sg;glyhfhJ@

• xU jdpahu; kUj;Jtkidapy; ngwg;gl;l rpfpr;irfspd;

tplaj;jpy;> nryTfs; njhlu;ghd vy;yhr; rpl;ilfSk;

tFjpg;gLj;jg;gLjy; Ntz;Lnkd;gJld;> tpguq;fSld;

jdpNtwhff; fhz;gpf;fg;gLjYk; Ntz;Lk;. lhf;lupd;

nryTfisr; Rl;bf;fhl;Lk;NghJ> jdpj;Jt kUj;JtupdJk;

Vida lhf;lu;fspdJk; nryTfs; jdpNtwhff;

fhl;lg;gLjy; Ntz;Lk;.

6.2 kfg;NgWfs; (,U jlitfSf;F kl;Lk; tiuaWf;fg;gl;ld)

• NkNyAs;s Mtzq;fSld;Nru;j;J Nkyjpfkhf>

gps;isapd; gpwg;Gr; rhd;wpjopdJ rhd;Wg;gLj;jg;gl;l

Page 9: Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; Claim form (tamil).pdf · Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; cjtp Kfhikahsu; 70>B.Mu;. tpN[tu;j;jd khtj;ij nfhOk;G 10. _____ cupikf;Nfhupf;if

9

epow;glg;gpujpnahd;W my;yJ mtuJ gpwg;Gg; gw;wpa

tpguq;fisf; nfhz;Ls;s Mtzj;jpd; rhd;Wg;gLj;jg;gl;l

gpujpnahd;W rku;g;gpf;fg;gLjy; Ntz;Lk;.

murhq;f kUj;Jtkidnahd;wpdhy; Neha;epUza ml;il

toq;fg;glhtpbd;> fUj;jupg;G mwpf;if gw;wpa

rhd;Wg;gLj;jg;gl;l gpujpnahd;W.

(kUj;Jtkidf;F mDkjpf;fg;gl;l NjjpAk;

kUj;JtkidapypUe;J mDg;gpitf;fg;gl;l NjjpAk;

Rl;bf;fhl;lg;gLjy; Ntz;Lk;).

6.3 %f;Ff; fz;zhbfSf;fhf (%yg;gpujpfs; rku;g;gpf;fg;gLjy;

Ntz;Lk;).

• fz;fspd; gupNrhjid jdpg;gl;l lhf;lu; xUtupdhy;

epiwNtw;wg;gl;bUg;gpd;> jdpg;gl;lKiwapy; MNyhrid

ngw;wikf;fhd fl;lzf;nfhLg;gdTf;fhd vz;gpg;ghfg;

gw;Wr;rPl;Lk; kUe;Jg; gl;NlhiyAk; (lhf;lupd;

ifnahg;gj;JlDk; lhf;lupd; mYtyfKiwahd

,yr;rpidAlDk;).

• fz;fspd; gupNrhjid murhq;f kUj;Jtkidnahd;wpy;

epiwNtw;wg;gl;bUg;gpd;> kUe;Jg; gl;Nlhiy (lhf;lupd;

ifnahg;gj;JlDk; mYtyfKiwahd ,yr;rpidAlDk;).

• %f;Ff; fz;zhbiaf; nfhs;tdT nra;jik njhlu;ghd

nfhLg;gdTg; gw;Wr;rPl;L> tpw;gid epiyaj;jpd;

mYtyfKiwahd ,yr;rpidAld; “gzQ;nrYj;jg;gl;lJ”

vd;w Gwf;Fwpg;igf; nfhz;bUj;jy; Ntz;Lk;. (3

Mz;LfSf;nfhUjlit fhg;GWjp nra;ag;gl;ltUf;F

kl;LNk nrYj;jg;gLk;).

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10

Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;

gbt ,y. 42

vdJ ,yf;fk;

…………………….

……………………

…………………….

…………………….

…………………….

cq;fs; ,yf;fk; Njjp

IauPu;/mk;kzp>

gfpuq;f Nritahsu;fspd; jdpg;gl;l tpgj;Jf;fSk; ,aw;if kuzq;fSk; gfpuq;f Nritahsu;fspd; jdpg;gl;l tpgj;Jf;fSk; ,aw;if kuzq;fSk; gfpuq;f Nritahsu;fspd; jdpg;gl;l tpgj;Jf;fSk; ,aw;if kuzq;fSk; gfpuq;f Nritahsu;fspd; jdpg;gl;l tpgj;Jf;fSk; ,aw;if kuzq;fSk;

njhlu;ghd fhg;GWjp NkTifnjhlu;ghd fhg;GWjp NkTifnjhlu;ghd fhg;GWjp NkTifnjhlu;ghd fhg;GWjp NkTif ---- 2010201020102010

jpU.jpU.jpU.jpU./jpUkjp (,we;jtu;) Nfhg;gpy.jpUkjp (,we;jtu;) Nfhg;gpy.jpUkjp (,we;jtu;) Nfhg;gpy.jpUkjp (,we;jtu;) Nfhg;gpy.

*kWnkhkWnkhkWnkhkWnkhopapWf;Fk;NghJ> NkNyAs;s Nfhg;gpyf;fj;ijf; Fwpg;gpLjy; opapWf;Fk;NghJ> NkNyAs;s Nfhg;gpyf;fj;ijf; Fwpg;gpLjy; opapWf;Fk;NghJ> NkNyAs;s Nfhg;gpyf;fj;ijf; Fwpg;gpLjy; opapWf;Fk;NghJ> NkNyAs;s Nfhg;gpyf;fj;ijf; Fwpg;gpLjy;

mj;jpahtrpakhdJ.mj;jpahtrpakhdJ.mj;jpahtrpakhdJ.mj;jpahtrpakhdJ.

NkNyAs;s cupikf;Nfhupf;if njhlu;ghf:

cq;fs; cupikf;Nfhupf;if tpz;zg;gk; ftdj;Jl;nfhs;sg;gl;L> 12/2005Mk;

,yf;f murhq;f epUthfr; Rw;wwpf;ifapd;gb> (�) vd;w Fwpapdhy; fPNo

Rl;bf;fhl;lg;gl;l fhuzj;Jf;fhf epuhfupf;fg;gl;lJ.

01. cupikf;Nfhupf;if tpz;zg;gk;> Njitg;gl;l fhyj;jpDs; (90

ehl;fspDs;) vkf;Fr; rku;;g;gpf;fg;gltpy;iy.

Page 11: Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; Claim form (tamil).pdf · Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; cjtp Kfhikahsu; 70>B.Mu;. tpN[tu;j;jd khtj;ij nfhOk;G 10. _____ cupikf;Nfhupf;if

11

02. fhg;GWjpnra;ag;gl;ltupd; Njrpa Msilahs ml;il

,yf;fkpy;yhky;> tpz;zg;gk; njhlu;ghf Nkw;nfhz;L eltbf;if

vLf;fKbahJ.

03. ,we;jtu; mf;u`hu jpl;lj;jpdhy; Nktg;gl;ltuy;y. (fhg;GWjp

nra;ag;gl;l xUtuy;y).

04. ,wg;Gf;fhd fhuzk;> 12/2005Mk; ,yf;f m.ep. Rw;wwpf;ifapdhy;

Nktg;gl;bUf;ftpy;iy.

05. Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak; vf;fhyg;gFjpf;fhff;

nfhLg;gdTfisr; nrYj;Jfpd;wNjh mf;fhyg;gFjpf;Ff; fhg;GWjp

nra;ag;gl;ltupd; ,wg;Gj;Njjp Vw;Gilaw;ghyjy;y.

06. gfpuq;f NritahsnuhUtu; ,isg;ghWtjd;Nky;> fhg;GWjp NkTif

fhyq;fle;JNghfpd;wJ.

07. 12/2005 Mk; ,yf;fr; Rw;wwpf;ifapd; epajpfspd;gb> ,we;Js;s

fhg;GWjpnra;g;gl;Nlhu; njhlu;gpyhd el;l<L> ,we;jtupd;

jq;fpthOeu;fSf;F kl;LNk nrYj;jg;gLfpd;wJ@

cq;fs; Nfhg;gpYs;s jftypd;gb jq;fpthOeu;fs; vtUkpy;iy.

KfhikahsUf;fhf>

tplaj;Jf;Fg; nghWg;ghfTs;s mYtyu;>

Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;.

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12

Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;

vdJ ,yf;fk;

…………………….

……………………

…………………….

…………………….

…………………….

cq;fs; ,yf;fk; Njjp

IauPu;/mk;kzp>

gfpuq;f Nritahsu;fspd; jdpg;gl;l tpgj;Jf;fSk; ,aw;if kuzq;fSk; gfpuq;f Nritahsu;fspd; jdpg;gl;l tpgj;Jf;fSk; ,aw;if kuzq;fSk; gfpuq;f Nritahsu;fspd; jdpg;gl;l tpgj;Jf;fSk; ,aw;if kuzq;fSk; gfpuq;f Nritahsu;fspd; jdpg;gl;l tpgj;Jf;fSk; ,aw;if kuzq;fSk;

njhlu;ghd fhg;GWjp NkTifnjhlu;ghd fhg;GWjp NkTifnjhlu;ghd fhg;GWjp NkTifnjhlu;ghd fhg;GWjp NkTif ---- 2010201020102010

jpU.jpU.jpU.jpU./jpUkjp (,we;jtu;) Nfhg;gpy.jpUkjp (,we;jtu;) Nfhg;gpy.jpUkjp (,we;jtu;) Nfhg;gpy.jpUkjp (,we;jtu;) Nfhg;gpy.

vy;yhf; fbjj;njhlu;GfspYk; Nvy;yhf; fbjj;njhlu;GfspYk; Nvy;yhf; fbjj;njhlu;GfspYk; Nvy;yhf; fbjj;njhlu;GfspYk; Nkw;Fwpg;gpl;l kw;Fwpg;gpl;l kw;Fwpg;gpl;l kw;Fwpg;gpl;l

Nfhg;gpyf;fj;ijf; $Wjy; mj;jpahtrpakhdJNfhg;gpyf;fj;ijf; $Wjy; mj;jpahtrpakhdJNfhg;gpyf;fj;ijf; $Wjy; mj;jpahtrpakhdJNfhg;gpyf;fj;ijf; $Wjy; mj;jpahtrpakhdJ

12/2005Mk; ,yf;f murhq;f epUthfr; Rw;wwpf;ifapd; epajpfspd;gb cq;fshy;

epiwNtw;wg;glNtz;ba Njitg;ghLfs;> (�) vd;w Fwpapdhy;

Rl;bf;fhl;lg;gLfpd;wd.

1. ,iaghd tpz;zg;gj;jpYs;s cupikf;Nfhupf;ifiag; ngWtjw;fhd

cupik njhlu;ghd cWjpg;gLj;Jiff; $w;W.

2. mYtyupd; gpwg;Gr;rhd;wpjopd; rhd;Wg;gLj;jg;gl;l epow;glg;gpujp

,y;yhik.

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13

3. tpz;zg;gfhuupd; gpwg;Gr;rhd;wpjopd; rhd;Wg;gLj;jg;gl;l epow;glg;gpujp

,y;yhik.

4. ,wg;Gr;rhd;wpjopd; rhd;Wg;gLj;jg;gl;l epow;glg;gpujp ,y;yhik.

5. tpthfr;rhd;wpjopd; rhd;Wg;gLj;jg;gl;l epow;glg;gpujp ,y;yhik.

6. jpUkzkhfhjtnud;w me;j];ij cWjpg;gLj;jp epWtdj;

jiytupdhy; toq;fg;gl;l rhd;wpjo; ,y;yhik.

7. gps;isfspd; gpwg;Gr; rhd;wpjo;fspd; rhd;Wg;gLj;jg;gl;l epow;glg;gpujp

,y;yhik.

8. kuzj;Jf;F Neu;Kw;Nghe;j khjj;jpditAk;> epWtdj; jiytupdhy;

rhd;Wg;gLj;jg;gl;litAkhd rk;gs tpguq;fs; ,y;yhik.

9. 2008Mk; Mz;bypUe;J fhg;GWjpg;gj;jpuj;jpd; kPjhd jtizg;

gzq;fspd; nfhLg;gditr; rhd;Wg;gLj;Jfpd;w fzf;fhsupd; rhd;wpjo;

,y;yhik. (fhNrhiyapd; tpguq;fs;> fzdpr; rupghu;j;jYf;fhfr;

nrk;ikahd Kiwapy; toq;fg;gLjy; Ntz;Lk;).

10. epWtdj; jiytupdhy; rhd;Wg;gLj;jg;gl;ljha; 2008Mk; Mz;bypUe;J

fhg;GWjp nra;ag;gl;ltu; Ntiy nra;j Ntiyj;jyj;jpd; tpguq;fs;.

11. nghypR “gP” mwpf;if (ePjpkd;wj;Jf;Fg; nghyprhu; ve;j

mwpf;ifapd;%yk; epfo;Tfisr; rku;g;gpj;jdNuh me;j mwpf;if).

12. rhd;Wld;> kuz tprhuizahsupd; tpgukhd mwpf;if.

13. kuz tprhuiz mwpf;if (Rfhjhuk; nghJ-42,y; Fwpj;Jiuf;fg;gl;l

jftYld;).

14. tpz;zg;gfhuupdJk; 18 taJf;F Nkw;gl;l mtupd; gps;isfspdJk;

Njrpa Msilahs ml;ilfspd; epow;glg;gpujpfs;.

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14

15. ,we;Js;s fhg;GWjp nra;ag;gl;ltupd; rhujp cupkj;jpd; epow;glg;gpujp.

16. 18 taJf;Ff;Fiwe;j gps;isfspd; Njrpa Nrkpg;G tq;fpAldhd

(NjNrt) Nrkpg;Gf; fzf;Ffspd; epow;glg;gpujpfSk;>

tpz;zg;gfhuupdJk; 18 taJf;F Nkw;gl;l gps;isfspdJk;

NtNwNjDk; tq;fpf;fzf;fpd; epow;glg;gpujpfSk;. (NjNrt rpWtu;

fzf;Ffs;> mQ;ryff; fpisfspy; jpwf;fg;gl;l

fzf;FfshftpUj;jyhfhnjd;gJld;> Vida fzf;Ffs;

$l;Lf;fzf;FfshftpUj;jYkhfhJ.

17. Vidait ……………………………………………………………………

…………………………………………………………………………………..

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15

cjtp KfhikahsUf;fhf

Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;

Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;

vdJ Fwpg;gPl;byf;fk;

……………………..

…………………….

…………………….

…………………….

cq;fs; Fwpg;gPl;byf;fk; Njjp:

IauPu;/mk;kzp>

jdpg;gl;l tpgj;Jf;fs;jdpg;gl;l tpgj;Jf;fs;jdpg;gl;l tpgj;Jf;fs;jdpg;gl;l tpgj;Jf;fs;/,aw;if kuzq;fs; vd;gtw;Wf;,aw;if kuzq;fs; vd;gtw;Wf;,aw;if kuzq;fs; vd;gtw;Wf;,aw;if kuzq;fs; vd;gtw;Wf;fhd fhg;GWjp NkTiffhd fhg;GWjp NkTiffhd fhg;GWjp NkTiffhd fhg;GWjp NkTif

jpU.jpU.jpU.jpU./jpUkjp jpUkjp jpUkjp jpUkjp …………………………………………………………………………....

cq;fshy; mwptpf;fg;gl;lthW> NkNy ngau;Fwpg;gplg;gl;ltupd; tpgj;J/,aw;if

kuzk; gw;wpa cupikf;Nfhupf;if njhlu;ghf> ,iaghd tpz;zg;gk; ,j;Jld;

mDg;gpitf;fg;gLfpd;wJ.

,t;tpz;zg;gk; ,we;jtupd; rl;lKiwahd jq;fpthOeu;fspdhy; nrk;ikahd

Kiwapy; epug;gg;gLtjw;Fk;> fhg;GWjpnra;ag;gl;ltupd; ,wg;Gj; NjjpapypUe;J 90

ehl;fspDs; ,iaghd Mtzq;fSld; vkJ epWtdj;Jf;F

mDg;gpitf;fg;gLtjw;Fkhd eltbf;iffis vLf;fTk;. cq;fSld; ehk;

njhlu;Gnfhs;tjid ,ayr;nra;tjw;F cq;fs; njhiyNgrp ,yf;fj;ij

(VNjDkpUg;gpd;) $wTk;.

90 ehl;fSf;Fg; gpd;du; mDg;gpitf;fg;gLk; tpz;zg;gq;fs;

epuhfupf;fg;gLnkd;gijf; ftdpf;fTk;.

cjtp Kfhikahsu; (cupikf;Nfhupf;iffs;)

Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;.

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16

kUj;Jtr; rhd;wpjo;kUj;Jtr; rhd;wpjo;kUj;Jtr; rhd;wpjo;kUj;Jtr; rhd;wpjo;

…………………………………………….. gw;wpa tpgj;Jj; njhlu;gpy;.

kWgf;fj;jpy; tptupf;fg;gl;l tpgj;jpy; CWf;Fl;gl;l NkNy

ngau;Fwpg;gplg;gl;ltiu ehd; gupNrhjid nra;Js;Nsndd;Wk;> CWfs;

gpd;tUkhW ,Ue;jdntd;Wk; ,j;jhy; rhd;Wg;gLj;Jfpd;Nwd;:-

1. CWf;Fl;gl;l gFjpfs;: ………………………………………………………….

………………………………………………………………………………………

………………………………………………………………………………………

(iffhnydpd;> tyNjh my;yJ ,lNjh vdf; $Wf)

2. CWfspd; jd;ikAk; msTk;: …………………………………………………

…………………………………………………………………………………….

…………………………………………………………………………………….

3. (m) tpgj;Jf;fhd fhuzj;ij ,ad;wtiu KOikahff; $Wf:

…………………………………………………………………………………….

…………………………………………………………………………………….

(M) Cwpd; Njhw;wk; mjNdhL xj;jpUf;fpd;wjh? …………………………

…………………………………………………………………………………….

…………………………………………………………………………………….

4. jw;Nghija ,ayhikf;Fk; VNjDk; Neha; my;yJ Kd;ida

,ayhikf;Fk; ,ilNa VNjDk; njhlu;Gz;lh? mt;thwhapd; vd;d?

………………………………………………………………………………………

………………………………………………………………………………………

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17

5. rj;jpurpfpr;ir Gupjy; mtrpakhfTs;sjh my;yJ mt;thW

GupaNtz;bajhf tuf;$ba rhj;jpaKz;lh? ………………………………..

……………………………………………………………………………………..

6. (m) Nehahsp> ,g;NghJ my;yJ tpgj;J Vw;gl;l Neuj;jpy;> CWf;Fg;

Gwk;ghd VNjDk; Neha;f;F my;yJ RftPdj;jpw;F cl;gl;ltuhf my;yJ

mjdhy; gPbf;fg;gl;ltuhf ,Uf;fpd;whuh my;yJ ,Ue;Js;shuh?

………………………………………………………………………………………

………………………………………………………………………………………

(M) mt;thwhapd;> mjd jd;ikiaf; $Wf: ………………………………

(,) mjd; Neu;jfTf; fhynty;iyAk; mJ Nehahsp Fzkiltij

ve;j msTf;Fg; ghjpj;Js;sJ vd;gJk;: ……………………

………………………………………………………………………………………

7. ckJ mgpg;gpuhaj;jpy;> CwhdJ epue;ju ,ayhikia tpistpf;Fkh?

………………………………………………………………………………………

………………………………………………………………………………………

8. (m) CWfshdit> Nehahsp mtuJ/mtsJ cau;njhopypy; my;yJ

njhopypy; <LgLtjpypUe;J my;yJ mjw;Ff; ftdQ;nrYj;JtjpypUe;J

mtiu/mtis KOikahf ,ayhjtuhf;Fk; mj;jifadthfTs;sdth?

…………………………………………………….

……………………………………………………………………………………..

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18

(M) CWfshdit> Nehahsp mtuJ/mtsJ cau;njhopypy; my;yJ

njhopypy; <LgLtjpypUe;J my;yJ mjw;Ff; ftdQ;nrYj;JtjpypUe;J

mtiu/mtisg; gFjpastpy; ,ayhjtuhf;Fk;

mj;jifadthfTs;sdth? …………………………………………………….

……………………………………………………………………………………..

9. ,jd;fz; tpgupf;fg;gl;l tpgj;jpd;gpd;du; fhg;GWjp nra;ag;gl;ltiu ePq;fs;

vj;Njjpad;W Kjd;Kjypy; fz;L gupNrhjid nra;jPu;fs;? ……………….

……………………………………………………………………………………..

K.F.:K.F.:K.F.:K.F.:---- jw;fhypf KOikahd ,ayhik (kUj;Jt yPT)jw;fhypf KOikahd ,ayhik (kUj;Jt yPT)jw;fhypf KOikahd ,ayhik (kUj;Jt yPT)jw;fhypf KOikahd ,ayhik (kUj;Jt yPT)

(cupikf;Nfhupf;ifahsu; mtuJ rhjhuz cau;njhopy;> tpahghuk; my;yJ

njhopy; vd;gtw;wpd; VNjDk; ghfj;ij KOikahff; ftdpf;f

,ayhjtuhf;fg;gLk;NghJ vOfpd;wJ).

mtu;/mts;> …………….. Mk; Mz;L ……………….. khjk; ………….. Me;

ehspypUe;J ……….. Mk; Mz;L ……………… khjk; …………… Me;

ehs;tiu> tpgj;Jf; fhuzkhf cwg;gl;l NkNyAs;s CWfspdhy; KOikahf

,ayhikf;Fl;gl;Ls;shnud;Wk;> mtu;/mts; ………………… fhyj;Jf;F

,ayhikf;Fl;gl;ltuhftpUf;Fk; rhj;jpaKz;nld;Wk; NkYk;

rhd;Wg;gLj;Jfpd;Nwd;.

jw;fhypfg; gFjpastpyhd ,ayhik (,yFthd flik)jw;fhypfg; gFjpastpyhd ,ayhik (,yFthd flik)jw;fhypfg; gFjpastpyhd ,ayhik (,yFthd flik)jw;fhypfg; gFjpastpyhd ,ayhik (,yFthd flik)

9.1 mtu;/mts;> …………… Mk; Mz;L …………. khjk; ……….

Me;ehspypUe;J tpgj;Jf; fhuzkhf cwg;gl;l NkNyAs;s CWfspdhy;

gFjpastpy; ,ayhikf;Fl;gl;Ls;shnud;Wk;> njhopy;jUeupdhy;

epug;gg;gl;L cupikf;Nfhupf;ifahsupdhy; rku;g;gpf;fg;gl;l gbtj;jpy;

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Fwpj;Jiuf;fg;gl;lthwhd mtuJ/mtsJ toikahd flikfisg;

Guptjw;F ,ayhJs;shnud;Wk;> ………………. Mk; Mz;L ………..

khjk; …………… Me;ehspypUe;J ……………… fhyj;Jf;F mtu;/mts;

mt;thW ,ayhikf;Fl;gl;ltuhftpUf;Fk; rhj;jpaKz;nld;Wk; NkYk;

rhd;Wg;gLj;Jfpd;Nwd;.

gjtpg;ngau;…………………….

ifnahg;gkplg;gl;lJ: ……………….

Kftup: ……………………………….

………………………………………...

Njjp: ………………….

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tpz;zg;tpz;zg;tpz;zg;tpz;zg;gj;ij epug;Gtjw;fhd mwpTWj;jy;fs;gj;ij epug;Gtjw;fhd mwpTWj;jy;fs;gj;ij epug;Gtjw;fhd mwpTWj;jy;fs;gj;ij epug;Gtjw;fhd mwpTWj;jy;fs;

1. fhg;GWjpnra;ag;gl;ltu; kl;LNk tpgj;Jf; fhg;GWjp NkTifapdhy;

Nktg;gLfpd;whu;.

2. cupikf;Nfhupf;if tpz;zg;gk;> yPtpd; gpd;du; Nritf;F tUifjUk;

NjjpapypUe;J xU khjj;jpDs; Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G

epjpaj;Jf;F mDg;gpitf;fg;gLjy; Ntz;Lk;.

3. cq;fs; Njrpa Msilah ml;il ,yf;fk;> cq;fshy; vkf;F

mDg;gg;gLk; fbjj;njhlu;G xt;nthd;wpYk; njspthfTk;

nrk;ikahdKiwapYk; vOjg;gLjy; Ntz;Lk;.

4. rku;g;gpf;fg;gLk;NghJ Mtzq;fspd; vy;yh epow;glg;gpujpfSk; epWtdj;

jiytupdhy; rhd;Wg;gLj;jg;gLjy; Ntz;Lk;.

5. tpz;zg;gj;Jld; Nru;j;jDg;gg;gLk; kUj;Jtr; rhd;wpjo; cq;fSf;Fr;

rpfpr;iraspj;j itj;jpaupdhy; (lhf;lu;) epug;gg;gLjy; Ntz;Lk;.

6. cupaKiwapy; epug;gg;gl;l tpz;zg;gj;Jld; gpd;tUk; Mtzq;fs;

rku;g;gpf;fg;gLjy; Ntz;Lk;:-

• tpgj;Jf;F Kw;Nghe;j khjj;jpdjha;> fzf;fhsupdhy;

rhd;Wg;gLj;jg;gll rk;gs tpguq;fs;.

• fhg;GWjpg;gj;jpuj;jpd;kPJ tUkjpahd vy;yhj;

jtizg;gzq;fisAk; njhlu;r;rpahff;

nfhLg;gdTnra;jikiar; rhd;Wg;gLj;jp fzf;fhsupdhy;

toq;fg;gl;l rhd;wpjo;.

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Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpak;

vdJ Fwpg;gPl;by:

cq;fs; Fwpg;gPl;by: Njjp:

kUj;Jt kw;Wk; jdpg;gl;l tpgj;Jf; fhg;GWjpj;jpl;lk;kUj;Jt kw;Wk; jdpg;gl;l tpgj;Jf; fhg;GWjpj;jpl;lk;kUj;Jt kw;Wk; jdpg;gl;l tpgj;Jf; fhg;GWjpj;jpl;lk;kUj;Jt kw;Wk; jdpg;gl;l tpgj;Jf; fhg;GWjpj;jpl;lk;

tpgj;Jr; rk;ge;jkhf cupikf;Nfhupf;ifiar; nra;tjw;fhd tpz;zg;gg;gbtk;tpgj;Jr; rk;ge;jkhf cupikf;Nfhupf;ifiar; nra;tjw;fhd tpz;zg;gg;gbtk;tpgj;Jr; rk;ge;jkhf cupikf;Nfhupf;ifiar; nra;tjw;fhd tpz;zg;gg;gbtk;tpgj;Jr; rk;ge;jkhf cupikf;Nfhupf;ifiar; nra;tjw;fhd tpz;zg;gg;gbtk;

,t;tpz;zg;gj;ij epug;GKd;du; ,jNdhL ,izf;fg;gl;Ls;s mwpTWj;jy;fis

thrpf;fTk;.

1. fhg;GWjpnra;ag;gl;ltupd; tptuq;fs;:

1.1 KOg;ngau; (rpq;fsj;jpy;): tz./jpU./jpUkjp/nry;tp ……………….

……………………………………………………………………………….

(Mq;fpyj;jpy;): tz./jpU./jpUkjp/nry;tp

1.2 Njrpa Msilahs ml;il ,yf;fk;

(Njrpa Msilahs ml;ilapd; rhd;Wg;gLj;jg;gl;l epow;glg;gpujpia

,izf;f)

1.3 jdpg;gl;l Kftup: (rpq;fsj;jpy;) …………………………………………

………………………………………………………………………………..

(Mq;fpyj;jpy;)

1.4 gpwe;j Njjp: ………………………………………………………………..

1.5 njhiyNgrp ,y: jdpg;gl;lJ ………… mYtyfKiwahdJ……….

1.6 kpd;dQ;ry; Kftup: ………………………………………………………...

mwptpj;jy; ,y:

Njjp:

cupikf;Nfhupf;if ,y.: Njfheep/

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2. njhopy; tpguq;fs;

2.1 gjtpg;ngau;: ………………………………………………………………

2.2 epWtdj;jpd; ngaUk; KftupAk;: ……………………………………..

3. tpgj;jpd; tpguq;fs;

3.1 tpgj;jpd; Njjp: …………………………………………………………..

3.2 ,lk;: ……………………………………….. Neuk;: ………………….

3.3 tpgj;J Vw;gl;l Kiw: ………………………………………………….

3.4 mJ mwpf;ifaplg;gl;l nghypR epiyak;: …………………………..

4. tpgj;jpd; tpisthf kUj;Jtkidapy; mDkjpf;fg;gl;bUg;gpd; mj;jifa>

tpguq;fs;

4.1 rpfpr;ir ngwg;gl;l kUj;Jtkid:……………………………………….

4.2 kUj;Jtkidapy; jq;fpapUe;j fhyg;gFjp: ……………………………

4.3 lhf;lupdhy;/itj;jpaupdhy; tpje;Jiuf;fg;gl;l yPTf; fhyg;gFjp:

………………………….

4.4 tpgj;jpd; tpisthf cq;fshy; cwg;gl;l CWghL: …………………

5. tq;fpf; fzf;Ffspd; tpguq;fs;.

cq;fs; nrhe;j tq;fpf;fzf;F> Njrpa Nrkpg;G tq;fp> kf;fs; tq;fp>

rk;gj; tq;fp> tu;j;jf tq;fp> nryhd; tq;fp> `w;wd; e\dy; tq;fp>

Ne\d;]; l;u];l; tq;fp> Njrpa mgptpUj;jp tq;fp> ghd; V\pah tq;fp>

n`hq;nfhq; md;l; \q;fha; tq;fp my;yJ ];lhd;Nlu;l; rhu;l;Nlu;l; tq;fp

vd;gtw;wpy; ,Uj;jy; Ntz;Lk;.

5.1 tq;fpf;fzf;fpy; cq;fs; ngaUk; KftupAk;: …………………………

…………………………..……………………………………………………

5.2 fzf;fpy:

5.3 tq;fpapd; ngau;: …………………. fpis: ………..

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23

6. mf;u`huj; jpl;lj;jpypUe;J ePq;fs; ngw;Ws;s ed;ikfspd; tpguq;fs;.

tFjp Njjp ngwg;gl;l njhif

kUj;Jtkidapy; jq;fpapUj;jy;fs;/rj;jpurpfpr;irfs; ………………………

……………………...

Nkw;Fwpg;gplg;gl;l cupikf;Nfhupf;if njhlu;ghf vd;dhy; NkNy

nfhLf;fg;gl;l jfty; cz;ikahdJk; rupahdJk; vdTk;> nrhy;yg;gl;l

cupikf;Nfhupf;if njhlu;ghf Kf;fpakhd vitNaDk; tpguq;fisj;

Njrpa fhg;GWjp ek;gpf;ifg;nghWg;G epjpaj;jplkpUe;J ehd;

kiwf;ftpy;iy vdTk; ,j;jhy; ntspg;gLj;Jfpd;Nwd;.

cupikf;Nfhupf;if njhlu;ghfr; nrYj;jg;gl;l nfhLg;gdit NkNy

05,d;fPo; $wg;gl;l tq;fpf; fzf;Ff;F tuTitf;Fk;gb ,j;jhy;

Ntz;LNfhs; tpLf;fpd;Nwd;.

…………………………….

tpz;zg;gfhuupd; ifnahg;gk;

Njjp:

7. jpizf;fsj;jiytupd; rhd;wpjo;:

Nkw;Fwpg;gplg;gl;l jpU./jpUkjp…………………… vd;gtupd;

fhg;GWjp cupikf;Nfhupf;ifia ,j;jhy; tpje;Jiuj;J mtrpakhd

eltbf;iff;fhf mDg;gpitf;fpd;Nwd;. mtuJ/mtsJ Ms;rhu;

Nfhg;gpd;gb NkNyAs;s tpguq;fs; cz;ikahditAk; rupahditAk;

vdr; rhd;Wg;gLj;Jfpd;Nwd;.

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tpgj;Jf;F Neu;Kw;Nghe;j khjj;Jf;fhd cjTnjhiffs; mwtplg;gl;L

…………….. tq;fpapd; …………… fpisapdhy; toq;fg;gl;l ……………………

Mk; ,yf;ff; fhNrhiy%yk; kf;fs; tq;fp> FtPd;]; tPjpf; fpisapYs;s 033-2-

001-2-2467951Mk; ,yf;ff; fzf;Ff;F tuTitf;fg;gl;ldntd;gJld;> nkhj;jj;

njhifAld; Nru;f;fTk;gl;ld@ mj;Jld; -

(m) mYtyu;> tpgj;Jg; gw;wp ……………… Me; Njjpad;W

,t;tYtyfj;Jf;F mwptpj;Js;shu;.

(M) mYtyu; Ntiyf;F tUifje;j Njjp ……………… MFk;.

(,) lhf;lu;/itj;jpau; ………. Me; NjjpapypUe;J …………….. Me;

Njjptiu yPT tpje;Jiuj;Js;shu;.

ifnahg;gk; :

ngau; :

gjtpg;ngau; :

(mYtyfKiwahd ,yr;rpid

mj;jpahtrpakhdJ)

Njjp: