¼dsoy iwoZ ls iathd`r r`rh; o"kZ ds ijh{kkfFkZ;ksa ds iz;ksx gsrq½
1. Registration No.
2. Roll No.
iath;u la[;k
¼ijh{kkFkhZ }kjk Hkjk tk;½
vuqØekad ¼ijh{kkFkhZ }kjk Hkjk tk;½
tk;½
tk;½
3. Programme/Exam Fee Details : ikB~;Øe@ijh{kk
Øe@ijh{kk 'kqYd fooj.k
a. Challan/Draft /Recpt.No.
b. Challan/Draft/Recpt.Date
c. Fee Amount
D D M M Y Y Y Y
4. Study Centre Name
v/;;u dsUnz dk uke
5. Name of the Programme / Examination
ikB~;Øe@
Øe@ijh{kk dk uke
6. Candidate's Name (Write in English Capital Letters Only)
Lo izekf.kr
QksVks pLik
djsa fiu ls u
yxk;sa
Signature (Pl. Sign. within Box)
gLrk{kj ¼ckDl esa djsa½
vH;FkhZ dk uke ¼fgUnh esa½
7. Candidate's Contact No.
8. Father's/Husband's Name
(Write in English Capital Letters Only)
vH;FkhZ ds firk@ifr dk uke ¼fgUnh esa½
9. Mother's Name
(Write in English Capital Letters Only)
vH;FkhZ dh ekrk dk uke ¼fgUnh esa½
10. Correspondence Address i=kpkj dk irk (Write in English Capital Letters Only)
i=&
i=&O;ogkj dk irk
11. Subject/Paper Name ¼fo"k;@iz'u i= dk uke½
uke½
1
7.
2
8.
3
9.
4
10.
5
11.
6
12.
fnukad
vH;FkhZ ds gLrk{kj@Signature
of the Candidate
gLrk{kj@
v/;;u dsUnz }kjk vxzlkj.k
fo'ofo|ky; iz;ksxkFkZ
vkosnd ijh{kkFkhZ mDr ijh{kk gsrq vgZ gSA gk¡@ughaA ;fn ugha rks dkj.k %
v/;;u dsUnz izHkkjh
kkjh ds gLrk{kj eqgj lfgr

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23.07.2014 - Transport Department

Application form for IMFL Shops for 2014-15