1- o;fdrxr fooj - jharkhandjharsewa.jharkhand.gov.in/resources/pdf/20/declaration...1- o;fdrxr...

1- O;fDrxr fooj.k

1 vkosnd@vkosfndk dk uke %&

2 LFkkuh; fuoklh izek.k i= ¼la[;k@fnukad½ %&

3 eksckbZy ua0 ¼;fn gks rks½ %&

4 tUe frfFk %& 5 fyax iq:"k¼ ½ efgyk ¼ ½ VªkaltsaMj ¼ ½

6 tkfr* 7 /keZ %&

8 vkoklh; irk %&

¼d½ LFkkbZ irk %& xk¡o@eqgYyk ----------------------------------------------------------------------------------------------- iz[k.M --------------------------------------------Mkd?kj ------------------------------------

Fkkuk -------------------------------------vuqe.My -------------------------------------- ftyk --------------------------------------------------- fiu ------------------------------------- jkT; ---------------------------------

¼[k½ oÙkZeku irk %&xk¡o@eqgYyk ----------------------------------------------------------------------------------------------- iz[k.M ------------------------------------------------Mkd?kj -------------------------------------------

Fkkuk -----------------------------------------vuqe.My -------------------------------------- ftyk ---------------------------------------------------- fiu ----------------------------------- jkT; --------------------------------------------

9 firk dk uke %& 10 firk dh tkfr %&

11 ekrk dk uke %&

12 ifr dk uke %& 13 ifr dh tkfr %&

2- ifjokj** ds lnL;ksa dh fooj.kh

Ø0la0 lnL; dk uke vkosnd ls lEcU/k vkosnu dh frfFk dks mez PAN

¼i½

¼ii½

3- vkosnu o"kZ ds iwoZ dk foÙkh; o"kZ---------------------------esa lHkh lzksrksa ls ikfjokfjd** vk; ¼;Fkk osru] d`f"k] O;olk;] is'kk

vkfn½ %&

¼i½ osru ls dqy vk;

¼ii½ d`f"k ls dqy vk;

¼iii½ O;olk; ls dqy vk;

¼iv½ is'kk ls dqy vk;

¼v½ vU; lzksr ls dqy vk;

dqy vk;

4- lEifÙk dk fooj.k ¼ifjokj** }kjk /kkfjr fofHkUu LFkkuksa@'kgjksa esa vofLFkr Hkwfe vkSj lEifr dks tksM+dj½ %&

eSa ;g ?kks"k.kk djrk@djrh gw¡ fd ;fn Hkfo"; esa esjh mi;qZDr ?kks"k.kk xyr ikbZ tkrh gS rks blds vkyksd esa

eq>s izkIr vkj{k.k ,oa vU; vkuq"kafxd lqfo/kkvksa dks jn~n djrs gq, /kkjk 193 Hkk0n0fo0 ,oa vU; lqlaxr /kkjkvksa ds

rgr esjs fo:) dkuwuh dkjZokbZ dh tk ldrh gSA

* vkosnd dh tkfr ogh ekuh tk,xh tks mlds firk dh tkfr gSA

** bl iz;kstukFkZ ^ifjokj* 'kCn esa vkosnd] mlds ifr@iRuh] mlds ekrk&firk] 18 o"kZ ls de mez ds HkkbZ&cgu rFkk vBkjg o"kZ ls

de mez dh larku lfEefyr gksaxsA

vkosnd@vkosfndk dk gLrk{kj

¼i½ dqqqqqq qq qy d`f"k ;ksX; Hkwfe¼,dM+ esa½

¼ii½ vkoklh; ¶ySV¼dqy {ks=Qy oxZQhV esa½

¼iii½ vf/klwfpr uxjikfydk {ks= esa vkoklh; Hkw&[k.M ¼ dqy {ks=Qy oxZxt esa½

¼iv½ vf/klwfpr uxjikfydk {ks= ls fHkUu {ks=ksa esa vkoklh; Hkw&[k.M ¼ dqy {ks=Qy

oxZxt esa½

1- O;fDrxr fooj.k ¼vo;Ld gsrq½ %&

1 vkosnd@vkosfndk dk uke %&

2 LFkkuh; fuoklh izek.k i= ¼la[;k@fnukad½ %&

3 eksckbZy ua0 ¼;fn gks rks½ %&

4 tUe frfFk %& 5 fyax iq:"k¼ ½ efgyk ¼ ½ VªkaltsaMj ¼ ½

6 tkfr* %& 7 /keZ %&

8 vkoklh; irk %&

¼d½ LFkkbZ irk %& xk¡o@eqgYyk ----------------------------------------------------------------------------------------------- iz[k.M ---------------------------------------------Mkd?kj ---------------------------------------

Fkkuk -----------------------------------------vuqe.My --------------------------------------------- ftyk -------------------------------------------------- fiu ------------------------------------ jkT; -----------------------------

¼[k½ oÙkZeku irk %& xk¡o@eqgYyk ----------------------------------------------------------------------------------------------- iz[k.M ---------------------------------------------Mkd?kj ------------------------------------

Fkkuk -----------------------------------------vuqe.My --------------------------------------------- ftyk -------------------------------------------------- fiu ------------------------------------ jkT; -----------------------------

9 firk dk uke %& 10 firk dh tkfr %&

11 ekrk dk uke %&

2- ifjokj** ds lnL;ksa dh fooj.kh

Ø0la0 lnL; dk uke vkosnd ls lEcU/k vkosnu dh frfFk dks mez PAN

¼i½

¼ii½

3- vkosnu o"kZ ds iwoZ dk foÙkh; o"kZ---------- esa lHkh lzksrksa ls ikfjokfjd** vk; ¼;Fkk osru] d`f"k] O;olk;] is'kk vkfn½ %&

¼i½ osru ls dqy vk;

¼ii½ d`f"k ls dqy vk;

¼iii½ O;olk; ls dqy vk;

¼iv½ is'kk ls dqy vk;

¼v½ vU; lzksr ls dqy vk;

dqy vk;

4- lEifÙk dk fooj.k ¼ifjokj** }kjk /kkfjr fofHkUu LFkkuksa@'kgjksa esa vofLFkr Hkwfe vkSj lEifr dks tksM+dj½ %&

¼i½ dqy d`f"k ;ksX; Hkwfe¼,dM+ esa½

¼ii½ vkoklh; ¶ySV¼dqy {ks=Qy oxZQhV esa½

¼iii½ vf/klwfpr uxjikfydk {ks= esa vkoklh; Hkw&[k.M ¼ dqy {ks=Qy oxZxt esa½

¼iv½ vf/klwfpr uxjikfydk {ks= ls fHkUu {ks=ksa esa vkoklh; Hkw&[k.M ¼ dqy

{ks=Qy oxZxt esa½

eSa ;g Hkh ?kks"k.kk djrk@djrh gw¡ fd ;fn Hkfo"; esa esjh mi;qZDr ?kks"k.kk xyr ikbZ tkrh gS rks blds vkyksd

esa esjs iq=@iq=h dks izkIr vkj{k.k ,oa vU; vkuq"kafxd lqfo/kkvksa dks jn~n djrs gq, /kkjk 193 Hkk0n0fo0 ,oa vU;

lqlaxr /kkjkvksa ds rgr esjs fo:) dkuwuh dkjZokbZ dh tk ldrh gSA

* vkosnd dh tkfr ogh ekuh tk,xh tks mlds firk dh tkfr gSA

** bl iz;kstukFkZ ^ifjokj* 'kCn esa vkosnd] mlds ifr@iRuh] mlds ekrk&firk] 18 o"kZ ls de mez ds HkkbZ&cgu rFkk vBkjg o"kZ ls

de mez dh larku lfEefyr gksaxsA

firk@ekrk dk gLrk{kj

¼firk@ekrk dk uke %&----------------------------------------------------------------------------------½

¼vkosnd ds vo;Ld jgus dh fLFkfr esa½

¼nks izfr;ksa esa½

lsok esa]

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egk'k;]

eq>s ---------------------------------------------------------------------------- ¼laLFkku@dk;kZy; dk uke½ }kjk

fnukad&------------------------------------------- rd vk; ,oa lEifÙk izek.k i= lefiZr djus dk funs'k izkIr gqvk

gSA lacaf/kr laLFkku@dk;kZy; ds ekax i= dh izfr layXu gSA

vuqjks/k gS fd layXu nLrkostksa dk voyksdu dj esjs i{k esa ^rRdky lsok* dk ykHk

izkIr djus gsrq lR;kiu fuxZr djus dh d̀ik dh tk;A

vuq0&;FkksDrA

fo'oklHkktu]

vkosnd dk gLrk{kj

LFkku&--------------------------------- uke& --------------------------------------------------------

fnukad& ----------------------------- firk@ifr dk uke& ------------------------------------------

LFkk;h irk& -----------------------------------------------------------

--------------------------------------------------------------------------------

eksckbZy ua0& ------------------------------------------------------

&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&&

¼dk;kZy; }kjk Hkjk tk;sxk½

Kkikad&------------------------------

fnukad& ---------------------------

dk;kZy; dk uke&-----------------------------------------------------------------------------------------------

>kjlsok iksVZy ij vk; ,oa lEifÙk izek.k i= ds fy, rRdky lsok izkIr djus ds lEcU/k esa

Jh@Jherh@lqJh ------------------------------------------------------------------------- firk@ifr dk uke ----------------------------------------

irk---------------------------------------------------------------------------------------------------------------------- ds }kjk izLrqr vkosnu rFkk

mlds lkFk vuqyXu lacaf/kr laLFkku@dk;kZy; ds ,rn~ lEcU/kh Kkiu@nLrkost dk voyksdu

fd;kA

budk vkosnu dkfeZd] iz'kklfud lq/kkj rFkk jktHkk"k foHkkx] >kj[k.M] jk¡ph ds i=kad&-------

---------------------] fnukad&-------------------------------------- eas of.kZr izko/kku ds vkyksd esa ^rRdky lsok* vUrxZr

izek.k i= fuxZr djus gsrq Lohdkj djus ;ksX; ik;kA

lR;kiu djusokys inkf/kdkjh

dk gLrk{kj ¼eqgj lfgr½

uke&------------------------------------------------

inuke&-------------------------------------------