XvKv cvIqvi wWw÷ªweDkb †Kv¤úvwb wj: (wWwcwWwm)

we`y¨r feb, 1, Avãyj MwY †ivW, XvKv-1000

wWwcwWwmÕi AvIZvaxb GjvKvq nvDR Iq¨vwis KvR cwi`k©b, Iq¨vwis I Avw_©s cixÿvKiY Kv‡Ri Rb¨ wKQz msL¨K
ABC jvB‡mÝavix Iq¨vwis cwi`k©b cÖwZôvb ZvwjKvf~³ Ki‡Yi D‡Ï‡k¨ Av‡e`b AvnŸvb Kiv hv‡”Q| AvMÖnx
cÖwZôv‡bi wbR¯^ ‡jUvi †nW c¨v‡W Av‡e`‡bi gva¨‡g Av‡e`b `vwLj Ki‡Z n‡e| Av‡e`bKvixi cQ›` Abyhvqx Av‡e`b
c‡Îi Dcwifv‡M wWwcwWwmÕi wZbwU †Rvb (b_©/mvD_/‡m›Uªvj) Gi g‡a¨ †h †Kvb GKwU †Rv‡bi bvg ¯úóvÿ‡i D‡jøL
Ki‡Z n‡e| GKwU cÖwZôvb †Kej gvÎ 01 (GK) wU †Rv‡b ZvwjKvf~w³i Rb¨B Av‡e`b Ki‡Z cvi‡e| GKvwaK †Rv‡bi
Rb¨ Av‡e`b Ki‡j D³ cÖwZôv‡bi mKj Av‡e`b cÎ evwZj wn‡m‡e MY¨ n‡e|

01| Av‡e`b `vwL‡ji mgq Av‡e`bc‡Îi mv‡_ wb‡¤œ: D‡jøwLZ WKz‡g›U/`wjjvw` Aek¨B `vwLj Ki‡Z n‡e t

K) †jUvi †nW c¨v‡W †Rv‡bi bvg (b_©/mvD_/‡m›Uªvj) D‡jøLc~e©K Av‡e`b|

L) wVKv`vix cÖwZôv‡bi
1) nvjbvMv` ABC jvB‡mÝ Gi d‡UvKwc|
2) nvjbvMv` †UªW jvB‡mÝ Gi d‡UvKwc|
3) VAT ‡iwR‡÷ªk‡bi d‡UvKwc|
4) e-TIN certificate Gi d‡UvKwc|
5) cÖwZôv‡bi ¯^ËvwaKvixi RvZxq cwiPq c‡Îi d‡UvKwc|

M) Iq¨vwis cÖwZôvb KZ©„K g‡bvbxZ mycvifvBRv‡ii nvjbvMv` ABC jvB‡mÝ Gi d‡UvKwc I RvZxq cwiPq
c‡Îi d‡UvKwc|
N) Av‡e`b wd eve` 2,000/- (`yB nvRvi) UvKvi †c-AW©vi/e¨vsK WªvdU|
O) Iq¨vwis Kv‡R e¨eüZ hš¿cvwZi ZvwjKv|

Dc‡i D‡jøwLZ WKz‡g›U/`vwjjvw` Qvov `vwLjK…Z Av‡e`b Am¤ú~Y© wnmv‡e MY¨ K‡i ZvwjKvf‚w³i Rb¨ we‡ewPZ n‡e bv|

02| Av‡e`bmg~n AvMvgx 18/12/2017 ZvwiL ch©šÍ Awdm PjvKvjxb mg‡qi g‡a¨ (mKvj 9:00 NwUKv n‡Z weKvj
5:00 NwUKv ch©šÍ) wWwcwWwmÕi wb‡¤œv³ Awdm/Kvh©vj‡q MÖnY Kiv n‡e t
K) cÖavb cÖ‡K․kjx, L) cÖavb cÖ‡K․kjx
GbIwmGm (DËi), evox bs-73/1, GbIwmGm (‡m›Uªvj),
†ivW bs-5/G, avbgwÛ, XvKv| 33/11 †Kwf mve‡ókb, mvwK©U nvDR †ivW,
KvKivBj Awdmvm© †KvqvU©vi (bxP Zjv), XvKv|

M) cÖavb cÖ‡K․kjx N) ZË¡veavqK cÖ‡K․kjx, wWRvBb mv‡K©j we`y¨r feb,

GbIwmGm (`wÿY), †j‡fj-12
59 (cyivZb 33) 1, Avãyj MwY †ivW, XvKv-1000|
Ckv Luv †ivW, wKjøvicyj, bvivqYMÄ|

O) ZË¡veavqK cÖ‡K․kjx,
Pzw³ I µq mv‡K©j,
we`y¨r feb (4_© Zjv), 1, Avt MwY
†ivW, XvKv - 1000

Page 1 of 14
03| Iq¨vwis cwi`k©b cÖwZôv‡bi KvR m¤úv`‡bi c×wZ, Iq¨vwis cwi`k©b wd, Pzw³i †gqv`/bevqb c×wZ I mvaviY
kZ©vejx wb‡¤œ D‡jøL Kiv n‡jvt

K) Kv‡Ri c×wZt
B‡jKwUªK¨vj Iq¨vwis cwi`k©b cÖwZôv‡bi wba©vwiZ mycvifvBRvi MÖvnK/Av‡e`bKvixi ¯’vcbv cwi`k©b I Iq¨vwis
cixÿv c~e©K mshy³ dig-1 I 2 Abyhvqx †U÷ †iRvë D‡jøL K‡i Iq¨vwis mvwU©wd‡KU cÖ`vb Ki‡eb| cwi`k©‡bi
mvwU©wd‡K‡Ui GKwU Kwc MÖvnK/Av‡e`bKvix‡K Ges GK Kwc mswkøó GbIwmGm `߇i Rgv cÖ`vb Ki‡Z n‡e|
gvwmK wfwˇZ D³ gv‡m m¤úw`Z Kv‡Ri cÖwZ‡e`b GbIwmGm `߇i `vwLj Ki‡Z n‡e|

cwi`k©bKv‡j wb‡¤œ DwjøwLZ welq¸‡jv wbwðZ Ki‡Z n‡et

 Iq¨vwis Gi Kw›UwbDwU †Uó †iRvë|
 Iq¨vwis Gi BÝy‡jkb †Uó †iRvë A_©vr †dR Ges Av_© Gi g‡a¨ cÖvß BÝy‡jkb|
 GK †dR/wZb †dR myBP mg~‡ni †cvjvwiwU †U÷ A_©vr D³ myBPmg~n †dR KÛv±‡i jvMv‡bv n‡q‡Q wKbv G
msµvšÍ Z_¨|
 cøvw÷K wgUvi †evW© Ges cÖ‡hvR¨ †ÿ‡Î wgUvi e· mwVKfv‡e ¯’vwcZ n‡q‡Q wKbv Zvi Z_¨|
 MÖvnK Avw½bvq ¯’vwcZ MÖvDwÛs Zvihy³ M¨vjfvbvBRW MÖvDwÛs i‡Wi mvBR|
 ‡gBb myBP/‡cÖ‡UKwUf wWfvBm A_©vr mwVK †iwUs Gi mvwK©U †eªKvi (MCB) jvMv‡bv Av‡Q wKbv Zvi weeiY|
 Av‡ew`Z †jv‡Wi mv‡_ mvgÄm¨c~Y© mvB‡Ri mvwf©m Zvi, wgUvi e‡· mwVKfv‡e ms‡hv‡Mi Rb¨ cÖ¯Z
‘ ivLv Av‡Q
wKbv G msµvšÍ Z_¨|
 I‡q`vi †nW cvBc/mvwf©m gv÷ mwVKfv‡e ¯’vwcZ Av‡Q wKbv Zvi weeiY|
 cÖwZwU wgUv‡ii Rb¨ c„_Kfv‡e wbDUªvj Av‡Q wKbv Zvi weeiY|
 cÖ‡hvR¨ †ÿ‡Î Av_© †iwR‡÷‡Ýi †U÷ †iRvë cÖ`vb|
 ÿz`ª wkí MÖvn‡Ki †ÿ‡Î mwVK cwigvY/gv‡bi wc Gd AvB miÄvg jvMv‡bv Av‡Q wKbv Zvi weeiY|
 mwVK ÿgZvi †mvjvi wm‡óg jvMv‡bv Av‡Q wKbv Zvi weeiY|
 ÷¨vÛ evB †Rbv‡iUi (†iwUsmn) e¨env‡ii †ÿ‡Î †PÄIfvi myBP mwVKfv‡e jvMv‡bv Av‡Q wKbv Zvi weeiY
BZ¨vw`|

L) Iq¨vwis cwi`k©b wdt

ZvwjKvf~³ Iq¨vwis cwi`k©b cÖwZôvb D³ Kv‡Ri cvwikÖwgK wnmv‡e cÖwZwU ¯’vcbvi wecix‡Z ms‡hvwRZ
†gvU †jv‡Wi wfwˇZ Money Receipt (mshy³ dig-4 Abyhvqx) cÖ`vb mv‡c‡ÿ wb‡¤œv³ nv‡i Iq¨vwis
cwi`k©b wd MÖnY Ki‡Z cvi‡e t

¯’vcbvq ms‡hvwRZ 07 wK:I: 08-20 wK:I: 21-35 wK:I: 36-49 wK:I:

†gvU †jv‡Wi cwigvb ch©šÍ
Iq¨vwis cwi`k©b wd 300/- 500/- 700/- 1,000/-

ZvwjKvf~³ †Kvb Iq¨vwis cwi`k©b cÖwZôvb Av‡e`bKvix/MÖvn‡Ki wbKU †_‡K Gi AwZwi³ A_© MÖnY Ki‡Z
cvi‡e bv| MÖvnK nqivbx ev wba©vwiZ wdÕi AwZwi³ A_© Av`v‡qi †Kvb cÖgvY cvIqv †M‡j ZvwjKvf~w³
evwZjmn RvgvbZ ev‡Rqvß n‡e|
Page 2 of 14
 M) RvgvbZ:

`vwLjK…Z KvMRcÎvw` hvPvB-evQvB †k‡l ZvwjKvf~w³i Rb¨ PzovšÍfv‡e wbe©vwPZ Iq¨vwis cwi`k©b
cÖwZôvb‡K ZvwjKvf~w³i Pzw³ m¤úv`‡bi c~‡e© wbivcËv RvgvbZ wnmv‡e wWwcwWwmÕi AbyK~‡j †h †Kvb
Zdwmj e¨vsK n‡Z 20,000/- (wek nvRvi) UvKvi †c-AW©vi/e¨vsK WªvdU `vwLj Ki‡Z n‡e| cieZ©x
eQ‡ii Rb¨ Pzw³i †gqv` bevqb bv n‡j ev mswkøó cÖwZôvb Pzw³ bevq‡b AvMÖnx bv n‡j Pzw³i †gqv`
†kl nevi 06 (Qq) gvm ci mswkøó GbIwmGm wefv‡Mi AbvcwËcÎ mn Iq¨vwis cwi`k©b cÖwZôv‡bi
Av‡e`‡bi †cÖwÿ‡Z wbivcËv RvgvbZ †diZ cÖ`vb Kiv n‡e|

N) Pzw³i †gqv`/bevqb c×wZ:

wWwcwWwmÕi wewfbœ †Rv‡bi AvIZvq ZvwjKvf~w³i Rb¨ g‡bvbxZ Iq¨vwis cwi`k©b cÖwZôv‡bi m‡½
cÖv_wgKfv‡e Pzw³ ¯^vÿ‡ii ZvwiL n‡Z 1(GK) eQ‡ii Rb¨ mshy³ di‡gU-5 Abyhvqx Pzw³ m¤úv`b
Kiv n‡e| Pzw³Kvjxb mg‡qi K‡Ri gvb/cvidi‡gÝ we‡ePbvq mswkøó GbIwmGm wefvM KZ…©K †cÖwiZ
Z_¨vw`/mycvwi‡ki wfwˇZ wbe©vnx cwiPvjK, Acv‡ikb Gi gZvg‡Zi Av‡jv‡K Ges e¨e¯’vcbv
cwiPvj‡Ki Aby‡gv`bµ‡g cieZ©x †gqv‡`i Rb¨ Pzw³ bevqb Kiv hv‡e| cÖwZevi bevqbKvjxb mgq
01(GK) eQi bevqb wd n‡e 2,000 (`yB nvRvi) UvKv| bevqb wd wWwcwWwmi KZ©„cÿ KZ©„K
cÖ‡qvR‡b cwieZ©b Kiv †h‡Z cv‡i|

Pzw³i †gqv‡`vËx‡Y©i b~¨bZg 01(GK) gvm c~‡e© mswkøó GbIwmGm wefvM KZ©„K Pzw³Kvjxb mg‡q
Iq¨vwis cwi`k©b cÖwZôvbmg~‡ni Kv‡Ri gvb/cvidi‡gÝ g~j¨vqbc~e©K cÖavb cÖ‡K․kjx (‡m›Uªvj/b_©/mvD_)
eivei cÖwZ‡e`b †cÖiY Ki‡e| Pzw³i †gqv‡`vËx‡Y©i c~‡e©B KZ…©c‡ÿi Aby‡gv`‡bi Av‡jv‡K cÖavb cÖ‡K․kjx
(‡m›Uªvj/b_©/mvD_) Gi `ßi KZ…©K bevqb ZvwjKv cÖKvk Ges cÖ‡hvR¨ †ÿ‡Î eQiv‡šÍ bZzb cÖwZôv‡bi
ZvwjKvf~w³i wel‡q cÖ‡qvRbxq e¨e¯’v †bqv n‡e|

O) mvaviY kZ©vejx:

1) cÖavb cÖ‡K․kjx (‡m›Uªvj/b_©/mvD_), wWcwWwm KZ…©K ZvwjKvf~³ cÖwZôvb‡K D³ †Rv‡bi AvIZvq

GbIwmGm Z_v Kvh© Gwiqv wba©viY K‡i †`qv n‡e| Pzw³Kvjxb mg‡q wWwcwWwmÕi cÖ‡qvRb Abyhvqx
mswkøó GbIwmGm †Rv‡bi cÖavb cÖ‡K․kjxi Aby‡gv`bµ‡g GKB †Rv‡bi AvIZvq GbIwmGm Z_v
Kvh© Gwiqv cyb: web¨vm Kiv hv‡e|

2) Iq¨vwis cwi`k©b cÖwZôvb KZ©„K Iq¨vwis cixÿvi Kv‡R b~¨bZg hš¿cvwZi ZvwjKv wb¤œiƒc hv
wWwcwWwm KZ©„cÿ PvwnevgvÎ cÖ`k©b Ki‡Z n‡e t

K) Av_© †U÷vi|
L) Bbmy‡jkb †U÷vi (‡gMvi 1000 †fvë)|
M) wK¬c Ab wgUvi|
N) gvwë wgUvi |
O) n¨vÛ Mø¨vfm, †gRvwis †Uc|
P) 230 †fvë †U÷vi I Avbymw½K Uzjm/hš¿cvwZ|

Page 3 of 14
3) AskMÖnYKvix cÖwZôvb KZ…©K `vwLjK…Z †Kvb KvMRcÎ/jvB‡mÝ g~j¨vqbKvjxb mg‡q wg_¨v cÖgvwYZ
n‡j D³ cÖwZôv‡bi Av‡e`b evwZjmn D³ cÖwZôvbwU‡K Kv‡jv ZvwjKvf~w³ Kiv n‡e| GQvovI
Pzw³Kvjxb Ae¯’vq Pzw³e× cÖwZôb KZ…©K Av‡e`b Rgv`v‡bi mgq †Kvb fyqv KvMRcÎ/jvB‡mÝ `vwLj
Kiv n‡q‡Q Giƒc †Kvb cÖgvY cvIqv †M‡jI wbivcËv RvgvbZ ev‡Rqvßmn ZvwjKvf~w³ evwZj I
Kv‡jv ZvwjKvf~w³ Kiv n‡e|

4) wWwcwWwm KZ…©K wba©vwiZ wb‡`©wkKv/bxwZgvjv ‡gvZv‡eK Iq¨vwis cwi`k©b KvR m¤úbœ Ki‡Z n‡e|
wb‡`©wkKv/bxwZgvjvmg~n mg‡q mg‡q cwieZ©b, cwiea©b I ms‡kvab‡hvM¨|

5) wWwcwWwm KZ…©K wba©vwiZ wd Gi AwZwi³ †Kvb wd MÖvnK/Av‡e`bKvix n‡Z MÖnb Kiv hv‡e bv|
wba©vwiZ cwi`k©K KZ©„K cwi`k©K/cixÿv Qvov †Kvb mvwU©wd‡KU cÖ`vb ev †Kvb wg_¨v Z_¨ cÖ`vb Ki‡j
wbivcËv RvgvbZ ev‡Rqvßmn D³ cÖwZôv‡bi ZvwjKvf~w³ evwZj Kiv n‡e|

6) Iq¨vwis cwi`k©b cÖwZôvb KZ©„K wb‡qvwRZ mycvifvBRv‡ii 02(`yB) Kwc iw½b cvm©‡cvU© mvB‡Ri Qwe,
†gvevBj b¤^i, Rxeb e„ËvšÍ, RvZxq cwiPq cÎ Ges wkÿvMZ †hvM¨Zvi mb`c‡Îi d‡UvKwc mswkøó
GbIwmGm Awd‡m Rgv w`‡Z n‡e|
7) Iq¨vwis cwi`k©b cÖwZôvb KZ©„K cÖ¯vÍ weZ cwi`k©K/mycvifvBRv‡i ‡hvM¨Zv Ges cwi`k©b Kv‡R e¨eüZe¨
hš¿cvwZi ¸bMZ gvb wbe©vnx cwiPvjK (Acv‡ikb), wWwcwWwmÕi mevcwZ‡Z¡ GKwU KwgwUi gva¨‡g wbwðZ Kiv
n‡e|

8) wWwcwWwm GbIwmGm Awdm KZ©„K Bmy¨K…Z cwiPq cÎ mMÖnc~e©K MÖvnK cÖv‡šÍ cÖ`k©‡bi Rb¨ mv‡_ ivL‡Z n‡e|
9) ZvwjKvf‚³ cÖwZôvb‡K GBPwU ms‡hvM e¨wZZ wWwcwWwmÕi Pvwn`v Abyhvqx Ab¨vb¨ mKj †kÖYxi MÖvn‡Ki Iq¨vwis
mvwU©wd‡KU (mshy³ dig Ô1Õ I ‡jvW weeiYx dig-Ô3Õ) cÖ`vb Ki‡Z n‡e (wWwcwWwm KZ©„K di‡gU cwieZ©b
Kiv n‡j cwiewZ©Z di‡g‡U wi‡cvU©/mvwU©wd‡KU cÖ`vb Ki‡Z n‡e) |
10) Iq¨vwis cwi`k©b †k‡l MÖvnK/Av‡e`bKvix‡K Iq¨vwis cwi`k©b wdi A_© iwk‡`i Kwc (mshy³ dig Ô4Õ
Abyhvqx) Aek¨B cÖ`vb Ki‡Z n‡e|
11) Iq¨vwis cwi`k©b KvR h_vkxNª (m‡e©v”P 03 w`‡bi g‡a¨) m¤úbœ Ki‡Z n‡e|

12) wWwcwWwm KZ©„K avh©¨K…Z PvR© e¨wZ‡i‡K MÖvnK ev Av‡e`bKvixi Dci AwZwi³ PvR© avh©¨, m‡iRwgb cwi`k©b
I cixÿv Qvov mvwU©wd‡KU cÖ`vb A_ev wg_¨v Z_¨ cÖ`vb Ki‡j wbivcËv RvgvbZ ev‡Rqvßmn ZvwjKvf~w³
evwZj Kiv n‡e| f‚j Z_¨ m¤úwK©Z Iq¨vwis mvwU©wd‡KU cÖ`v‡bi Rb¨ †Kvb `yN©Ubv NU‡j Zvi `vq `vwqZ¡
Iq¨vwis cwi`k©b cÖwZôvb‡K enb Ki‡Z n‡e Ges Gi Rb¨ ÿwZc~iY/Rwigvbv avh©¨ Ki‡j Zv Iq¨vwis cwi`k©b
cÖwZôvb cwi‡kv‡a eva¨ _vK‡e|

13) wWwcwWwm KZ©„K wba©vwiZ GbIwmGm wefv‡Mi AvIZvf‚³ GjvKvi evB‡i †Kvb MÖvnK/Av‡e`bKvix‡K Iq¨vwis
mvwU©wd‡KU cÖ`vb Kiv hv‡e bv|
14) kZ©vejx‡Z D‡jøL bvB Ggb wel‡q †Kvb mgm¨vi D™¢e n‡j wWwcwWwm KZ©„c‡ÿi wm×všÍ P‚ovšÍ e‡j we‡ewPZ
n‡e|

15) ‡Kvb KviY `k©v‡bv e¨wZ‡i‡KB †h †Kvb/mKj Av‡e`b MÖnY ev evwZj Kivi ÿgZv wWwcwWwm KZ©„cÿ KZ©„K
msiwÿZ|

Page 4 of 14
 Document No.:

Revision No.:

Effective Date:

Page 1 of 1
Iq¨vwis mvwU©wd‡KU dig bs -1
GB g‡g© cÖZ¨qb Kiv hvB‡Z‡Q †h,

Rbve/‡eMg:....................................................................................................................

wcZv/¯^vgx/cÖwZôvb: ..........................................................................................................

wVKvbv: ..........................................................................................................................

................................................................................................................................
....

dvBj UªvwKs bs.............................................. GbIwmGm &:.........................................D³ ¯’vcbvq eZ©gvb

Av‡ew`Z................................., wK:I: †jvW, ....................wU wgUv‡ii Iq¨vwis h_vh_fv‡e m¤úbœ Kwiqv‡Qb|
m¤úvw`Z Iq¨vwis Gi Av_© †iwR‡÷ªkb I Bbmy‡jkb †Uó †iRvë m‡šÍvlRbK| h_vh_fv‡e wm‡÷g cÖ‡UKkb mvwK©U
†eªKvi ¯’vcb Kiv n‡q‡Q| GgZve¯’vq Av‡e`bKvixi ¯’vcbvq •e`y¨wZK ms‡hvM †`Iqv hvB‡Z cv‡i|

‡Uó †iRvë

‡Uó weeiY ‡iwRó¨Ý (‡gMv Ing) †gMvi †¯úwmwd‡Kkb

R-N (MΩ) R-N (MΩ) B-N (MΩ) Average
‡dBR I wbDUªvj †gMvi wmwiqvj bs-
............ 1000 †fvë
R-Y (MΩ) Y -B (MΩ) B-R (MΩ) †gW Bb: ............
‡dBR I †dBR
wbDUªvj Ges Av_©

Av_© †iwRó¨vÛ (Ing) … …………..Ω

Av_© †Uóvi †¯úwmwd‡Kkb: g‡Wj/eªvÛ … …………..
Av_© †Uóvi wmwiqvj bs … …………..

‣e`y¨wZK mycvifvBRv‡ii bvg, ¯^vÿi I

mxj
jvB‡mÝ bs:... .. .. ... .. .. ..
‡gvevBj bs:.................................

ZvwjKvf~w³ Aby‡gv`‡bi ¯§viK bs .......................................

Page 5 of 14
 cÖwZôv‡bi bvg I g‡bvMÖvg dig bs -2
Iq¨vwis cwi`k©b wi‡cvU©

cwi`k©‡bi ZvwiL:................................

dvBj UªvwKs bs: ............................................wefvM:

..........................................................

1. Av‡e`bKvixi bvg : ............................................................................................................

2. wcZv/¯^vgxi bvg : ............................................................................................................
3. Av‡e`bKvixi wVKvbv : ............................................................................................................
4. ¯’vcbvi cÖK…wZ : wUb‡kW/eûZj feb/wbg©vbvaxb feb/ÿz`ª wkí/evwY¨wR¨K cÖwZôvb/Ab¨vb¨
5. fe‡bi cÖK…wZ : ..........................Zjv ¯’vqx feb/AvavcvKv Ni/A¯’vqx ¯’vcbv|
6. ms‡hv‡Mi weeiY : GK †dR/wZb †dR|
7. Iq¨vwis h_vh_fv‡e : nu¨v/bv/AvswkK/c~Y©
m¤úbœ n‡q‡Q wKbv
8. wK‡P‡bi msL¨v : ...........................wU
9. BDwb‡Ui msL¨v : ...........................wU
10. mvwf©m cvBc mwVKfv‡e ¯’vcb Kiv n‡q‡Q wKbv : nu¨v/ bv/ AvswkK/cwieZ©b Ki‡Z n‡e|
11. ‡gBb †evW© jvMv‡bv Av‡Q wKbv : nu¨v/ bv/ AvswkK/cwieZ©b Ki‡Z n‡e|
12. Avw_©s io h_vh_fv‡e ¯’vcb Kiv Av‡Q wKbv : nu¨v/bv |
13. ms‡hvM ¯’‡j †Rbv‡iUi Av‡Q wKbv : nu¨v/bv |
14. wc.Gd.AvB Av‡Q wKbv (cÖ‡hvR¨ †ÿ‡Î) : fvj/ Lvivc
15. evm-evi/mvwK©U †eªKvi mwVK Av‡Q : nu¨v/ bv |
16. fe‡bi Dc‡i eRªcvZ AvUK e¨e¯’v Av‡Q wKbv : nu¨v/ bv |
17. mvwf©m jvBb KwÝj Iq¨vwis wKbv : nu¨v/ bv/ wcwfwm KbRywqU Iq¨vwis Ki‡Z n‡e|
18. mvwf©m Zv‡ii msL¨v KqwU (GKvwaK _vK‡j) : ...............................wU
19. mvwf©m Wªc `~iZ¡ : ...............................wgUvi
20. UªvÝdigvi bs........................UªvÝdigvi †_‡K ¯ú¨vb ..................c‡i|
21. we`y¨r e¨envi Kib wKbv (Ki‡j wKfv‡e K‡ib) : ...................................
22. gšÍe¨:
............................................................................................................................................
............................................................................................................................................

Av‡e`bKvixi ¯^vÿi cwi`k©bKvixi ¯^vÿi

bvg:
‡gvevBj bs:..

Page 6 of 14
 Office of the
…………………..
……………………
Bidyut Bhaban (11th Floor)
1 Abdul Gani Road, Dhaka -1000
Tel: 9564215, Fax: 9566518
e-mail: e-mail: sed@dpdc.org

Load Assessment Form dig bs - 3

Date: File tracing no:

NOCS Division:
Location Point Type Watt Unit No: Unit No: Unit No: Unit No: Unit No: Unit No:
per No. of Load No. of Load No. of Load No. of Load No. of Load No. of Load
Point Point (KW) Point (KW) Point (KW) Point (KW) Point (KW) Point (KW)
Single Point Per room
Bed /drawing /dining/
Two Point Per room
living/ dressing/
Kitchen room for light More than Two Point Per
room
Bed /drawing /dining/ light (A)
living/ dressing/
Kitchen room
light (B)
light (C)
Garage / basement/ light
veranda/ garden/open
yard
Corridor light
/passage/toilet/stair
Bed/drawing /dining 2 Pin Single Point Per room
living /dressing / Kitchen (x)
room / corridor/passage / Two Point Per room
toilet (Y)
More than Two Point
Per room (Z)
3 Pin Single Point Per room
(x)
Two Point Per room
(Y)
More than Two Point
Per room (Z)
Garage / basement / 2 Pin
veranda / garden / open 3 Pin
Page 7 of 14
 yard /stair
Refrigerator
Television
Micro-weave oven
Washing machine
Iron
Air Cooler (A.C.)
Electric Geezer
Electric bumer/ heater
Lifi
Water Pump
Industrial Machine/Medical Equipment
Any other Electric equipment appliances
Total Load Per unit Total Total Total Total Total Total

Visited by:
GT Total Load:

Page 8 of 14
dig-04

cÖwZôv‡bi bvg I g‡bvMÖvg cÖwZôv‡bi bvg I g‡bvMÖvg

wWwcwWwmÕi c‡ÿ Iq¨vwis mvwU©wd‡KU cÖ`v‡b gvwb wiwmÞ wWwcwWwm Õi c‡ÿ Iq¨vwis mvwU©wd‡KU cÖ`v‡b gvwb wiwmÞ

µwgK bs (Printed no.) ........ZvwiL............. µwgK bs (Printed no.) ........ZvwiL...............

MÖvn‡Ki bvg.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. MÖvn‡Ki bvg.. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. .. ..
U¨vwid....................dvBj UªvwKs bs................wefvM:.................. U¨vwid....................dvBj UªvwKs bs................wefvM:..................
wVKvbv:................................................................................ wVKvbv:................................................................................
Kv‡Ri weeiY UvKvi cwigvY Kv‡Ri weeiY UvKvi cwigvY
K) wgUv‡ii msL¨v: K) wgUv‡ii msL¨v:
1) 1-‡dR................................ 1) 1-‡dR................................
2) 3-‡dR................................ 2) 3-‡dR................................
L) †gvU †jv‡Wi cwigvY: ...............wK:I: L) †gvU †jv‡Wi cwigvY: ...............wK:I:
M)..........Zjv fe‡bi.........‡d¬v‡ii Kv‡Ri gRywi| M)..........Zjv fe‡bi.........‡d¬v‡ii Kv‡Ri gRywi|
‡gvU UvKv ‡gvU UvKv

K_vq: K_vq:
Iq¨vwis mvwU©wd‡KU eve` wWwcwWwmÕi Aby‡gvw`Z wej Gi AwZwi³ Avwg †Kvb A_© Iq¨vwis mvwU©wd‡KU eve` wWwcwWwmÕi Aby‡gvw`Z wej Gi AwZwi³ Avwg †Kvb A_©
cÖ`vb/MÖnY Kwi bvB cÖ`vb/MÖnY Kwi bvB

MÖvn‡Ki ¯^vÿi MÖnxZvi ¯^vÿi MÖvn‡Ki ¯^vÿi MÖnxZvi ¯^vÿi

ZvwjKvf~w³ Aby‡gv`‡bi ¯^viK bs: ......................................................... ZvwjKvf~w³ Aby‡gv`‡bi ¯^viK bs: ...............................................

Page 9 of 14
Page 10 of 14
 Pzw³ bvgv dig-5

Pzw³ bs t

cÖ_g cÿ t

wØZxq cÿ t

Pzw³i welq t wWwcwWwmÕi AvIZvaxb GjvKvq B‡jKwUªK¨vj Iq¨vwis cwi`k©b I mvwU©wd‡KU cÖ`v‡bi ZvwjKvf‚³
KiY|

ZvwjKvf‚³ nevi wbwg‡Ë wØZxq cÿ B‡jKwUªK¨vj Iq¨vwis cwi`k©bKvix cÖwZôvb wn‡m‡e P~ovšÍ evQvB‡q DËxY©
nIqvq cÖ_g cÿ KZ©„K wb¤œewY©Z kZ©vejx †g‡b Pj‡Z eva¨ _vK‡e| GQvov mg‡q mg‡q cÖewZ©Z Ab¨vb¨ kZ©vejx
‡g‡b Pj‡e| kZ©vejx cÖwZcvj‡b †Kvbiƒc e¨Z¨q NU‡j †Kvb cÖKvi KviY `k©v‡bv e¨wZ‡i‡K cÖ_g cÿ wØZxq
cÿ‡K ZvwjKvf‚w³ †_‡K evwZj Kivi ÿgZv msiÿY K‡ib|

kZ©vejx t

1| ---------------- 2017 Bs n‡Z Kvh©Kix mv‡c‡ÿ wWwcwWwmÕi AvIZvf‚³ bZzb ms‡hvM/‡jvW e„w×i Rb¨
Av‡e`bKvix/MÖvnK‡`i B‡jKwUªK¨vj Iq¨vwis mvwU©wd‡KU cÖ`v‡bi Rb¨ cÖv_wgK fv‡e GB ZvwjKvf‚w³ -----
-----2017 Bs ch©šÍ ejer _vK‡e| Z‡e KZ©„c‡ÿi cÖ‡qvR‡b Pzw³i †gqv` Kg/‡ekx Kiv n‡Z cv‡i|

2| wØZxq cÿ wWwcwWwmÕi ------- GbIwmGm wefv‡Mi B‡jKwUªK¨vj Iq¨vwis cwi`k©Y I cixÿvi mvwU©wd‡KU
cÖ`vb Ki‡Z cvi‡e|

3| wWwcwWwmÕi mswkøó wefvM KZ©„K Bmy¨K…Z cwiPq cÎ msMÖn c~e©K MÖvnK cÖv‡šÍ cÖ`k©‡bi Rb¨ me©`v mv‡_
ivL‡Z n‡e|

4| wØZxq cÿ ZvwjKvf‚³ cÖwZôvb wn‡m‡e GBP.wU ms‡hvM e¨ZxZ Ab¨vb¨ mKj †kÖbxi MÖvn‡Ki wWwcwWwm
KZ…©K cÖZ¨vqbK…Z di‡g‡U Iq¨wis mvwU©wd‡KU cÖ`vb Ki‡Z cvi‡eb|

Page 11 of 14
5| wØZxq cÿ‡K Iq¨vwis/BÝU‡jkb mvwU©wd‡KU cÖ`v‡bi D‡Ï‡k¨ MÖvnK/Av‡e`bKvixi Avw½bvq ¯’vwcZ
Iq¨vwis Ges •e`y¨wZK miÄvgvw` cwi`k©b Ges cixÿY c~e©K mwVK Z_¨ Iq¨vwis/BÝU‡jkb mvwU©wd‡KU G
wjwLZfv‡e cÖ`vb Ki‡ n‡e|

6| wØZxq cÿ ZvwjKvf‚³ B‡jKwUªK¨vj Iq¨vwis cwi`k©bKvix cÖwZôvb wn‡m‡e MÖvnK/Av‡e`bKvixi

Iq¨vwis/BÝU‡jkb mvwU©wd‡KU cÖ`v‡bi D‡Ï‡k¨ MÖvnK/Av‡e`bKvixi Avw½bvq ¯’vwcZ Iq¨vwis Ges
‣e`y¨wZK miÄvgvw` cwi`k©b Ges cÖ‡qvRb gvwdK wb¤œwjwLZ cixÿY mg~n m¤úv`b K‡i G‡Z cÖvß
djvdj Iq¨vwis/BÝU‡jkb mvwU©wd‡KU cÖ`vb Ki‡eb t

K) Iq¨vwis Gi Kw›UwbDwU †Uó †iRvë|

L) Iq¨vwis Gi BÝy‡jkb †Uó †iRvë A_©vr †dR Ges Av_© Gi g‡a¨ cÖvß BÝy‡jkb|
M) GK †dR/wZb †dR myBP mg~‡ni †cvjvwiwU †U÷ A_©vr D³ myBR mg~n †dR KÛv±‡i jvMv‡bv n‡q‡Q
wKbv G msµvšÍ Z_¨|
N) cøvw÷K wgUvi †evW© Ges cÖ‡hvR¨ †ÿ‡Î wgUvi e· mwVKfv‡e ¯’vwcZ n‡q‡Q wKbv Zvi Z_¨|
O) MÖvnK Avw½bvq ¯’vwcZ MÖvDwÛs Zvihy³ M¨vjfvbvBRW MÖvDwÛs i‡Wi mvBR|
P) ‡gBb myBP/‡cÖ‡UKwUf wWfvBm A_©vr mwVK †iwUs Gi mvwK©U †eªKvi (MCB) jvMv‡bv Av‡Q wKbv Zvi
weeiY|
Q) Av‡ew`Z †jv‡Wi mv‡_ mvgÄm¨c~Y© mvB‡Ri mvwf©m Zvi, wgUvi e‡· mwVKfv‡e ms‡hv‡Mi Rb¨ cÖ¯Z
‘ ivLv
Av‡Q wKbv G msµvšÍ Z_¨|
R) I‡q`vi †nW cvBc/mvwf©m gv÷ mwVKfv‡e ¯’vwcZ Av‡Q wKbv Zvi weeiY|
S) cÖwZwU wgUv‡ii Rb¨ c„_Kfv‡e wbDUªvj Av‡Q wKbv Zvi weeiY|
T) cÖ‡hvR¨ †ÿ‡Î Av_© †iwR‡÷‡Ýi †U÷ †iRvë cÖ`vb|
U) ÿz`ª wkí MÖvn‡Ki †ÿ‡Î mwVK cwigvY/gv‡bi wc Gd AvB miÄvg jvMv‡bv Av‡Q wKbv Zvi weeiY|
V) mwVK ÿgZvi †mvjvi wm‡óg jvMv‡bv Av‡Q wKbv Zvi weeiY|
W) ÷¨vÛevB †Rbv‡iUi (†iwUsmn) e¨env‡ii †ÿ‡Î †PÄIfvi myBP mwVKfv‡e jvMv‡bv Av‡Q wKbv Zvi
weeiY BZ¨vw`|
7| wØZxq cÿ‡K †h †Kvb KvR m‡e©v”P 03(wZb) w`‡bi g‡a¨ m¤úv`b Kiv mn KvRwU m¤úbœ-Am¤úbœ hvB
†nvK bv †Kb wi‡cvU© K‡i MÖvnK Ges †Wm‡Kv Awdm‡K mieivn Ki‡Z n‡e|

8| wWwcwWwmÕi wba©vwiZ wb‡`©wkKv/bxwZgvjv †gvZv‡eK Iq¨vwis cwi`k©‡bi KvR m¤úbœ Ki‡Z n‡e|
wb‡`©wkKv/bxwZgvjv mg~n mg‡q mg‡q cwieZ©b, cwiea©b I ms‡kvab‡hvM¨|

9| D‡jøwLZ Kv‡Ri Rb¨ wØZxq c‡ÿi cÖ`Ë `i/cvwikÖwgK wb¤œewY©Z QK Abymv‡i n‡e t

Page 12 of 14
 ¯’vcbvq ms‡hvwRZ 07 wK:I: ch©šÍ 08-20 wK:I: 21-35 wK:I: 36-49 wK:I:

†gvU †jv‡Wi cwigvb

Iq¨vwis cwi`k©b wd 300/- 500/- 700/- 1,000/-

10| B‡jKwUªK¨vj Iq¨vwis/BÝU‡jkb mvwU©wd‡KU cÖ`v‡bi cvwikÖwgK Pvwn`vK…Z †jv‡Wi Dci wfwË K‡i kZ©
bs-09(bq) †gvZv‡eK mswkøó MÖvnK/Av‡e`bKvixi wbKU n‡Z 1g cÿ KZ©„K cÖZ¨vqbK…Z di‡g‡U gvwb
wiwmÞ Gi gva¨‡g MÖnY Kiv hv‡e Ges †Kvb Ae¯Ív‡ZB MÖvnK ev Av‡e`bKvixi wbKU n‡Z AwZwi³ PvR©
avh© ev Av`vq Kiv hv‡e bv| Ab¨_vq wbivcËv RvgvbZ ev‡Rqvß mn ZvwjKvf‚w³ evwZj Kiv n‡e|

11| wg_¨v Z_¨ Ges cwi`k©b I cixÿv Qvov mvwU©wd‡KU cÖ`vb Ki‡j wbivcËv RvgvbZ ev‡Rqvß mn
ZvwjKvf‚w³ evwZj Kiv n‡e| GQvovI f‚j Z_¨ m¤úwK©Z mvwU©wd‡KU cÖ`v‡bi Rb¨ †Kvb `yN©Ubv NU‡j Zvi
`vq `vwqZ¡ wØZxq c‡ÿi Dci eZ©v‡e Ges MÖvnK/Av‡e`bKvixi cÖ‡qvRbxq ÿwZc~iY w`‡Z eva¨ _vK‡eb|

12| wb‡¤œv³ WKz‡g›Um& mg~‡ni †Kvb GKwU Pzw³ cieZ©x mg‡q Rvj/wg_¨v/evwZj/‡gqv‡`vËxY© cÖgvwbZ nq Z‡e
Pzw³ evwZj e‡j MY¨ n‡e| WKz‡g›Um& mg~n h_vµ‡g t-

K) nvjbvMv` ABC jvB‡mÝ Gi d‡UvKwc|

L) nvjbvMv` †UªW jvB‡mÝ Gi d‡UvKwc|

M) VAT ‡iwR‡óªk‡bi d‡UvKwc|

N) e-TIN certificate Gi d‡UvKwc|

O) cÖwZôv‡bi ¯^ËvwaKvixi RvZxq cwiPq c‡Îi d‡UvKwc|

P) Iq¨vwis cÖwZôvb KZ©„K g‡bvbxZ mycvifvBRv‡ii nvjbvMv` ABC jvB‡mÝ Gi d‡UvKwc I RvZxq cwiPq
c‡Îi d‡UvKwc|

Q) wbivcËv RvgvbZ wnmv‡e wWwcwWwmÕi AbyK‚‡j Zdwmjx e¨vs‡K `vwLjK…Z 20,000/- (wek nvRvi)
UvKvi †c-AW©vi/e¨vsK WªvdU|
Page 13 of 14
13| 1g cÿ †Kvb cÖKv‡ii Kvib `k©v‡bv e¨wZ‡i‡K ZvwjKvf‚³ B‡jKwUªK¨vj Iq¨vwis cwi`k©bKvix cÖwZôv‡bi
Kvh©µg ¯’wMZ ev evwZ‡ji ÿgZv msiÿY K‡ib|

14| kZ©vejx‡Z D‡jøL bvB Ggb wel‡q †Kvb RwUjZvi m„wó n‡j cÖ_g c‡ÿi wm×všÍB P‚ovšÍ e‡j we‡ewPZ
n‡e|

Avwg/Avgiv wb¤œ¯^vÿiKvixMY ¯^Áv‡b I my¯’¨ gw¯Í‡¯‥ A`¨ ------- Bs Zwi‡L G Pzw³ bvgv ¯^vÿi Kijvg|

Page 14 of 14