At]m^mdw (hntZiw)
At]m^mdw kuP\yamWv
If t^mtm
(]mkvt]mv sskkv)
(Please read the guidelines before filling up the application. Use only CAPITAL Letters)
(At] ]qcn-n-p--Xn\v ap]v \n_--\-I hmbnp-I. Cwojv henb A-cn
]qcnn-p-I)
District (Pn)
Panchayat/Municipality/Corporation
(]mbv/ap\n-kn-m-enn/tIm-td-j)
({]hm-kn-bpsS Hv)
1.
2.
3.
4.
Day
Month
Year
Znhkw
amkw
hjw
Month
Year
Znhkw
amkw
hjw
Country of Residence
6.
E-mail (Csabn)
Telephone No with ISD code (t^m \ tImUv DssS)
7.
District (Pn)
8.
Profession (sXmgn)
9.
Xmaknpp)
10.
PIN Code(]ntImUv):
hjw
amkw
Page: 2
11.
Educational Qualifications
(hnZym`ymk tbmKyXI)
12.
Abroad
In native place
hntZiv
kztZiv
Single
Divorced
13.
14.
Religion (aXw)
15.
16.
Relationship (_w)
Age (hbv)
Relationship (_w)
Age (hbkv)
Declaration ({]Xn)
I declare that the details given above are true to the best of my knowledge and belief. If anything stated is found false, legal action may be taken
against me. (apIfn sImSpncnp hnhcsfmw Fs Adn-hns-n-S-tmfw kXyamsWv Rm CXn\m kmysSppp.
........................................................................
FOR OFFICE USE ONLY
Code number
: .............................................................
Date of Registration
: .............................................................
ID Number
: .............................................................
Status
: .............................................................
Norka-Roots
Page: 3
At]IcpsS {ibvv
{]hmkn Xncn--dn-b ImUv ]Xn 2008 BKv apX-emWv kwm-\v \ne-hn h-Xv. {]hmkn Xncn--dn-b ImUv
BZy-L--n \ne-hn hntZi cmPy--fn D-hv am{X-amWv \Ip-Xv. CXv {]hmkn ae-bm-fn-Iv tIc-f-n Hcp
Xncn-dn-b tcJ-bmbn D]-tbm-Kn-p--tXm-sSm-w, ImUp-S-a-Iv A]-I-S--sf-p-Sp--m-Ip AwK-ssh-I-eypw
A]- I - S - a - c - W - pw c- v - e w cq]- h sc e`n- p Cjz- d kv ]cn- c - bpw Dd- p- h - c p- p- p. km- c ns hnhn[
{]hmknta- ]-Xn-I-fpsS ASnm-\-tc-Jbpw {]hmkn Xncn--dn-b ImUv BWv. CXns Imem-h[n aqv hj-am-Wv. -c-Pnkvt{S-j ^okv 300/ cq]-. Cu ]Xn tIc-f- km t\m hIp-ns \nb-{-W-n-ep t\m-dqvkv hgn-bmWv \S-mp--Xv.
hntZiv Bdp-am-k-n-e-[nIw tPmen-sN-p-Itbm dkn-U v s]anv t\Sn Xma-kn-p-Itbm sNp 18 hbv ]qnbmb {]hm-kn- tI-c-fo-bv {]hmkn Xncn--dn-b ImUn\v At]-n-mw.
At]-m-^md-nse Fm tImf-fpw hy-ambn ]qcn-n-t-- XmWv. A]qWhpw A]m-I-X-I DXpamb At]-I ]cn-K-Wn-p--X-.
At]-m-^m-d-n ImWn-n-p hnh-c- icn-bm-sWv AXXv cmPy--fnse Cy Fw_kn As-n \mnep hmUv sa/ Iukn-e, ]m-bv {]kn-U v/ ap\nkn- sNbam/tab/Kk-Uv Hm^o-k Fn-hcn Bsc-nepw kmy-s-Sp-n- t]-tcm-Sp-IqSn ko ]Xn-np Hp-sh-t-- Xm-Wv.
lmPcmt- tcJI
1. ]mkvt]mns kzbw kmysSpnb _s t]PpI hnk t]Pv DssS
2. \ne-hn-ep hnk/sXmgn s]anv/Xmak s]anv ]Iv
3. tdj ImUv e`y-am-sW-n ]Iv
4. ]m-kvt]mv sskkv t^mtm 2 Fw
5. cPnkvt{Sj ^okv 300 cq]
Pn, taJe
ZnW taJe
Thiruvananthapuram, Kollam, Pathanamthitta
a[y taJe
Thrissur, Ernakulam, Palakkad, Kottayam,
Alappuzha, Idukki
Dc taJe
Kasargod, Kannur, Kozhikode, Malappuram, Wayanad
AUTHORISATION LETTER
I Sri/Smt..............................................................(name of the NRK) bearing Passport No: ....................................(passport number) working in ................................................
...............................................................................................................................................
................................................................................................................. (address abroad)
with permanent address ..........................................................................................................
...............................................................................................................................................
...................................................................................... (address in India) do hereby authorize
Sri./Smt..................................................................................................................................
my .....................................(wife/husband/father/mother/son/daughter/brother/sister/any
other relationship) to apply and collect NRK ID Card on behalf of me. The nominee given
in the application form is as per my decision.
Date:
Place: