dFr$q ailqFr zozo tB€mrfr errfiftq daftd fu frru) TANSEN SAMMAN : 2020 (For.lndian Classical Music) rl1tiur RECOMMENDATION

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Heilir.D tEr fthil-wl ;Il{/Name: EtfliHt/ Signature :

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u-$iut vsrcffr', TRTfd (ts-*,Ts ersrflrcr q}q-q1-a62q16 q{ q"t Fwr rislo-'rtdq, r-ffi TrR * frd), * ct s.r 6,e 6i r ilo-drcr ErErFr (3( urBd) zozo IKBAL SAMMAN : 2020 (Urdu Literature) rt1eim (RECOMMENDATTON)

Tft{f,r o-q { sTkoilq dq rrqrm-{ According to seniority maximum three Recommendation

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wgwvt qqft qsrq-{dq, (tgfirs ersrflr€ r}qr6-452s16 qu Ewt frrerr, r-ffi TrR h fr}), *. cA w ri-ei aT si r milU UI5}IFI (Hr.frq rrrqr3fr of 6tud] tu ftu) 2O2O KABIR SAMMAN: 2020 (For-Indian Poetry) iil( RECOMMBNDATION T0-{dr m-q fr qBoa-q fi-{ Trqrfi According to seniority maximum three Recommendation

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(G-d aiaq, dfud frdq, eiar{q, P*dtq, sr+8, q-{ dtrd .xTR) SHARAD JOSHI SAMMAN : 2020 (RECOMMENDATTON) Tt{rtrr m-q fr elkoaq drq rrqioq According to seniority maximum three Recommendation

dEl-

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a-jVrcn Tfqlcrfi, qqro-;rreq, TrR (te-firs enrk1rr rfrq-s-462915 qt qp 5w ffi l-frrEr$ + tr$), * w ,M fl of r mlfucrfl er*rFr (errsftdr Eiaftd) 2ozo KALIDAS SAMMAN (CLASSICAL MUSIC) :2020 n{eirfl (RECOMMENDATION)

Tt{dr m"q { sTko-flq d-{ ;il-qio.-{ According to seniority maximum three Recommendation

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gKrtr$' ifi-r frfiq,/DETATLS OF PROPOSER grqA.{ame: awtrt/Signature:

R$Trsl+{r{d w {-i-d sr6 tEr qdrlPostal Address:

erEim qsrffirf,q, (i-s-firs q}qro-+ozo16 rn qE Fva {iqtrfr, Tiq.fr l-ftrsrfr TrR er*qnro & fr&), *'ct rH sT Et I mrfrrdrfl ErErFr (erdq Tdr) 2o2o KALIDAS SAMMAN (CLASSICAL DANCE) :2020 3n-5Yr$r GECOMMENDATTON)

Tfr{dr m-q fr sTkoilq fiq qrqroq According to seniority maximum three Recommendation

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ITTJ : Name:

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seflirTl / Artist lg9-dMqf, Trqr6-{ 6-1 3ilqF/Achievement & Base of Recommendation

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KALIDAS SAMMAN (VISUAL ART) :2O2O

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Address :

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iFI : Name:

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grkTIZItF M K+IUT/DETAILS oF PRoPoSER qrqA.Jame: rwnr/Signature:

({tTrsl+{r{d' sq {-t-f, sr6 6r qor/Postal Address:

wglut riqtcts', (ts-firs 3rsldrer rfrq16-a62s16 qt qT 5w sr$fr {iqrd-ir@, l-frrsr$ rrn + *}), S ca rH ou et r IITGII d]i8fr TTEIFI 3 2O2O (arirft ftfdrt cefa-dwn fu1 MAHATMA GANDHI SAMMAN : 2020 (necourMENDATIoN) Tflq-dr ffi il qfkoilq fi-{ qrqi6{ According to seniority maximum three Recommendation

g[f,fqd, qrqiffi iil oilqR / Achievement & Base of Recommendation

qnnv (uft qlqrE-a c. srodda-e,fr)

Phone/MobileNo. : Email:-

TII : Name:

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Address :

q}+qd 'qnnv (ufr 'i. qro d d ca,fr) Phone/Mobile No. : Email:-

Awv (uR dqr{d c. Erdddm,fr) Phone/Mobile No. : Email:-

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ergivt riqlqfs', qslo-{es, (tsfirq 3rsknd rfrqr6-462q16 qe Svar iiq.fd l-ffi TrR * t&), *, cil w eH fi st r tfr Brfuil Ergrrd :2020 (mo ud stfonfr qrruFo mmrfr 15 6ru-qBnl momrt) DEVI AHILYA SAMMAN : 2020 (For-Tribal and Folk (WOMAN) Artist only) 3l :Ieirfl (nr covrMENDATroN) qfts-dr mq d srfffi-f,q dq qrqr6-{ According to seniority maximum three Recommendation

6-drmFl / Artist sq-akqfi, Trqifiq tD'I sTlEllt/Achievement & Base of Recomrnendation

ITII : Name:

gdT : Address: I a*nv (uR +fl{dT =i. sro d c} ire rt) Phone/Mobile No. : Email :-

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Address :

'prv (ufr +flEd c. sro d d ce,fr) Phone/Mobile No. : Email:- iFI: Name:

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Address :

f*ffq (qR m-{rqd n. sro d d m ,fr) Phone/I\dobile No. : Email:- gRr{fr' qil frfiqTDETArLS oF pRoposER TrqA.,lame: rwnt/Signature: sr6 oI qor/Postal Address: Es,Trsl+{r{n w {-trd

qJYisr Tisrss', TrR (i-e-5.rs 3reinfr qlqrd-462s16 q{ qg Tcql ffic sqma'eq, r-ffi * *d), * ct ,M fl st r q;mrfr ur*rFr z 2O2O (cil-6 uti mffi qrgrqfro mmril fr 6dm-{ mm:fr fu ftu-g-ou m-omrr) TULSI SAMMAN z 2O2O (Male Aftist for Folk and Tribal Traditional Painting) 3r{Qiril (nn conaMENDATroN)

Tfr{f,r mq fr 3Tf*o.dq 6q qrqrfi-{ According to seniority maximum three Recommendation

iD-ATiFIt/Artist gq-dfuqY, qrqrE { 6-I sfrEfl-t/Achievement & Base of Recommendation

IFT : Name:

tlclT : Address:

-qr.rv I (vR dEE-d t aro d d ae rft)

Phone/MobileNo. : Email:-

NTTI : Name:

qrII :

Address :

krTq (qft +{r5d d sro d d a-a rfi) Phone/MobileNo. : Email:-

ITTI : Name:

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Address :

qrurv (uR +{r{d d sro d d aa rft) Phone/I\{obile No. : Email:-

TRilZTF 5,1 foaqqTDETAILS oF PRoPOSER 'Trq/lrlame : awnrr/Signature:

6urv/ders-a \'a {-f-d sro. 6T qor/Postal Address: pwt ot-$tw vqtddr, rlqr€-a62616 qu Tiq.fr *iq-e-+eq, l-ffi TrR (tgfirs ertqdr(I *, fi-&), * cil w M 6t qt r crdr rider6-{ rrgrFr (fuH-z'iufd ftdera) z 2o2o LATA MANGESHKAR SAMMAN (Film - Music Direction) 2o2o = 3r{eirfl (nrcovr M EN DATtoN) Tftffir o-q { oTtro-f,q fic qrqrfi According to seniority maximum three Recommendation

frN-d ftdYrfi / MUS IC DIRE CTOR sq-afuqY, Trqf6-{ zFl 3ilqR/Achievement & Base of Recommendation

Tfq : Name:

qdT :

Address :

I-$rrs (qfr +qT{d c. Erd d d e-6,ft)

Phone/MobileNo. : Email:-

qITI : Name:

rI.Il :

Address :

krrs (qfr qfeigd c sro d d e-6 fi) Phone/MobileNo. : Email:-

;nrl : Name:

qiIT :

Address :

'qrvrv (qR q)-+rgd i sro d d aa rfr)

PhonefiVlobile No. : Email:-

Y.KIFTF, OT h+IUT/DETAILS oF PROPOSER qrqAllame: awrcn/Signature:

T.vqterg{rqrri?rf,s', Tffiqsldil-dq, r-ffiTrR (t-s'firs 3firkne* dd), q}qrf,-462s16 *qil.n q-di616s6tr fuefu gtqru rrErFI (fuEq-aftd +n{) 3 2O2O KISHOR KUMAR SAMMAN (Fi|m-LYRICS) : 2020

3I{eiul ( necovr M ENDAnoN) Tft{f,r mq q erko-oq fic qrqro.-{ According to seniority maximum three Recommendation

rfra-on/Lyrics Writer sqaFqqi, qrI[i6-q if'f 3IIErrt,/Achievement & Base of Recommendation

qITI : Name:

rkll :

Address :

ISvrv (uR m-{rnd'i. sro d d q-6 $)

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qTIJ : Name:

qTIT :

Address :

fuurv 1qR m-+6d i. era d d qe rff) Phone/lVfobile No. : Email:-

;nq : Name:

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Address : 3* Phone/lVlobile No. : Email:-

9Hr{tr' 5'1 ftaqqTDETArLS oF pRoposER qrqA.{ame: rwrex/Signature:

({'Tts/irdT{d vq {-n-d ero 6-r qot/Postal Address:

erEvfm wsrcr.F, (tsm'rg rfrq-q-a62s15 qt 7m sqfrr sqrffir€q, 1-flwirfr TrR srskrro * frd), *. cil fti.i sT qs st r ararlfr terga Er*rl;r . 2O2O (sro,rfu6, di+of,d-6 ?rq{+[dl, 3611-4, qfrqB, 3IIrzrGI, qjwr, sqrq uzi ft-f,rfl AE qfu tfti den + ftu) NANAJI DESHMUKH SAMMAN :2020 (person or institution in the field of social, cultural, spiritual, traditional and societal upliftment, harmony and development)

3r{siur (necoru MEN DATtoN) qt{dr ,rq q orlfoilq #q rrqifq According to seniority maximum three Recommendation

5tq 3leffir sFsil 6"I ;nq sq-AFqqi, Tfqf6-{ .D'I 3IlEfR,/Achievement & Base of Recommendation

llg : Name:

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;ITTI : Name:

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Address :

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iTTI : Name:

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Address :

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grvTderr-a C{ {-f-d srn sI qo/Postal Address:

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z.iril iD[;rEI sq-dfuifi, qrqr6-{ zFI 3flElrt/Achievement & Base of Recommendation

qITI : Name:

qTIT :

Address :

I-$rTIY (qR +{r{f, i. en d d ca rfr) Phone/Mobile No. : Email:-

BITI : Name:

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Address :

EiqTs (qR +{rgd q. er-a d d s-6.fr) Phone/MobileNo. : Email:-

;nq : Name:

qtTT : Address:

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9(Efl?ffi, iF.r frfiuI/DETAILS oF PROPoSER srqllrlame: rwrert/Signature:

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Tfrq-rr m-q fr srkodq 6q nqffi According to seniorify maximum three Recommendation

oft-oftftdlTeoet sq-AFqqfi, Tfqr+-{ iD-I 3llElft/Achievement & Base of Recommendation

TFI : Name:

IKIT :

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Address :

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qITI : Name:

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Address :

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Ar+rv7++rqa cq {-t"d srr 6-t qa/Postal Address:

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;It{ : Name:

ITcII :

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Address :

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9iIT : Address:

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sEC arqqr r*en o-r Trq gq-afud, qfql.D-{ oT glTqR/Achievement & Base of Recommendation

;ITT[ : Name:

IKII :

Address :

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;[TIT : Name:

qcn :

Address :

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1TII : Name:

qtIT :

Address :

3*'qrrnv (uft m-*t{d i. gra d d ar.fr) Phone/Mobile No. : Email:-

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3r{Qiur (necoru M EN DATtoN)

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gsq 3tq-iil s.*efi 6r Trq sq-aMqf, Trqr6-{ tD'I 3TlElR,/Achievement & Base of Recommendation

;IFI : Name:

gdl :

Address :

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IITI : Name:

qclT :

Address :

(tlils (qR +{r{d q. sra d d ce,fr) Phone/MobileNo. : Email:-

;IFI : Name:

qfIT :

Address :

3*'qwrv (rrfr m-qrgd i. gro d d m,fr) Phone/MobileNo. : Email:-

TKTFTft, +.T fr+tur/DETAILS oF PRoPOSER trqA.{ame: rromn/Signature:

{nTrsl+{r{f, W {-t-d Er6 or qor/Postal Address:

eryiur tiqrcrs', qqfr r (t-s-*.rs rlqm-a62s16 q{ Svot ssrd-ffiq, -ffi TrR orslilq * fr&), *'ct ffi o.r ou oi I IuqroTTailErrjl -2O2O (H fr aE fu u.f ilffi fir+ sd ql@ gtr6f 6 fuu to-c 6 f,i frl

3tlQiur (necour M EN DATtoN)

Tftq-dr m-q fr ofq-6dq fi{ qrqro.-{ According to seniority maximum three Recommendation

5-5rt 3I?IEI q.*gn or qrq ggdMqfi, Tfqliil-{ iD-f 3[IElR,/Achievement & Base of Recornmendation

qfq : Name:

9cll : Address:

I (qfr m-+lgd q-a Ss,Trs i. sro e} d fr) Phone/Irdobile No. : Email:-

IITI : Name:

rkfi :

Address :

krrq (qft dergcT c. Frd d d s-6 fi) Phone/lvfobile No. : Email:-

;[rI : Name:

rkll :

Address :

L'{$Trs (qR dqr{d i. sro d d s-6 !fi) PhoneilVlobile No. : Email:-

gNRIFTfi' 51 ftAqUTTDETAILS OF PROPOSER nrqArlame: eraru-t/Signature:

WTrqZdqr{d v+ {-+d s15 6l qar/Postal Address:

ot-gvru (ts-firq rfrqm-462915 qt.R Ev

3r{eiur (necoru MEN DATtoN)

{0-q-dr mq { 3Tk6-d-q fiq rrql-o-{ According to seniority maximum three Recommendation

s$q slerqr isrsn 6-r ;rFI scaMqfi, Trqrfi rF-I urqrqT4chievement & Base of Recommendation

ITTI : Name:

qdT :

Address :

1 an+rv (uR +{rE-d i. sro d d e-6 ,fr) Phone/Mobile No. : Email:-

qTTI : Name:

{iIT : Address:

(rurv 1qR qiryf, c. srd d d ae rff) Phone/lVlobile No. : Email:-

;TTTI : Name:

qiIT :

Address :

3*'qnnv (qR m-{rgd q. grd d d q-E rfi) Phone/MobileNo. : Email:-

gl.frTffi. q K+

WTrs/qhr{f, Tq {-t-d s;1-5 sr cdr/Postal Address:

qlq-q1-a62916 qu Twr wgvrvt t'flqrq', TiWfr vqm-,rreq, r-frrsr$ rrR (ts-firq srskncr + fr&), *. ct w rH sT st r ftrffi Fr-2O2o (ffiullffitutuu)

3trileiur (necorra M EN DATtoN)

Tftq-fl mq f oTko-flq fi{ Trqrf,q According to seniority maximum three Recommendation

trR-fliDn 6"I ;ITq sq-dffud, qrqrfi tfT $g1-gT4.hievement & Base of Recommendation

;ITTI : Name:

qiIT :

Address :

IErrrv (uR dmrgd t sro d d co,fr) Phone/Mobile No. : Email:-

qTIJ : Name:

qdT :

Address :

kqTs (qR +{rE-d c. srd d d e-6,fr) Phone/MobileNo. : Email:-

TFI : Name:

9clT :

Address :

L'qnnv (uR qf{r5d a. sro d d cE,fr) Phone/lVlobile No. : Email :-

}I-KIFFF, +T fu+IUT/DETAILS oF PRoPOSER qrqA.lame: rwnr

({flqTdqr{f, w {-t'd s1-5 6r qor/Postal Address:

ot-g{r$ (tsfirq }rskrrd rfrqr6-462s15 qT E.r+ frrfi?tr, ffi Tfsrfl{Eq, 1-ftrsrfr nrn * fr}), *'cA w ,M oe 6t r ftrffiilErra -2o2o tduktuftu)

rr{eiu (necoru M EN DATtoN)

qfts-dr m-q fr qErodq fi{ qrqrf,{ According to seniority maximum three Recommendation

grRr.q-orq itr'r rFI gq-Akd, Tfqf6-{ ?D'f 3llElft/Achievement & Base of Recommendation

iITI : Name:

tI-dT : Address:

1qrtTrs (qfr *+lgd i. sro d d ca.ft) Phone/IVlobile No. : Email:- iFI: Name:

tkfl :

Address :

(wn 1qP +-flEd i. sro d d rc rff) Phone/lvlobile No. : Email:-

;IFJ : Name:

ITiIT :

Address :

3*'qnnv 1qP +dT{d i. sro d d q-E rfi) Phone/MobileNo. : Email :-

gHr{+. OT K+IUT/DETAILS oF PRoPoSER qrq/Name: rwrcx/Signature:

WTrs/+{r{d Ts g-n-d s1-5 s-I qnr/Postal Address:

erglivr silcrf,-+ozoro qil q;t qu Srar H?rffit, {i$fd riETdrrflq, r -flvrer$ rrn (tsmrq ersldrer *'ctS), * w rH st r ftrffiiltrrn -2o2o (rifiUdilrlffififuu)

rr{eim (necou M EN DATtoN)

Tftq-dr m-q { orfho-flq fi-c qrqr6-{ According to seniority maximum three Recommendation

$rR-fffin iD"I ;IFI sq-afud, Trqr6-f if'f 3ilElR/Achievement & Base of Recommendation

qFI : Name:

gcII :

Address :

*{rurv 1 (vR +{rrd i. oro d d qE ,fr) Phone/Ivlobile No. :

;TT{ : Name:

rkll :

Address :

kqTs (qR m-+r5d c. Ern d d qa rff) Phone/IVlobile No. : Email:-

;ITTI : Name:

I qor: I oaa..r*

3* gp +-ora c srd d d s-6.fi) Phone/TvlobileNo.: I I Email :-

9KTIZIIF ffi KfiUT/DETAILS oF PRoPOSER qrq/lrlame: e-wnr/Signature:

{nTrslqhr{d g{ {-+-d s;1-5 @T qor/Postal Address:

ywn (tsmrq srsknfl rfrq61-462s16 rH qe erytw ffi +rekfirflq, r-ffi TrR * fr&), * cA.R ET 6t r ftrffiilErFr -2o2o tstioroarcilfufru)

:r{eiu ( necoru M EN DATIoN)

{ft{f,r mq f orlfqrflq fi-{ Trqio.-{ According to seniority maximum three Recommendation

iD-dT.D"rt iD'I ;IFI gq-aMd, qfqffi if-f 3llqR,/Achievement & Base of Recommendation

nrq : Name:

qflT :

Address :

I-q{'Trs (?TR +{rgd c. Ero ei d s-6.fr) Phone/Mobile No. : Email:-

TFI : Name:

9clT :

Address :

t$Ts (qft qi{r{d i. sro ei d m ,fr) Phone/MobileNo. : Email:-

iFI : Name:

q.IT : Address:

L'qilTrq (qR m-{iE-d i. sro d d s-6 fi) Phone/Mobile No. : Email:-

HffiTfl{. OT ft-+IUT/DETAILS oF PROPoSER =TrqA.,lame: rrcnrt/Signature:

qnrrql+{r{d G {-n-d g1q @I qar/Postal Address: (ts-firq qlqr€-452s16 5-wr eryiw +fltrir, tq.n *re-+ma, r-flvrqrfi nrR orsmrfl * fr&), *, cfr w M *.r os 6t r ftrffiggrn -2o2o (fer6fus)

rrgeiut (necoru M EN DATtoN)

Tfts-dr m-q d sTfuo-ilq fi-{ ;Tmiffi According to seniority maximum three Recommendation

o-drfirt iDl lIrI wakd, Tfqr6-{ iD'I 3llElT{,/Achievement & Base of Recommendation

qrq : Name:

qtIT :

Address :

Iqrwv (uR d-+rgd q. sro d d s6 fi) Phone/lVlobile No. : Email:-

iFI : Name:

qiTT :

Address : ) furv iqP m-+rqd i. sro d a} m ,fr) Phone/IVlobile No. : Email:-

;ITTI : Name:

9clT : Address:

3*'qnnv (uR +{r5d c. srf, d d ar.ff) Phone/lvlobile No. : Email :-

gKI-{S. 51 ft-AqUTTDETAILS oF PROPoSER qrqllriame : rwrert/Signature:

{rrTrqldqr{d rq {-i-d s;1-q' 6-I rrm/Postal Address:

u-gssr lislqrfr, €srd-fldq, 1-Rrsr$ (t-sfirq 3rskle rfrqrf,-a62616 qt gH qs Twr ffi T'R *'*d), * cA or st r ftnffiutrrn -2o2o (arcofuftilu)

sr{eim (necorta M EN DATtoN)

Tft{dr m-q i orlfo-f,q fi-c qrqro-{ According to seniority maximum three Recommendation

6-6IT6-rt ib-I iFI sq-ofutfi, Trqr.D-{ iD'I 3llErR,/Achievement & Base of Recommendation

iITI : Name:

qdT :

Address :

I5tqrs (qR r)-{r{6T c. flif, d d aa .fr) Phone/MobileNo. : Email:-

qITJ : Name:

qTTT :

Address :

funv 1qP ++r5d t sro d d m.fr) Phone/Mobile No. : Email :-

1ITI : Name:

qdl :

Address :

3*'qurnr (uft qf+rgd i. sra d d m.fi) Phone/lVlobile No. : Email :-

q-ftIFrfi' 5T ft4-qETDErArLS oF pRoposER qm/Name: rwnn/Signature:

qt.rrsZ+{r{d gq {-i-d{ sr?F 6r qor/Postal Address:

u-gvrcn t'eter.F, (t-sfirq rlq-6-452s15 qz $.lvt Tffid eqre-troq, l-ffi TrR srskn€ * fr&), * cil cr rH HT qt r ftrffi$Enf, -2o2o t+ftafufuu)

rrdeisr (necoru MENDATIoN) qfts-crr oq d effo-a-q fi-{ qr{ro-{ According to seniority maximum three Recommendation

o-drfiR ir-t lTrI gq-oM, fl:qifi .trI ollgrR,/Achievement & Base of Recommendation

1TTI : Name:

tK[I :

Address :

*qrurv I (uR m-+rgd c. Eid d o) ca,fr) Phone/lvlobile No. : Email :-

qIII : Name:

qTIT :

Address :

fum 1qP +{r{dr i. sro e} e} s-d fi) Phone/]vlobile No. : Email :-

iITI : Name:

rkll :

Address :

L'qnnv (uft qf{igd {. sro d d qr ,ft) Phone/lVlobile No. : Email:-

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{$Trql+{r{d w {-+d 3;1-s 6-t qor/Postal Address:

p.vw lrgYisr riqler6', qqm-lieq, r (t-c-firs orsknf, q{ ,}cA ffid -ffi TrR + frS), *qrd-462016 * cA Er os st r ftrffiugrFr -2o2o tmffiuddt6oapilfifuu)

sr{eiur (necoru M EN DATToN) Tftqdr o-q { qko-o-q fi{ qrqrfi{ According to seniority maximum three Recommendation

dElTifrt iDT ;ITq vq-aM, Tl-{im-{ irl 3llEll{,/Achievement & Base of Recomrnendation

ilq : Name:

qCII : Address:

1 awrv (vR m-{rad c. Ea d d m ,fr) Phone/IVlobile No. : Email:-

;IITT : Name:

ITdT :

Address :

kiqrs (qR +qT{d i. sro d d e-6.fi) Phone/Tvlobile No. : Email :-

iTTI : Name:

tl.ilT :

Address :

3*'Xwrv (ufr q)-{rrd q. sn d d w ,fr) Phoneilvlobile No. : Email:-

gHt-{s' fl ft-fiIf/DETATLS oF pRoposER qrqA.{ame : ewnrt/Signature:

{rurvTf+rra gs {-ta Gr6 or qor/Postal Address:

F.r+ eryiw {iqe,rs-, {i$fr qqtoilf,q, r -ffi TrR (i-s-firq srsdrer + fi&), rtwo-ffi ftrffiilqrfl -2o2o tfdrrdrsffiFrfufuu)

sryiul (necoru M EN DATtoN)

Tft{dr m-q { srkodq frq il-qr6-{ According to seniority maximum three Recommendation

ir-anif'Fl oT ;IIq sqakcfi, qrqifi tD.r gllElF,/Achievement & Base of Recommendation

IITI : Name:

qiTT : Address:

1q{'Trs (qR ++rga c. Erd d d a-a.fi) Phone/lvlobile No. : Email:-

qIII : Name:

q.II :

Address :

(*nv 1qft qf+r{d d. sro d ril qe rff) Phone/lVlobile No. : Email:-

;IT+I : Name:

qiIT : Address:

L'({'Trs (qR +fl{d c. srfl d d q-a fi) Phone/lVfobile No. : Email:-

II-KIIZIUfi' + K+IUT/DETAILS OF PROPOSER qrqA.{ame : awert/Signature:

6wv7f+rra cq {-+-m s1-5 znt qor/Postal Address: pv+rerym{i{rf,+., Tiq.frs'srf,-fldq, r-ffiT'R (tsfirssrskTto*frd), r}qrd-452916*.cAq{ !Hslezotr