lqe'jg ljZjljBfno
k/LIff lgoGq0f sfo{fnoaNv'ldlt M =========================>Ldfg\ k/LIff lgoGqsHo",d}n] jflif{s k/LIff k|0ffnL cg';f/ lgDglnlvt Joxf]/fsf] k/LIff pQL0f{ u/]sf] 6«fG;lqmK6 kfpg z'Ns ?===========.– ;lxtof] lgj]bg u/]sf] 5' .
ljBfyL{sf] k"/f gfd-In English)
Block Letter
ljBfyL{sf] k'/f gfd-b]jgfu/Ldf_
cWoog ;+:yfg jf ;+sfo

lq=lj=btf{

d"n ljifo

pQL0f{ u/]sf] tx

SofDk;sf] gfd
k/LIff lbPsf] ljj/0f
jif{
@)
@)
@)
@)
@)
@)

k|yd jif{/f]n g+= jif{
@)
@)
@)
@)
@)
@)

Dff]afO{n g+= M=====================lgj]bsn] Wofg lbg' kg]{ s'/fx? MlåtLo jif{/f]n g+=

jif{
@)
@)
@)
@)
@)
@)

Od]n M ================================

t[tLo jif{/f]n g+=

jif{
@)
@)
@)
@)
@)
@)

rt'y{ jif{/f]n g+=============================-ljBfyL{sf] b:tvt_!= lq=lj=/lhi6«]g g+= / k|fKt dfs{;L6x?sf] clen]v ?h' ubf{ Ps?ktf gePdf /lhi6«]zg sf8{sf] k|ltlnlk, ;Ssn dfs{;L6, ;Ssn k|j]z kq,
gful/stfsf] k|ltlnlk / SofDk; tyf If]=k=lg=sf=sf] l;kmfl/; kq ;+nUg u/L ;DalGwt uf]Ko zfvfdf clen]vdf Ps?ktf sfod ug{ lgj]bg lbg]
. lgj]bgdf sf/jfxL eO{ ;a} clen]vfdf Ps?ktf eP kZrft\ dfq 6«G;lqmK6sf] nflu of] lgj]bg k]z ug]{ .
@= k/LIff jif{, /f]n g+=, k/LIff lbP cg';f/ qmd ldnfP/ z'4 / :ki6;+u n]Vg' kb{5 . cGoyf 6«fG;lqmK6 tyf k|f]lehgn ;l6{lkms]6 tof/ x'g] 5}g \ .
#= lgj]bgsf] ;fydf o; sfof{noaf6 ljBfyL{nfO{ lbO{Ps]f /lhi6«]zg :nLksf] kmf]6f]skL ;+nUg ug'{kb{5 .
$= ;DalGwt ljBfyL{n] rf]/L ePsf], x/fPsf], cfunfuL jf cGo dgfl;j sf/0f v'nfO{ ;f]sf] ;DalGwt SofDk;sf SofDk; k|d'v / k|fO{e]6 ljBfyL{x?n]g]kfn ;/sf/sf] clws[t jf ;f] ;/xsf clws[tn] k|dfl0ft u/fP kl5 dfq k|ltlnlk lbO{g]5 . 6«fG;lqmK6 tyf k|f]lehgn ;l6{lkms]6 lnPsf] ^dlxgf gk'Ub} x/fPdf k|x/L sfof{nosf] l;kmfl/;kq ;d]t k]z ug'{kg]{5 .
%= o; sfof{noaf6 6«fG;lqmK6 / k|f]lehgn ;l6{lkms]6 lng] k/LIffyL{x?sf] y]l;;sf] dfs{ OG6«L u/]sf] / kmd{ e/]sf] ldn]sf] 5 eg] lgj]bg lbPsf] %lbgleq ;DalGwt ljBfyL{sf] kl/ro v'Ng]] -kmf]6f] ePsf]_ kl/ro kq / z'Ns a'emfPsf] /l;b x]/]/ dfq lbO{g]5 .
^= Ps dfq d"n ljifo lbg] ljBfyL{x?sf] nAwf+s–kq dfq lbO{g]5 .
&= lq=lj=k=lg=sf=sf] gfddf Unf]an a}+=ln=df /x]sf] r=lx=g+= )%)!)!))))%)) / g]=a}=ln df /x]sf] r=lx=g+= )$%!!^)))((!!)))))!) df /sd
a'emfPsf] ef}r/nfO{ k=lg=sf=sf] n]vf cfDbfgL zfvfdf a'emfO{ 5fk nufO{ ;DalGwt 6«fG;lqmK6 zfvfdf a'emfpg' kg]{5 .
*= lzIffzf:q SofDk;, sLlt{k'/ / ;a} :gftsf]Q/ txsf] 6«fG;lqmK6 tyf k|f]lehgn ;l6{lkm]s6 lng cfpFbf s]Gb|Lo k':tsfnosf Library Clearance
Card clgjfo{ ?kdf k]z ug'{kg]{5 .
(= s'g} klg txsf] 6«fG;lqmK6, k|f]lehgn ;l6{lkm]s6 ln+bf k/LIff lbPsf] ;a} jif{sf] nAwfÍkqsf] k|ltlnlk -kmf]6f]skL_ clgjfo{ ?kdf a'emfpg' kg]{5 .
!)= s'g} 6«fG;lqmK6 k|f]lehgn ;l6{lkm]s6df sfof{nosf] tk{maf6 k|fljlws q'6L x'g uPdf k|fKt u/]sf] ldltn] #% lbg leq ;Rofpg lgj]bg lbg' kg]{5 .
pQm cjlw kl5 ;Rofpg k/]df k"/} z'Ns nfUg]5 .
6«fG;lqmK6z'Ns
6«fG;lqmK6
z'Ns!= k|jL0ftf k|df0fkq tx -;]d]i6/_#%).–
k|jL0ftf k|df0fkq tx -jflif{s_#%).–@= :gfts tx -;]d]i6/_%%).–:gfts tx -jflif{s_$%).–#= :gftsf]Q/ tx -;]d]i6/_&%).–:gftsf]Q/ tx -jflif{s_%%).–!!= :gfts÷:gftsf]Q/ txsf] nflu lbOg] k|f]lehgn ;l6{lkm]s6 ;f] ;d"xsf] bLIffGt ;df/f]x geP;Ddsf] nflu x'g]5 .
!@= :yfoL k|df0fkq bLIffGt ;df/f]x ;DkGg ePkl5 pknAw x'g]5 .
!#= k/LIffyL{x?n] cfk"mn] k|fKt u/]sf] 6«fG;lqmK6÷k|df0fkq x/fPdf jf s'g} sf/0f gi6 ePdf ;f] 6«fG;lqmK6 x/fPsf] jf gi6 ePsf] xf] eGg] tf]lsPsf
cflwsfl/s lgsfox?sf] l;kmfl/; kqx? / lgh k/LIffyL{sf] gful/stfsf] k|dfl0ft k|ltlnlk ;lxt tf]lsPsf] ;fljs z'Nsdf klxnf] k6s bf]Aa/ /bf];|f] k6s t]Aa/ b:t'/ a'emfO{ SofDk;sf] l;kmfl/; ;lxt cfj]bg lbPdf a9Ldf b'O{k6s;Dd k|ltlnlk 6«fG;lqmK6 lbOg]5 .

-/lhi6«]zg gDa/ sfod ug]{, ;Rofpg], uon (Absent) x6fpg], gfdy/ ;Rofpg], ljifo sfod ug]{
tyf x6fpg] ;DaGwL lgj]bg
ldlt M @)====÷======÷
>Ldfg\ k/LIff lgoGqsHo",k/LIff lgoGq0f sfof{no aNv' .
-============================= uf]Ko zfvf_
ljifo M clen]vdf Ps¿ktf sfod ug]{ ;DaGwdf .
>Ldfg\,
pk/f]Qm ljifodf d]/f] ======================================================================= txsf] tkl;ndfpNn]lvt dfs{;L6x¿df /lhi6«]zg cg';f/ Ps¿ktf sfod ePsf] gb]lvPsf]n] clen]vdf Ps¿ktf
sfod ul/lbg' x'g cg'/f]w ub{5' . ;fy} lgodfg';f/ nfUg] b:t'/ a'emfPsf] ef}r/ o;};fy ;+nUg 5 .
tkl;nl;= Year/Semester /f]n g+=
;fn
ePsf]
sfod ug'k{ g]{g+=;+nUg M!= /lhi6«]zg sf8{sf] k|ltlnlk@= ;Ssnk|a]z kqx¿#= ;Ssndfs{;L6$= SofDk; / ;DalGwt If]=k=lg=sf=sf] l;kmfl/; kq%= cfjZostf cg';f/ gful/stfsf] k|df0fkqsf] k|ltlnlk
ejbLo,
ljBfyL{sf] x:tfIf/ M
gfd M/lhi6«]zg g+= M
tx M
SofDk; Mdf]afO{n g+= M
Od]n M! k|lt=======k|lt========k|lt========k|lt========k|lt

ldlt M @)*==÷ ÷>Ldfg\ k/LIff lgoGqsHo",
lq=lj=k/LIff lgoGq0f sfof{no,aNv' .
ljifo M k|ltlnlk dfs{;L6 kfpFm eGg] af/] .
dxf]bo,pk/f]Qm ;DaGwdf dnfO{ lgDgfg';f/sf] k|ltlnlk dfs{l;6sf] cfjZostfk/]sf]n] pknAw u/fO{ lbg' x'g cg'/f]w ub{5' . ;f] jfkt k|lt dfs{l;6 ?=!@%.– sfb/n] Unf]an cfO{PdO{ a}+s ln=df a'emfPsf] a}+s ef}r/ o;};fy ;+nUg u/]sf] 5' .
l;=g+=!=

k/LIff /f]n g+=======================;fn==================

v08=====================@================================================================#================================================================lgj]bs,gfd M ===================================
SofDk; M ==============================;+sfo M ================================
tx M ====================================/lh=g+= M ===============================

lqe'jg ljZjljBfno
k/LIff lgoGq0f sfo{fno, aNv'
ldlt M @) .

.

>Ldfg k/LIff lgoGqsHo" ,k/LIff lgoGq0f sfo{fno, aNv' .
ljifo M l/6f]6lnË ul/lbg] af/] .
dxfzo,
lq=lj= åf/f @)*=== ;fnsf]=============== dlxgfdf ;+rflnt============================== k/LIffdf lgDg
ljifo / kqdf kfPsf] cÍ lrQ ga'em]sf]n] lgodfg';f/ dfs{ l/6f]6lnË u/fpg k|To]s kqsf] ?=@)).–
sf b/n] nfUg] z'Ns hDdf ?= ==============a}+s ef}r/ ;lxt lgj]bg u/]sf] 5' .
SofDk;sf] gfd M/]u'n/÷k|fOe]6

ljBfyL{sf] k"/f gfd M

cWoog ;+:yfg÷;+sfo

k/LIff s]Gb|sf] gfd M

lq=lj=btf{ g+= M

k/LIff qmdfÍ M

qm=;+=

v08 M k|yd÷låtLo÷t[tLo÷rt'y{

ljifo

kq

k|fKtf°s}lkmotgf]6 M ljifo, k/LIff qmdfÍ, k/LIff s]Gb| / 7]ufgf :ki6;Fu eg'{ xf]nf .

======================
ljBfyL{sf] b:tvt
kmf]g g+= M

lqe'jg ljZjljBfno

k/LIff lgoGq0f sfof{nok/LIff /f]n g++ x]g]{ lgj]bg – kmd{
ldlt M @)* .

.

>Ldfg\ k/LIff lgoGqsHo",k/LIff lgoGq0f sfof{no, aNv' .
dxf]bo,d]/f] tkl;n adf]lhd ;fnsf] dfs{;L6 Pj+ k|j]z –kq ;d]t x/fPsf] / xfn dnfO{ 6«fG;lqmK6 lngsf]
nflu pQm /f]n g+=x? cfjZos k/]sf] x'gfn] ;f] pknAw u/fO{ lbg' x'g k|lt /f]n g++ ?=%).– sf b/n] x'g
cfpg] hDdf /sd ?=.– ;lxt lgj]bg ub{5' .
tkl;nl;=g+= /f]n g+= x]g'{kg]{ /f]n g+= x]g'{kg]{
;fn
v08

!
#
%
&
(
!!
!#
!%

x]l/Psf] /f]n g++=l;=g+= /f]n g+= x]g'{kg]{;fn/f]n g+= x]g'{kg]{ x]l/Psf] /f]n g++=
v08

@
$
^
*
!)
!@
!$
!^
_____
x:tfIf/k/LIffyL{sf] ljj/0f!_ k/LIffyL{sf] k"/f gf -c+u|]hLdf_ =======================================================================================@_ k/LIffyL{sf] k"/f gfd -g]kfnLdf_ M– =================================================================================#_ SofDk;sf] gfd M– =========================================== $_ lq=lj=btf{ g++ M– ===========================%_ cWog ;+:yfg÷;+sfo M– =================================== ^_ tx M– =======================================

lqe'jg ljZjljBfno
k/LIff lgoGq0f sfof{no, aNv'

ldlt M>Ldfg\ k/LIff lgoGqsHo",k/LIff lgoGq0f sfof{no,aNv' .
dxf]bo,dnfO{ b]xfodf pNn]v ul/P adf]lhdsf] O{G6/÷k|df0fkq tx÷k|jL0ftf k|df0fkq txsf] ;Ssn k|df0fkq
kfpg z'Ns ?=!))).– sf] a}+sdf hDdf u/]sf] ef}r/sf] ;Ssn /l;b Pj+ 6«fG;lqmK6 / gful/stfsf] k|df0fkqsf]
kmf]6f]skL o;};fy ;+nUg u/L lgj]bg u/]sf] 5' .
lgj]bssf]!= k"/f gfd, y/ -g]kfnLdf_ M@= k"/f gfd, y/ -c+u]|hLdf_ M#= lnË M$= 7]ufgf M%= pQL0f{ u/]sf] k/LIff tx M^= cWoog ;+:yfg÷;+sfo M&= 6«fG;lqmK6 O:o" g++= M*= k/LIffsf] clGtd /f]n g+= M(= pQL0f{ u/]sf] ;fn M!)= pQL0f{ u/]sf] >]0fL M!!= /lhi6«]zg g+= M!!= SofDk; M==========================lgj]bssf] b:tvtdf]afOn g+=M ============================

b|i6Jo M != of] lgj]bg;fy 6«fG;lqmK6sf] / gful/stfsf] ;kmf kmf]6f]skL ;+nUg ug'{ kg]{5 .
@= k|df0fkq lng rfxg] JolQmn] lgj]bg a'emfP kl5 o; sfof{non] af]nfPsf] ;dodf
kl/ro kq÷gful/stf k|df0fkq÷lgjf{rg kl/ro kq÷kf;kf]6{÷jf kmf]6f], k|dfl0ft;Ssn k]z ug'{ kg]{5 .
#= cfjZos z'Ns Unf]an cfO{PdO{ a}+s ln=jf g]=a}=ln=aNv'df hDdf u/]sf] ef}r/k=lg=sf=sf] n]vf zfvfdf a'emfO{ /l;b -ekf{O{_ agfPsf] x'g'kg]{5$= /l;b x/fPdf ?=!)).– lt/L k|ltlnlk lng'kg]{5 .
%= of] lgj]bg a'emfPsf] !% lbg kl5 k|df0fkq kfO{g]5 .
_____________________________________________________________
6«fG;lqmK6 zfvfaf6 k|dfl0ft ug]{sf],b:tvt M
gfd M
ldlt Mlqe'jg ljZjljBfno

k/LIff lgoGq0f sfo{fno, aNv'
ldlt M @) ÷ ÷>Ldfg\ k/LIff lgoGqsHo",dfkm{t M >L SofDk; k|d'vHo"dxf]bo,dnfO{ lqe'jg ljZjljBfnoaf6 cGo ljZjljBfnodf cWoog ug{ hfg, :yfgfGt/0f k|df0fkq
dfOu|];g ;l6{lkms]6_ cfjZos ePsf]n] ?=!))).– sf] g]=a}+=ln=aNv' zfvfsf] ef}r/ o;};fy /fvL lgj]bg u/]sf] 5'. d]/f] k/LIff ;DaGwL ljj/0fx? lgDg k|sf/sf 5g\ . SofDk;sf] /]s8{df s}lkmot hgfO{ pQm dfOu|];g ;l6{lkms]6
lbnfO{ lbg' x'g cg'/f]w ub{5' .
!= k'/f gfd -g]kfnLdf_ M@= k'/f gfd -c+u|]hLdf 7"nf] cIf/df_ M#= :yfoL 7]ufgf M$= lq=lj=btf{ gDa/ M%= gfd btf{ ePsf] SofDk; M^= SofDk;sf] /f]n g+= M&= cWoog ;+:yfg/ ;+sfo M
dfOu]|;g ;l6{lkms]6 rflxPsf] sf/0f Mlgj]bssf] pk/f]Qm ljj/0f ?h" u/L SofDk;sf] /]s8{df s}lkmot hgfO{ ;lsPsf]5 . pQm k|df0f kq SofDk;df
k7fO{ lbg' xf]nf cyjf ljBfyL{nfO{ g} lbg' xf]nf egL l;kmfl/z ug]{ ;DalGwt SofDk; k|d'vsf] ;xL, ldlt /sfo{fnosf] 5fk .
k|fOe]6 5fqsf] xsdf g]kfn ;/sf/sf] zfvf clws[t jf ;f] eGbf dflysf clws[taf6 l;kmfl/z u/fO{ kb;d]t v'Ng] u/L sfo{fnosf] 5fk nufP/ Nofpg' kg]{5 .
SofDk;sf lgoldt cWoog ug]{ tyfk|fOe]6sf] xsdf g]kfn
lgj]bssf] k"/f ;xL
ul//x]sf ljBfyL{sf nflu;/sf/sf] clws[tsf] b:tvt
tyf 7]ufgf M
SofDk; k|d'vsf] b:tvt SofDk;sf] 5fk M/ 5fk Mb|i6Jo M!= dfOu]|;g lng] ljBfyL{n] k/LIff lgoGq0f sfof{non] pknAw u/fPsf] /lhi6«]zg sf8{ jf:nLk klg clgjfo{ ?kdf of] lgj]bg;+u} k]z ug'{kg]{5 .
@= dfOu]|;g a'lem lng ;DalGwt ljBfyL{sf] kmf]6f] ;lxtsf] kl/ro kq, gful/stfsf] k|df0fkq jf
lq=lj=sf] k/LIffdf ;fd]n ePsf] kmf]6f] ;lxtsf] k|j]zkq b]vfO{ l7s b]lvPdf dfq lbOg]5 .
#= cfkm} gcfO{ c?nfO{ k7fPdf x:t]jf/Ldf lbOg] 5}g t/ dfOu]|;g kfpg] ;DalGwt ljBfyL{
tyf dfOu]|;g lng cfpg] JolQm b'a}sf] ;Ssn tyf k|ltlnlk gful/stf NofP kl5 dfq lbg;lsg]5 .
$= dfOu|];g lnP kl5 lq=lj=sf] s'g} klg k/LIffdf ;lDdlnt x'g kfOg] 5}g, ePdf k/LIff /2 x'g]5 .
%= dfOu|];g kfpgsf] nflu lgj]bg k]z u/]sf] #% -k}QL;_ lbgleq dfOu|];g a'lem lnO{ ;Sg' kg]{5,cGoyf sfof{no hjfkmb]xL x'g] 5}g . Psk6s dfOu|]zg lnO{ ;s]kl5 x/fPdf jf gfl;Pdf k|ltlnlk kfO{g]5}g .

To The Controller,
Office of The Controller of Examinations,
Balkhu, Kathmandu, Nepal .
Dear Sir,I request you for the Duplicate T.U.Registration Memo Slip with Bank Voucherof Rs. 200/- (Two hundred)
Write in Block Letter
Name in Nepali : ...............................................................
Name in English : ..............................................................
Father's Name : ..................................................................
First Registered Campus Name : .......................................
Faculty : .................................................

Date of Birth : ................................

Admit Year : .........................................

Level : ............................................

T.U.Registration Number : ............................
...........................................
Full Signature of Applicant