1. This document is a letter regarding the registration of a cooperative/society formed in 2003 under the name [name removed]. 2. The cooperative/society is requesting registration as it was formed based on the 12th Kerala Cooperative Societies Act of 1955. 3. The letter provides details of the members of the cooperative/society such as their names and addresses.

1. {]kn-Uâv/sk{I-«dn
PnÃm cPn-kv{SmÀ/skmsskän cPn-kv{SmÀ
Xncp-h--´-]pcw
kÀ,
hnjbw:-þ kwLw cPn-ÌÀ sN¿p-¶Xv kw_-Ôn¨v
kqN:þ cPn-kvt{S-j³ ¼À. än. 2003
...................................................
200 am-v amkw þmw XobXn IqSnb s]mXp-tbmK Xocp-am--{]-Im-cw
.................................................................................................................................. F¶ t]cn Hcp kanXn- /kwLw cq]o-I-cn-¨p. Cu
kanXn/kwLw 1955 þ se 12-þmaXv Xncp-hn-Xmw-IqÀ sIm¨n kmln-Xy imkv{Xob [mÀ½nI kwL-§Ä cPn-kv{Sm-¡Â BIvSv
Ap-k-cn-¨pÅ Hcp kwLw / kan-Xn-bmbn cPnÌÀ sN¿m³ Xocp-am-n-¨n-cn-¡p-¶p. Bb-Xnm Sn kwLw / kanXn cPn-ÌÀ
sNbvXp Xc-W-sa¶p At]-£n-¡p-¶p.
hniz-kvX-X-tbm-sS,

2. {]kn-Uâv / sk{I-«dn
Øew:þ
XobXn:þ
Un¢-td-j³
Nmcn-ä-_nÄ skmsskän BIvSv Ap-k-cn¨v Cu Øe¯v CtX t]cn Hcp kwL-S Ct¸mÄ cPn-ÌÀ sNbvXp
{]hÀ¯n-¡p-¶nà F¶p-IqSn CXn-m kXyw t_m[y-s¸-Sp-¯n-sIm-Åp-¶p.
HutZym-Kn-I-Ømw t]cpw taÂhn-em-khpw
H¸v

3. 1.
2.
3.
sat½m-dm-w Hm^v Atkm-kn-tb-j³
1. kwL-¯nsâ t]cv :

4. 2. taÂhn-emkw :
t]mÌm-^o-knsâ t]cv :
3. A[n-Im-cm-XnÀ¯n :
4. Dt±-i-§Ä :
1. AwK-§-fpsS CS-bn ka-Xzhpw kmtlm-Z-cyhpw GÀs¸-Sp-¯p-I.
2. AwK-§-fpsS km¼-¯n-I-hpw, kmwkvIm-cn-I-hpw, kmaq-ln-I-hp-amb A`n-hr-²n-¡p-th-n {]hÀ¯n-¡p-I.
3. sXmgn cln-X-amb AwK-§Ä¡v kzbw sXmgn Is--¯p-¶-Xnv Bh-iy-amb sXmgn ]cn-io-e tI{µ-§Ä Øm]n-¡p-I,
sXmgn kuIcyw D-m¡n sImSp-¡p-I.
4. kmln-Xym-`n-hr-²n-¡p-th-n hmb-m-im-e, {KÙ-im-e, NÀ¨m ¢mÊp-IÄ, {]kn-²o-I-c-W-§Ä F¶nh GÀs¸-Sp-¯p-I.
5. hnZym-`ym-k-an-Ãm-¯-hÀ¡p-th-n ÌUn-¢m-Êp-IÄ GÀs¸-Sp-¯p-I.
6. mSnsâ ³a-bv¡p-th-n sFIy-t¯m-Sp-IqSn kmaq-ln-I-tk-hw S-¯p-I, km[p- ¡-fmb P-§-fpsS kÀÆ-tXm-
·p-J-amb A`n-hr-²n-¡p-th-n {]hÀ¯n¡p-I.
7. BXp-c-im-e-Ifpw, Am-Y-im-e-Ifpw S-¯p-I.
8. AwK-§-fpsS Iem-`n-cpNn hfÀ¯p-I, kwKo-Xw, Nn{X-sa-gp-¯v, mS-Iw, Um³kv, t^mt«m-{Km^n
aäv kpIp-amc Ie-IÄ, IY-I-fn, Hm«³Xp-ÅÂ, IYm-{]-kwKw apX-em- b-h-bpsS A`n-hr-²n-¡p-th-n kuI-cy-
§Ä GÀs¸-Sp-¯p-I.

5. 9. AwK-§-fpsS Btcm-Ky-kw-c-£-W-¯nv PnwJm-, tbmKm-`ymk ¢mÊp-IÄ, kvt]mÀSvkv Ch
S-¯p-I.
10. imkv{Xo-b-amb coXn-bn sXmgnÂ, Irjn, Ch S-¯p-¶-Xn-p-th- ÌUo-¢m-Êp- IÄ, imkv{X ]Tw
Ch S-¯p-I. Kth-j-W-§Ä S-¯p-¶-Xnv Øm]--§Ä S-¯p-I.
11. Nn{X-§Ä aäv Iem-]-c-amb ]Wn-IÄ, {]IrXn Ncn-{X-]-c-amb kw`-c-W-§Ä bm{´n- I-hpw, XmXzo-I-
hp-amb I-p-]n-Sn-¯-§Ä D]-I-c-W-§Ä AYhm DÂ]-¶-§Ä Ch {]ZÀin-¸n-¡p¶ ayqknbw Kymedn Ch-
bpsS Øm]--¯npw kwc-£-W-¯npw th-n {]hÀ¯n-¡p-I. Ah-cpsS kwL-S--IÄ¡v / kan-Xn-IÄ¡v bpà-sa-
¶p-tXm-¶p¶ Dt±-i-§Ä aäp-h-Ã-hbpw Ds--¦n Ahbpw tNÀ¡m-hp-¶-Xm-Wv.
12 ssPh-Irjn hym]-I-am-¡p-I. anX-amb nc-¡n aäp-Å-hÀ¡v hnj-c--lnX `£y-[m- y-§Ä Dev]m-Zn-
¸n-¡p-Ibpw hn]-Ww S-¯p-Ibpw sN¿p-I.
13 ImÀjn-I-cw-K¯v qX--amb kvtI-XnI hnZy-IÄ¡v {]mapJyw ÂIp-Ibpw S-¸n- em-¡p-Ibpw sN¿p-
I.
14 ]c-¼-cm-KX hn¯n--§Ä I-s--¯p-Ibpw kwc-£n-¡p-Ibpw sN¿p-I.
15 IÀj-IÀ¡pw IÀj-I-sXm-gn-em-fn-IÄ¡pw ImÀjn-I-cw-K¯v Imem-p-K-X-amb ImÀjnI hnÚmw ]IÀ¶p-sIm-Sp-¡p-I.
16 ImÀjn-tIm-ev]-¶-§Ä kwcw-`n-¡p-Ibpw hn]-Ww S-¯p-Ibpw sN¿p-¶-Xnv th-n kzm{ib hn]Wn Øm]n-¡p-I.

6. Un¢-td-j³
hÀjw amkw XobXn ..................... IqSnb s]mXptbmK Xocp-am {]Imcw Cu kwLw /
kamPw -1955 se Xncp-hn-Xmw-IqÀ-þ-sIm¨n kmln-Xy þ imkv{X [mÀ½nI kwL§Ä cPn-Ìm-dm-¡Â BIvSv Ap-k-cn-
¨pÅ Hcp kwL-ambn / kam-P-ambn cPn-ÌÀ sN¿m³ Xocp-am-n-¨n-cn-¡p-¶p. Bb-Xn-te¡v `mc-ta¸n-¡-s¸« `cW
kanXn AwK-§-fpsS t]cpw H¸pw.
t]cv taÂhn-emkw sXmgn H¸v
{]knUâv: 1) ssjte-PvIp-amÀ.-Un., hm-Ko-`-h³, ]g-b-Ip-¶p-t½Â
sk{I-«dn : 2) F.-lw-k-¡p-ªp, dmknn-hm-kv, ]pXn-b-Im-hv, Infn-am-qÀ
{Sj-dÀ : 3) kpaÂ.-F³.-kn., kpim-´v, ]pXn-b-Im-hv, Infn-am-qÀ

7. ssh: {]kn: 4) _np, tkm]m-t, sSp-¼-d-¼v.]n.H
5) apl-½Zv Ckvam-bnÂ, CSp-]-Sn-¡Â, ]pXn-b-Imhv
6) {ioIp-amÀ.-BÀ, I-I-¸-Ån-ho-Sv, ]g-b-Ip-¶p-½Â
7) Aw_n
8) {]Zo-]v sI.-F-kv.-F-^v.C , iàn `h³, tah-d-bv¡Â, Bew-tImSv
9) A`n-em-jv, BÀ.-]n.-`-h³, ]m¸m-e, Infn-am-qÀ
10) kpIp-am-c³, Ipgn-hn-f-ho-Sv, IÃ-tIm-Ww, Infn-am-qÀ
tPm: sk: 11) _nPn-tamÄ þ s]mcp-´-a¬, _nPp-`-h³, ae-¨n-d, Xmfn-¡pgn ]n.H
kwL-¯nsâ / kam-P-¯nsâ n_-Ô--IÄ
1. kwL-¯nsâ t]cv :
2. taÂhn-emkw :

8. Unkv{SnIvSv :
Xmeq¡v :
]©m-b¯v :
hntÃPv :
3. B^okv :
4. {]hÀ¯ ]cn[n:
5. Dt±-i-§Ä :
1. AwK-§-fpsS CS-bn ka-X-zhpw kmtlm-Z-c-yhpw GÀs¸-Sp-¯p-I.
2. AwK-§-fpsS km¼-¯n-I-hpw, kmwkv¡m-cn-I-hpw kmwkvIm-cn-I-hp-amb A`n-hr-²n-¡p-th-n {]hÀ¯n-¡p-I.
3. sXmgn cln-X-cmb AwK-§Ä¡v kzbw sXmgn Is--¯p-¶-Xnv Bh-i-y-amb sXmgn ]cn-io-e tI{µ-§Ä Øm]n-¡p-
I, sXmgn kuI-cyw D-m¡n sImSp-¡p-I.
4. kmln-X-ym-`n-hr-²n¡pth-n hmb--im-e, {KÙ-im-e, NÀ¨m ¢mÊp-IÄ, {]kn-²o-I-c-W-§Ä F¶nh GÀs¸-Sp-¯p-I.
5. hnZ-ym-`-ym-k-an-Ãm-¯-hÀ¡p-th-n ÌUo-¢m-Êp-IÄ GÀs¸-Sp-¯p-I.
6. mSnsâ ·-bv¡p-th-n sFI-y-t¯m-Sp-IqSn kmaq-ly tkhw S-¯p-I, km[p-¡-fmb P-§-fpsS kÀÆ-tXm-·p-J-amb A`n-
hr-²n-¡p-th-n {]hÀ¯n-¡p-I.
7. BXp-c-im-e-Ifpw Am-Y-im-e-Ifpw S-¯p-I.
8. AwK-§-fpsS Iem-`n-cpNn hfÀ¯p-I, kwKo-Xw, Nn{X-sa-gp-¯v, mS-Iw, Um³kv, t^mt«m-{K^n, IY-I-fn, Hm«³Xp-
ÅÂ, IYm-{]-kwLw apX-em-b-h-bpsS A`n-hr-²n-¡p-th-n kuI-c-y-§Ä GÀs¸-Sp-¯p-I.
9. AwK-§-fpsS Btcm-Ky kwc-£-W-¯nv tbmKm-`-ym-k-§Ä, kvt]mÀSvkp-IÄ Ch S-¯p-I.
10. imkv{Xob coXn-bn sXmgnÂ, IrSn Ch S-¯p-¶-Xn-p-th- ÌUo-¢m-Êp-IÄ, imkv{X ]Tw Ch S-¯p-I.
11. Nn{X-§Ä, aäv Iem-]-c-amb ]Wn-IÄ, {]IrXn Ncn-{X-]-cam kw`-c-W-§Ä bm{´n-Ihpw XmX-zo-I-hp-amb I-p-]n-
Sn-¯-§Ä D]-I-c-W-§Ä AYhm D¸-¶-§Ä Ch {]ZÀin-¸n-¡p¶ ayq-kn-bw, Kmedn Ch-bpsS Øm]--¯npw kwc-£-
W-¯npw th-n {]hÀ¯n-¡pI. IqSmsX Ah-cpsS kwL-S--IÄ¡v / kan-Xn-IÄ¡v bpà-sa¶p tXm¶p¶ Dt±-i-y-§Ä aäv
hÃ-hbpw Ds-¦n Ahbpw tNÀ¡m-hp-¶-Xm-Wv.
12 ssPh-Irjn hym]-I-am-¡p-I. anX-amb nc-¡n aäp-Å-hÀ¡v hnj-c--lnX `£y-[m- y-§Ä Dev]m-Zn-
¸n-¡p-Ibpw hn]-Ww S-¯p-Ibpw sN¿p-I.

9. 13 ImÀjn-I-cw-K¯v qX--amb kvtI-XnI hnZy-IÄ¡v {]mapJyw ÂIp-Ibpw S-¸n- em-¡p-Ibpw sN¿p-
I.
14 ]c-¼-cm-KX hn¯n--§Ä I-s--¯p-Ibpw kwc-£n-¡p-Ibpw sN¿p-I.
15 IÀj-IÀ¡pw IÀj-I-sXm-gn-em-fn-IÄ¡pw ImÀjn-I-cw-K¯v Imem-p-K-X-amb ImÀjnI hnÚmw ]IÀ¶p-sIm-Sp-¡p-I.
16 ImÀjn-tIm-ev]-¶-§Ä kwcw-`n-¡p-Ibpw hn]-Ww S-¯p-Ibpw sN¿p-¶-Xnv th-n kzm{ib hn]Wn Øm]n-¡p-I.
6. AwK-Xzw
18 hb-Ênvta {]mb-apÅ GhÀ¡pw kwL n_-Ô--IÄ Ap-k-cn¨v {]hÀ¯n-¡m³ k½-X-ap-Å-hÀ¡pw `cW kan-Xn-bpsS
AwKo-Im-c-¯nv hnt[-b-ambn AwK-ambn tNcm-hp-¶-Xm-Wv.
7. {]th-iw
1. AwK-ambn tNc-W-sa-¶p-Å-hÀ Bb-Xn-te-¡pÅ At]£m ^md-¯n FgpXn H¸n«v ............. ss]k {]th-i ^okpw
amk-h-cnbpw HSp-t¡---Xm-Wv. XpSÀ¶pÅ amk-hcn Hmtcm Cw¥ojv amk-¯nepw ...................... þmw Xob-Xn¡v
ap¼v AS-¨n-cn-t¡---Xm-Wv.
2. aq¶v amkw IpSn-ÈnI hcp-¯p-¶-hsc kwL-¯n n¶pw o¡w sN¿p-¶-Xm-Wv. AhÀ¡ thm«-h-Im-ihpw aäv AwK-§-
sf-t¸mse bmsXmcp Ah-Im-ihpw D-m-b-cn-¡p-¶-X-Ã.
3. amk-¡p-Sn-ÈnI H¶mbn AS¨p XoÀ¡p-I-bm-sW-¦n I½n-än-bpsS AwKo-Im-c-¯nv hnt[-b-ambn ho-pw AwK-
ambn XpS-cm-hp-¶-Xm-Wv.
8. {]th-i cPn-ÌÀ
1. AwK-ambn tNcp-¶-hÀ I½n-än-bpsS AwKo-Imcw e`n-¨p-I-gn-ªm AUvan-j³ cPn-Ì-dn H¸n-tS---Xm-Wv.
2. AwK-¯n n¶pw o¡w sN¿s¸Sp-t¼mÄ B hnhcw cPn-Ì-dn tcJ-s¸-Sp-¯p-¶-Xm-Wv.
9. AwK-Xzw CÃm-Xm-¡pI
1. kzbw tcJm-aqew cmPn At]£ kaÀ¸n-¡p-Ibpw BbXv `cW kanXn AwKo-I-cn- ¡p-Ibpw thWw.
2. kwLw n_-Ô--IÄ¡pw, Xm¸-c-y-§Ä¡pw, b-¯npw hncp-²-ambn {]hÀ¯n-¡p-I, A¯cw Imc-y-§-fn `cW kanXn
tcJm-aqew tjmt¡mkv tm«okv sImSp-t¡--Xpw Hcm-gvN-¡Iw X¡-Xmb kam-[mw ÂIm-Xn-cn-¡p-Itbm ta¸-dª
kam-[mw ÂIp-I-bm-sW-¦n BbXpw `cW kanXn ]cn-tim-[n¨v kwL n_-Ô--IÄ¡v hncp-²-ambn {]hÀ¯n¨p F¶v
t_m²-y-am-hp-Itbm sN¿p¶ ]£w o¡w sN¿m-hp-¶-Xm-Wv.
3. aq¶p amk-¯n-p-ta IpSn-ÈnI hcp-¯p-I-bm-sW-¦nÂ
4. acWw kw`-hn-¡p-I-bm-sW-¦nÂ
10. {]hÀ¯w

10. {]th-i ^okv, amk-h-cn, kw`m-h--IÄ Kh¬saân nt¶m aäv klmb Øm]--§-fn nt¶m e`n-¡p¶ {Kmâp-IÄ,
hmbv]-IÄ kwL-¯nsâ {]hÀ¯--§-fn n¶pw In«p¶ BZm-b-§Ä Ch apX Iq«p-¶-Xm-Wv.
11. s]mXp-tbmKw
1. {]th-i cPn-Ì-dn t]cv tNÀ¯n-«p-Å-hsc FÃm s]mXp-tbm-K-¯nse AwK-§- fmbn IW-¡m-¡m-hp-¶-Xm-
Wv.
2. Hmtcm AwK-¯npw thm«-h-Imiw D-m-bn-cn-¡pw.
3. s]mXp-tbmKw B-n c-p-X-h-W-sb-¦nepw IqtS---Xm-Wv.
4. Hmtcm Ie--À hÀjhpw kwL-¯nsâ Hcp hÀj-am-bn-cn-¡p-¶-Xm-Wv.
5. hmÀjnI s]mXp-tbmKw Hmtcm B-nepw Unkw-_À 3þmw Xob-Xn-¡p-ap¼v IqtS--- Xm-Wv.
6. hmÀjnI s]mXp-tbm-K-¯n hmÀjnI hchv sNehv IW-¡p-Ifpw _m¡n ]{Xhpw _UvPäpw Ah-X-cn-¸n¨v
]mkm-t¡---Xm-Wv.
7. s]mXp-tbm-K-¯nv tImdw BsI AwK-§-fpS aq¶n c-p `mKtam ........... GXmWv Ipdhv AXm-bn-cn-¡pw.
8. s]mXp-tbm-K-¯nv Ipd-ªXv ]¯v Znhkw ap¼mbn Imcy ]cn-]mSn klnXw sk{I-«dn tm«okv ÂIn-bn-cn-t¡---Xm-
Wv.
9. s]mXp-tbm-K-¯n n¶pw kwLw `cWw S-¯p-¶-Xnv ...................... t]À DÄs¸« Hcp `cW kan-Xnsb sXc-sª-Sp-t¡-
--Xm-Wv. th-n-h-¶m XK-j-ky _meäv aptJ-bpw BIm-hp-¶-Xm-Wv.
10. FÃm s]mXp-tbm-K-§fnepw lmP-cm-tI--Xv AwK-§-fpsS IS-a-bm-Wv.
11. km[m-cW ]cn-X-Øn-Xn-bn Ccp]¯nbt©m AXn-e-[n-Itam AwK-§-fpsS tcJm- aq-e-amb At]£m {]Imcw
AhÀ Bh-i-y-s¸-Sp-I-bm-sW-¦n sk{I-«dn hnti-jm s]mXp-tbmKw hnfn-¨p-Iq-«m-hp-¶-Xm-Wv. A{]-
Imcw sN¿m¯ ]£w- {]-kvXpX AwK-§Ä¡p-Xs¶ s]mXp-tbmKw hnfn-¨p-Iq«n Imc-y-§Ä Xocp-am-n-¡m-hp-¶-
Xm-Wv.
12. kwLw n_-Ô--I-fn GsX-¦nepw t`Z-KXn hcp-¯p-I-bm-sW-¦n Ipd-ªXv ]¯v Znh-k-¯nv ap¼v
tm«okv sk{I-«dn sImSp-¯n-cn-t¡--Xpw A{]-Imcw IqSp¶ s]mXp-tbm-K-¯n lmP-cm-Ip¶ AwK-§-fpsS menÂ
aq¶v `mKw AwK-§-sf-¦nepw t`Z-K-Xn-b-p-k-cn-k¨v ]mkm-t¡--Xpw AÃm-¯h Akm-[phpw BIp-¶p. ]mkm-¡-s¸«
t`Z-K-Xn-bpsS Hcp icn-]-IÀ¸v `cW kan-Xn-bnse ap¶v AwK-§Ä H¸n«v s]mXp-tbmK XobXn 14 Znh-k-¯n-Iw
PnÃm cPn-kv{Sm-dm-^o-kn lmP-cm-t¡---Xm-Wv.
13. kwL-¯nsâ _m¡n ]{Xhpw sNehv IW¡pw BZ-ys¯ {]mh-i-y-t¯-Xm-sW-¦n s]mXp-tbm-K-¯n n¶pw nb-an-
¡p¶ BUn-ä-dm-bmepw ]cn-tim-[n-¡-s¸-tS---Xm-Wv.
14. kwLw `cW kan-Xn-bn-te-¡pÅ kIe Imc-y-§-fp-tSbpw ]c-am-[n-Imcw s]mXp-tbm-K-¯n-m-Wv.

11. 15. s]mXp-tbmKw AwKo-I-cn-¡p¶ kIe b-]-cn-]m-Sn-Ifpw ]²-Xn-Ifpw S-¸n hcp-
t¯--Xv `cW kan-Xn-bpsS Npa-X-e-bm-Wv.
16. GsX-¦nepw `cW kanXn AwKtam `cW kanXn AwK-§-tfm, `cW kan-Xntbm
kwL-¯nsâ ne-n¸nv lmn-I-c-am-sW¶v t_m²-y-s¸-«m ]ncn-¨p-hn-Sm³ s]mXp-tbm-K-¯nv
A[n-Imcw D-m-bn-cn-¡p-¶-Xm-Wv.
17. kwLw hI apX-ep-IÄ If-hv- t]m-hp-Itbm, ImWm-Xm-hp-I-tbm, CuSm-¡m³ nhr ¯n-bn-ÃmsX hcp-Itbm
sNbvXm Ahsb kw_-Ôn¨v A´na Xocp-amw FSp-¡p-¶-Xnv s]mXp-tbm-K-¯nv am{Xta A[n-Imcw D-m-bn-cn-
¡p-I-bp-Åq.
12. AwK-§Ä
{]knUâv: 1) ssjte-PvIp-amÀ.-Un., hm-Ko-`-h³, ]g-b-Ip-¶p-t½Â
sk{I-«dn : 2) F.-lw-k-¡p-ªp, dmknn-hm-kv, ]pXn-b-Im-hv, Infn-am-qÀ
{Sj-dÀ : 3) kpaÂ.-F³.-kn., kpim-´v, ]pXn-b-Im-hv, Infn-am-qÀ
ssh: {]kn: 4) _np, tkm]m-t, sSp-¼-d-¼v.]n.H
5) apl-½Zv Ckvam-bnÂ, CSp-]-Sn-¡Â, ]pXn-b-Imhv
6) {ioIp-amÀ.-BÀ, I-I-¸-Ån-ho-Sv, ]g-b-Ip-¶p-½Â
7) Aw_n
8) {]Zo-]v sI.-F-kv.-F-^v.C , iàn `h³, tah-d-bv¡Â, Bew-tImSv
9) A`n-em-jv, BÀ.-]n.-`-h³, ]m¸m-e, Infn-am-qÀ
10) kpIp-am-c³, Ipgn-hn-f-ho-Sv, IÃ-tIm-Ww, Infn-am-qÀ
tPm: sk: 11) _nPn-tamÄ þ s]mcp-´-a¬, _nPp-`-h³, ae-¨n-d, Xmfn-¡pgn ]n.H

12. 13. `cWw
1. s]mXp-tbm-K-¯n n¶pw Xnc-sª-Sp-¡-s¸-Sp¶ ................ t]À DÄs¸« Hcp `cW kan-Xn-bn n£n-]vX-am-
bn-cn-¡p¶XmWv.
2. Ah-cn n¶pw Xmsg ]d-bp¶ HutZ-ym-KnI AwK-§sf `qcn-]£ thm«nsâ ASn- Øm--¯n `c-W-
I£n AwK-§-fn n¶pw sXc-sª-Sp-t¡---Xm-Wv.
1) {]kn-Uâv 2) sshkv {]kn-Uâv 3) sk{I-«dn
4) tPmbnâv sk{I-«dn 5) JPm³Pn
3. `cW kan-Xn-bpsS tImdw 7Bbn-cn-¡pw.
4. `cW kan-Xn-bpsS Imem-h[n Hcp sImÃ-am-bn-cn-¡pw.
5. ]pXnb `cW kan-Xn-bpsS sXc-sª-Sp¸v Ignªv AhÀ NmÀsÖ-Sp-¡p-¶-Xp-hsc ]gb `cW kanXn
A[n-Im-c-¯n XpS-cp-¶-Xm-Wv.
6. s]mXp-tbmK XobXn apXÂ14 Znh-k-¯n-Iw `cW kanXn AwK-§-fpsS enÌv PnÃmcPn-kv{Sm-dm-^o-kn ^bÂ
sNt¿---Xm-Wv.
7. `cWkan-Xn-b-n D-m-Ip¶ CS-¡me Hgn-hp-I-fn-te¡v thsd AwK-§f tman-täv sN¿m³ {]kn-Uânv A[n-Icw
D-m-bn-cn-¡p-¶-Xm-Wv. BbXv `cW kanXn AwKo-I-cn-t¡---Xm-Wv.
8. XpSÀ¨-bmbn 3 `cWkanXn tbmK-§-fn X¡-Xmb ImcWw IqSmsX lmP-cm-Im¯ `cWkanXn AwK§sf
`cWkanXnbn n¶pw o¡w sN¿m-hp-¶-Xm-Wv. X¡-Xmb ImcWw Ds-¶v `cWkanXn¡v t_m²-y-s¸-Sp-¶-]£w
AwKs¯ ho-pw XpS-cm³ Ap-h-Zn-¡p-¶-Xm-Wv.
9. GsX-¦nepw `cWkanXn AwKo-I-cn-¨m am{Xta {]m_-e-y-X¯n hcn-I-bp-Åq. AbmÄ¡v kwL-¯nÂ
bmsXmcp IS-_m-²-y-X-Ifpw D-m-bn-cn-¡m³ ]mSn-Ã.
10. {]kn-Uâv cmPnhbv¡p-I-bm-sW-¦n Xm¡m-en-I-ambn sshkv {]kn-Uâns NmÀÖv GÀ¸n-t¡--Xpw `cWkanXn
cmPn kzo-I-cn-t¡---Xp-am-Wv. kwL-¯n bmsXmcp IS- _m-²-y-X-Ifpw {]kn-Uânv CÃmXncn¡pIbpw
sNbvXm am{Xta cmPn S-¸n hcn-I-bp-Åq. ASp¯ IqSp¶ `cWkanXn tbKw ]pXnb {]kn-Uâns sXc-sª-Sp-t¡---
Xm-Wv.
11. GsX-¦nepw Imc-W-h-im `cWkanXnbnse `qcn-]£w AwK-§fpw cmPn hbv¡p-I
bm-sW-¦n sk{I-«dn DS³Xs¶ Hcp hnti-jm s]mXp-tbmKw hnfn-¨p-Iq«n ]pXnb `cWkanXn AwK-§-fpsS
sXcsªSp¸v S-¯m³ th- S-]-Sn-IÄ kho-I-cn-t¡--- Xm-Wv.
12. `cWkanXn amk-¯n c-p Xh-W-sb-¦nepw IqtS---Xm-Wv.

13. 13. Hmtcm amk-¯nepw BZ-ys¯ `cWkanXn tbmK-¯n ap³am-km-h-kmw hsc-bpÅ hchv sNehv IW-¡p-Ifpw hu¨dp-
Ifpw cko-Xp-Ifpw `c-WkanXn ]cn-tim-[n-t¡--Xpw icn-bm-sW¶v t_m²-ys¸«m am{Xw Ah ]mÊm¡n H¸n-tS---Xp-
am-Ip-¶p. GsX-¦nepw hy-X-ymkw ImWp¶ ]£w AXnv Imc-W-¡m-cmb DtZ-ym-K-Ø-tcmSv kam-[mw Bh-i-y-s¸-
tS--Xpw Ah-cn n¶pw hà XpIbpw CuSm-¡m-p-s-¶p ImWp¶ ]£w B XpI CuSm-¡m-pÅ S-]Sn DS³ S-t¯---Xp-
am-Ip-¶p.
14. hmÀjnI _m¡n-]-{Xhpw hc-hp-sN-ehv IW-¡p-Ifpw BZ-ys¯ {]mh-i-y-t¯-Xm-sW-¦n `c-WkanXn nb-an-¡p¶ BUn-ä-
sd-s¡m-pw ]cn-tim-[n-¸n-t¡---Xm-Wv.
15. Hmtcm B-pw hmÀjnI s]mXp-tbmKw Ign-ªm DS³ Xs¶ B XobXn apX 21 Znh-k-¯n-Iw ]mÊm-¡-s¸« hc-
hvsN-ehv IW-¡p-I-fp-tSbpw _m¡n-]-{X-¯ntâbpw Hcpicn-]-IÀ¸v `c-WkanXn AwK-§-fn c-p-t]-sc-¦nepw H¸n«v
PnÃm cPn-kv{Sm-dm-^o-kn lmP-cm-t¡---Xm-Wv.
16. `c-WkanXnbnte-¡pÅ sXc-sª-Sp¸v Ign-ªm s]mXp-tbmK XobXn apX 14 Znh-k-¯n-Iw kan-Xn-bpsS enÌv PnÃm
cPn-kv{Sm-dm-^o-kn lmP-cm-t¡---Xm-Wv.
17. GsX-¦nepw Imc-y-§Ä¡v k_v I½nän cq]o-I-cn-t¡-n h¶m Hmtcm k_v I½n-än- bpsS NmÀÖv Hmtcm `c-W-k-
anXn AwKw hln-t¡---Xm-Wv.
18. kwL-¯n knÂ_-Ôn-Isf nb-an-¡p-¶Xv kw_-Ôn-¨pÅ tkh hy-h-Ø-IÄ AS§nb N«-§Ä D-m-¡p-I.
19. kwL-¯nsâ Iogn S-¯p¶ Øm]--§Ä¡v hmb--im-e, {KÙ-im-e, _me-hm-Sn- IÄ apX-em-b-hbv¡p th-p¶ N«-§f FgpXn
D-m-¡p-I.
20. kwLm-`n-hr-²n¡pw AwK-§-fpsS t£a-¯npw Bh-i-y-sa¶p tXm¶p¶ ]²-Xn-IÄ Bhn-jv¡-cn¨v s]mXp-tbm-K-¯nÂ
Ah-X-cn-¸n-¡p-I.
21. kwL-¯nv th-n FSp-¡p¶ hmbv]-IÄ {]kn-Uâpw, sk{I-«-dnbpw JPm³Pnbpw, `c-W-k-anXn AwK-§-fn Ipd-ªXv c-p-
t]-sc-¦nepw H¸n-«n-cn-t¡---Xm-Wv.
14. HutZ-ym-KnI AwK-§-fpsS A[n-Im-c-§fpw Npa-X-e-Ifpw
1. {]kn-Uâv
1. kwLw `c-W-Im-c-y-§-sf-¡p-dn-¨pÅ s]mXp-tm«w hln-¡p-I.
2. kwL-¯nv th-n-bpÅ kIe {]am-W-§-fpw, dn¡mÀUp-Ifpw {]knUânsâ t]cn Bbn-cn-¡pw.
3. FÃm `c-WkanXn tbmK-§-fnepw s]mXp-tbm-K-§-fnepw A²-y£w hln-¡p-I.
4. kwL-Im-c-y-§Ä S-¯p-¶-Xnv knÂ_-Ôn-Isf nb-an-¡p-I, ]ng Npa-¯p-I, kkvs]âv sN¿p-I, ]ncn¨p hnSpI Ch-bv¡pÅ A[n-
Imcw {]kn-Uânv D-m-bn-cn-¡pw. F¶m HSp-hn-es¯ c-v kwK-Xn-IÄ¡pw `c-WkanXnbpsS AwKo-Imcw th--Xm-
Wv.

14. 5. GsX-¦nepw tbmK-§-fn {]kn-Uânv lmP-cm-Im³ km[n-¡m-¯-]£w hnhcw ap³Iq«n sk{I-«-dn-
tbbpw sshkv {]kn-Uân-tbpw Adn-bn-¨n-cn-t¡---Xm-Wv.
6. kwLw hI _m¦v nt£-]-§Ä FÃmw {]kn-Uânsâ t]cn Bbncnt¡--Xm-Wv.
s]mXp-tbmKw nÝ-bn-¡p¶ ]£w {]kn-Uâns IqSmsX sk{I-«-dn-bp-sSbpw JPm³Pn-bp-sSbpw t]cn Iq«mbn _m¦v
A¡u--p-IÄ BIm-hp-¶-Xm-Wv. A{]-Im-c-apÅ kwK-Xn-I-fn nt£]w ]n³h-en-¡p-¶-Xnv AhÀIqSn H¸n-«n-cn-t¡---Xm-
Wv.
2. sshkv {]kn-Uâv
1. {]kn-Uânsâ A`m-h-¯n sshkv {]kn-Uâv tbmK-¯n A²-y-£X hln-t¡---Xm-Wv.
2. kwL-¯nsâ `c-W-Im-c-y-¯n {]kn-Uâns klm-bn-¡p-I.
3. `c-W-k-anXn nÝ-bn-¡p¶ aäv Imc-y-§Ä
3. sk{I-«dn
1. {]kn-Uânsâ taÂhn-Nm-c-¯n-pÄs¸«v kwL-¯nsâ ssZwZn Imc-y-§-fpsS Npa-Xe hln-¡p-I.
2. kwL-¯nv Bh-i-y-apÅ kIe dn¡mÀUp-I-fpw, IW-¡p-I-fpw, _p¡p-I-fpw, cPn-Ì-dp- Ifpw X¿m-dm¡n kq£n-¡p-I.
3. kwL-¯nsâ kIe kz-¯p-¡-fp-tSbpw ssIIm-cyw IÀ¯r-X-z-¯nsâbpw Npa-Xe hln-¡p-I.
4. kwLw kw_-Ôn-¨pÅ kIe Fgp-¯p-Ip-¯p-Ifpw S-¯p-I.
5.- s]mXptbmK-§fpw `cWkanXn tbmK-§fpw hnfn¨pIq«p-I.
6. Bb-Xn-te¡v tm«o-k-b-bv¡p-I.
7. kwL-¯nsâ {]hÀ¯ dnt¸mÀ«p-IÄ, hc-hvsN-ehv IW-¡p-I-fpsS tÌävsaâp-IÄ, _e³kvjo-äv, `c-W-k-an-Xe tbmK-¯nsâbpw
s]mXp-tbm-K-¯nsâbpw dnt¸mÀ«p-IÄ, hmÀjnI _UvP-äp-IÄ Ch X¿m-dm-¡p-Ibpw kq£n-¡p-Ibpw sN¿p-I,
hmÀjnI hc-hp-sN-ehv IW-¡p-Ifpw hmÀjnI {]hÀ¯ dnt¸mÀ«p-Ifpw _m¡n-]-{Xhpw s]mXp-tbm-K-¯n kaÀ¸n-¡p-I.
8. cPn-kv{S-dm-^o-kn ^b sNt¿---Xmb `c-W-k-anXn AwK-§-fpsS enÌv kwL- ¯nsâ cPn-tÌÀUv B^okv amäp-t¼m-
gpÅ hnhcw s]mXp-tbm-K-¯n ]mkm-¡-s¸« hchvv sNehv IW-¡p-I-fp-tSbpw _m¡n-]-{X-¯ntâbpw icn-]-IÀ¸p-IÄ n_-
Ô] t`Z-KXnI-fpsS ]IÀ¸v Ch bYm-k-abw lmP-cm-¡p-I.
9. `cWkanXnbpw s]mXp-tbm-Khpw nÝ-bn-¡p¶ aäv Imc-y-§Ä.
10. kwL-¯nsâ Hmtcm Bh-i-y-¯npw th-n-h-cp¶ XpI-IÄ, _UvP-än Ap-h-Zn-¨n- «pÅ {]Imcw JPm³Pn-bpsS ]¡Â
n¶pw hu¨-dp-IÄ aptJ hm§n sNe-hm-t¡---Xm-Wv.

15. 11. _UvP-än Ihn-ªpÅ XpI-IÄ sNe-hm-¡p-¶-Xnv `cWkanXnbpsS AwKo-Imcw hm§n-bn-cn-¡p-Ibpw B--h-
kmw AUo-j-W _UvP-ämbn s]mXp-tbm-K-¯n Ap-hmZw hmt§---Xm-Wv.
4. tPmbnâv sk{I-«dn
1. `cW Imc-y-§-fn sk{I-«-dnsb klmbn¡pI.
2. sk{I-«dn lmP-cm-Im-¯-t¸mÄ sk{I-«-dn-bpsS Npa-X-e-IÄ hln-¡p-I.
5. JPm³Pn
1. ]Ww kw_-Ôn-¨pÅ kIe CS-]m-Sp-I-fp-tSbpw D¯-c-hm-Zn-Xzw JPm³Pn-bp-tS-Xm-bn-cn- ¡pw.
2. kwL-¯n n¶pw ]ncn-ªp-In-«p¶ kIe ]W-¯nsâbpw IW-¡p-IÄ icn-bmbn FgpXn kq£n-¡p-I.
3. HutZ-ym-KnI cko-Xp-IÄ H¸n-«p-sIm-Sp-¡p-I.
4. kwLw Imc-ym-Zn-IÄ S-¯p-¶-Xnv AX-ym-h-iy sNe-hp-IÄ¡mbn ................................. cq] hsc-bpÅXpI JPm³Pn-bpsS
ssIhiw hbv¡m-hp-¶Xpw IqSp-XÂ hcp¶ XpI `cWkanXntbm, s]mXp-tbm-Ktam nÝ-bn-¡p¶ GsX-¦nepw AwKo-
IrX _m¦n {]kn-Uânsâ t]cn nt£-]n-t¡-pw BIp-¶p.
5. sImSp-¡p¶ ]W-¯nv icn-bmb hu¨-dp-Ifpw t_m-p-t^m-d-§fpw H¸n« hm§n kq£n-t¡---Xm-Wv.
6. ]mkv _p¡p-Ifpw sN¡p-_p-¡p-Ifpw kq£n-¡p-I.
7. kwL-¯n n¶pw sImSp-¡p¶ FÃm cko-Xp-Ifpw kwL-¯nsâ ap{Z-h¨p sImSp-t¡---Xm-Wv.
15. kwLw kq£n-t¡---Xmb dn¡mÀUp-I-fpsS hnhcw
1. kwLw n_-Ô--I-fp-sSbpw cPn-kvt{S-j³ kÀ«n-^n-¡-äntâbpw ^bÂ.
2. ann«vkv _p¡v.
3. {]th-i cPn-ÌÀ.
4. ckoXv _p¡p-IÄ.
5. tÌm¡v cPn-ÌÀ.
6. hchv sNehv IW-¡p-I-fpsS _p¡v.
7. kwLw hI apX-ep-I-fpsS cPn-ÌÀ
8. ]mkv _p¡p-Ifpw sN¡v _p¡p-I-fpw.
9. nt£-]-§-fpsS cPn-ÌÀ.
10. hcphv sNehv IW-¡p-I-fpsS tÌävsaâp-IÄ ({]-hÀ¯ dnt¸mÀ«p-IÄ, _m¡n-]{Xw apX-em-b-h-bpsS ^bÂ.
11. tm«okv _p¡v.

16. 12. Fgp-¯p-Ip-¯p-I-fpsS ^bÂ.
13. C³thÀUv cPn-ÌÀ.
14. Hu«v thÀUv cPn-ÌÀ.
15. Ìm¼v A¡u-v cPn-ÌÀ.
16. kwL-¯nv Ah-iyw th--Xmb cPn-ÌÀ.
16. kwL-¯nepw kwK-¯n-t·-epÅ hy-h-lm-c-§Ä
1. kwL-¯nv th-ntbm kwL-¯nsâ t]Àt¡m DÅ kIe tIkp-Ifpw kwL-¯npth-n sk{I-«dn S-¯p-¶-Xm-Wv.
2. kwLw FSp-¯n-«pÅ hmbv]-IÄ¡v kwLhpw `cWkanXnbpw D¯-c-hm-Zn-I-fm-bn-cn-¡p-¶-Xm-Wv.
3. kwL-¯nv ]ncn-ªp-In-«m-pÅ XpI-IÄ hÃ-Xp-ap-s--¦n AXv F#u-Sm¡n FSp-¡p-¶-Xnv `cWkanXn¡v A[n-Imcw
D-m-bn-cn-¡p-¶-Xm-Wv.
17. Ipä-¡m-cmb AwK-§Ä A-y-sc-t¸mse in£mÀl-cm-Wv.
kwLw `cWkanXnbnÂs¸-«-h-cm-bn-cp-¶mepw icn, aäw-K-§-fm-bn-cp-¶mepw icn kwLw hI XpI-IÄ ssII-cyw
sN¿p-¶-Xm-tbm, aäp kwLw hI GsX-¦nepw jvS-s¸-Sp-¯p-I-tbm, tamjvSn-¡p-Itbm A]-l-cn-¡p-Itbm AsÃ-¦n GsX-
¦nepw kz¯v a:-]qÀÆw t{Zml-_p-²n-tbm-Sp-IqSn in-¸n-¡p-Itbm , tISp-h-cp-¯p-Itbm sN¿p-I, kwL-¯nv [ jvSw tcn-
S-¯-¡-h®w GsX-¦nepw {]am-W-tam, I¨o-t«m, ]m«-¯n-pÅ CutSm, ckotXm aäp-hà tcJ-Itfm hym-P-ambn nÀ½n-¡p-
Itbm sNbvXm kwL-¯nse GsXm-cw-Khpw knÂ_-Ôn-Ifpw t{]mkn-I-yq-j³ in£n-¡-s¸-Sp-¶-Xpam-Ip-¶p.
18. kwLw ]ncn¨p hnSp-¶-Xnpw Ah-bpsS Imc-y-§Ä S-¯p-¶-Xn-p-apÅ hy-hØ
kwLw AwK-§-fn men aq¶p `mK-¯n Ipd-bm¯ AwK-§Ä¡v kwKw ]ncn-¨p-hn-S-W-sa¶v XoÀ¨ sN¿m-hp-
¶Xpw A§s sNbvXm DS-stbm At¸mÄ k½-Xn-¨n-«pÅ ka-bt¯m kwLw ]ncn¨p hntS--Xpw kwL-¯nsâ BØn-_m-²-y-X-
IÄ Xn«-s¸-Sp-¯n-b-Xnp tijw sImSp¯p XoÀt¡- IS-§Ä hÃ-Xp-ap-s--¦n BbXv kwL-¯nv (kw-Lmw-K-§Ä¡v) Xncn¨v
hoXn-¨p-sIm-Sp-¡m³ ]mSn-Ãm-¯Xpw kwL-¯nsâ Dt±-i-e-£-y-§Ä kmZr-iyw hln-¡p¶ aäp-hà kwLhpw B Øet¯m kao-
]t¯m Ds--¦n Ahbv¡v sImSp-t¡---Xm-sW¶v XoÀ¨ sN¿m-hp-¶-XpamWv. A{]-Imcw kwL-§Ä CsÃ-¦n BhI kz-¯p-¡Ä
Kh-s×ânv Gsä-Sp-¡m-hp-¶-Xm-Wv.
19. kwL-¯nv Hcp cPn-tÌÀUv B^okpw ap{Zbpw sbnw t_mÀUpw D-m-bn-cn-¡p-¶-Xm-Wv.

17. Cu n_-Ô--I-fn kwLw S-¯n-¸nv th--Xmb Imc-y-§Ä hÃXpw hn«p-t]m-bn-«p-s--¦n DÄs¸-Sp-¯p-¶-Xnv
ss_em t`Z-K-Xn-IÄ s]mXp-tbm-K-¯n ]mÊm-¡n-b-Xn-p-tijw S-¸n hcp-¯m-hp-¶Xpw ]mÊm-¡-s¸« s]mXp-tbm-K-
¯nsâ Xob-Xn-ap-X 14 Znh-k-¯n-Iw cPn-kv{Sm-dm-^o-kn lmP-cm¡n ^-b sNt¿---Xp-am-Wv.
1. {]k-e-Uâv
2. sk{I-«dn
3. JPm³Pn
(kwLw cPn-ÌÀ sNbvXp-I-gn-ªm Cu B^o-kp-am-bpÅ FÃm I¯n-S-]m-Sp-Ifpw n§-fpsS kwL-¯nsâ cPn-ÌÀ ¼cpw kwLw
cPn-ÌÀ sNbvX hÀ-jhpw tNÀ¯n-cn-t¡---Xm-Wv).

18. 05.09.2015
SALARY CERTIFICATE
This is to cetify that Mr.Nithin V.R, S/o Raghunathan V, Kochuvadakkathil
(H) Mottalil, Vellalloor, Trivandrum is working in our organization as
Marketing Coordinator and is drawing a monthly salary of Rs. 15100/- as
detailed below.
Earnings Deducations
Basic+DA 12080.00 PF 1450.00
ESI 0
HRA 3020.00 WWF 20.00
Travelling Allowance 0.00
Total 15100.00 1470.00
Net pay Rs. 13630/- (Rupees Thirteen Thousand Six Hunded and Thirty Only)

19. This certificate is issued to him as per his request for submitting before
Sundaram Finance, Kollam, for pruchease loan. By issuing this certificate the
company will not be liable for any default in his regard.
For ATLAS JEWELLERY PVT LTD.
Authorized Signatory.