No.foqio1 2 1 91j-3.

9
(E*o)' (oe;uoO*re. rriftlrr6rgo,cio,
?.

(Apncycodeioffirihio) {schdulello./nio)

sITeTrg
(Fomt{0./ffnio)

I. vrsq*odwlffi

o.qio, q. wffqnftfuddqc*; ......... ?. qt-Teircio- (grsqfrr*d'reioi'ct)*: l. q* oqio - (ersc *cs dq{){':

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

c. +{FqiF: (froui6 +<ar)'F

9. \'dffi{'soi+eR: thq$dqiq

'.rt*E

o.re*fl

t.*ftssdf]

tffiE

(qTft*lnrfr)* .....,....... trsqr66rqio.:

q. RrErqFffil: i. f$rr cfr6l Fcio': (cC+ rs1fi;'r ?.q{ffi ei.Gis}qq*rfl I

({'woi+rrtrssrrrrorqrfra cGffft{o)'n .........

q.qTRrqtWd

o.qftc-qtiqftdt I

e.:+dRlqrcfo,f 8.5tr{ n o'qio {6rqrri6 nfiq iwnr Efr#ffr +ffIRqfro,T (ds6rg): (erremuffiqtrff)o
Gicr c. v$q FilTezr qlqiT cfr6l trci6':

(errersrffilirffi)* 3. frg$tmr*ron:
c. i{qqqi$ftnER*ilfl

u.v$aggaaruolw<t

.. {trr o.Frtixdfroffiam*rwr ; * ffi *tr{ #.Fs Fci6:(qftfr wr&)

qo. *q qr6o o.qi6: (qGd s{ffi ;':'

tr

t. iifrtrqidftwm+*t
\. vr$qqfanr*qcr

E E

1.arauraro*w<r q..t$oTdTrordffiindriliT[

t. drtqr&

*cgworcn- e.q*qo{e E
qroftgwdr q9. ffi

?.ftilrffi E

r.eradr+q []

u.ie

t]

\.rc* E

prio: (errere qrGd.r{d)'F .,............. aqrff.

';'qGfr {sflrs YorqrddqIfrffiffi

N o . r : m q1a 1 i2

gl!29

.(Agencycdelqffi lscheduhllo./nio) dhit)

llo,/ni{nio) {torm

Venue Borur: / Time/ ia:

Signatureof AuthorisedAgency sTfrg'dGt|M drshft sS