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ÚäæÇä ÇáÍÕÉ:...............................äæÚ ÇáäÔÇØ : ........................ ÇáÞÓã:.................................
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ÎáÇá åÐå ÇáÍÕÉ ÊÊã ãäÇÞÔÉ ÇáæÖÚíÉ ÇáÊÚáãíÉ ãä ÌãíÚ ÌæÇäÈåÇ¡ ãÚ ÇáÊÑßÒ Úáì: ãÑÇÍáåÇ¡ ÇáæÞÊ ÇáãÎÕÕ áßá ãÑÍáÉ¡ ÃåãíÉ ÇáÊÞæíã ÇáÊßæíäí¡ ÃåãíÉ ÇáÊÓÌíá Úáì ÇáÓÈæÑÉ¡ ãÇ íßÊÈå ÇáÊáÇãíÐ Úáì ßÑÇÑíÓåã¡ ÇÓÊÛáÇá ÇáæÓÇÆá ÎáÇá ÇáÍÕÉ.....ÅáÎ
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ÇáÍÕÉ ÇáÓÇÏÓÉ: ãÊÇÈÚÉ ''æÖÚíÉ ÊÚáãíÉ"(ÏÑÓ) æãäÇÞÔÊåÇ (2)
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ÈÚÏ ãÊÇÈÚÉ ÇáÍÕÉ ÇáÊí íäÔØåÇ ÇáÃÓÊÇÐ Çáãßæä ÊÊã ÇáãäÇÞÔÉ ßÇáÂÊí:
- ãÞÇÑäÉ ãÇ ÍÖÑå ÇáãÊÑÈÕ ãÚ ãÇ ÍÖÑå ÇáÃÓÊÇÐ Çáãßæä ãÊÈæÚÇ ÈãäÇÞÔÉ ãÓÊÝíÖÉ.
- ãäÇÞÔÉ ÇáÍÕÉ ãä ÌãíÚ ÌæÇäÈåÇ¡ ãÚ ÇáÊÑßÒ Úáì : ãÑÇÍáåÇ¡ ÇáæÞÊ ÇáãÎÕÕ áßá ãäåÇ¡ ÃåãíÉ ÇáÊÞæíã ÇáÊßæíäí¡ ÃåãíÉ ÇáÊÓÌíá Úáì ÇáÓÈæÑÉ ¡ ãÇ íßÊÈå ÇáÊáÇãíÐ Úáì ßÑÇÑíÓåã¡ ÇÓÊÛáÇá ÇáæÓÇÆá ÇáÊÚáíãíÉ ÎáÇá ÇáÍÕÉ¡ .....ÅáÎ.
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ÈÚÏ ãÊÇÈÚÉ ÇáÍÕÉ ÇáÊí íäÔØåÇ ÇáÃÓÊÇÐ ÇáãÊÑÈÕ ÊÊã ÇáãäÇÞÔÉ ßÇáÂÊí:
- ãÞÇÑäÉ ãÇ ÍÖÑå ÇáãÊÑÈÕ ãÚ ãÇ ÍÖÑå ÇáÃÓÊÇÐ Çáãßæä¡ ãÊÈæÚÉ ÈãäÇÞÔÉ ãÓÊÝíÖÉ.
-ãäÇÞÔÉ ÇáÍÕÉ ãä ÌãíÚ ÌæÇäÈåÇ¡ ãÚ ÇáÊÑßÒ Úáì: ãÑÇÍá ÇáÍÕÉ¡ ÇáæÞÊ ÇáãÎÕÕ áßá ãäåÇ¡ ÃåãíÉ ÇáÊÞæíã ÇáÊßæíäí¡ ÃåãíÉ ÇáÊÓÌíá Úáì ÇáÓÈæÑÉ ¡ ãÇ íßÊÈå ÇáÊáÇãíÐ Úáì ßÑÇÑíÓåã¡ ÇÓÊÛáÇá ÇáæÓÇÆá .
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• ÃäæÇÚ ÇáÊÞæíã : ÇáÊÔÎíÕí¡ ÇáÊßæíäí¡ ÇáÊÍÕíáí
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ÎáÇá åÐå ÇáÍÕÉ íÑÇÌÚ ÇáÃÓÊÇÐ Çáãßæä ÑÝÞÉ ÇáÃÓÊÇÐ ÇáãÊÑÈÕ ãÌãæÚÉ ãä ÃæÑÇÞ ÇáÅÌÇÈÇÊ¡ æ íÔÑÍ áå ßíÝíÉ ÇÓÊäÊÇÌ ÇáäÞÇÆÕ ÇáæÇÌÈ ãÚÇáÌÊåÇ æßÐÇ ØÑÇÆÞ ÇáãÚÇáÌÉ ÇáãÞÊÑÍÉ.
ãáÇÍÙÉ: íØáÈ ÇáÃÓÊÇÐ Çáãßæä ãä ÇáãÊÑÈÕ ÅÚÏÇÏ ÈÍË ÞÕíÑ Íæá '' ãÝåæã ÇáãÚÇáÌÉ ÇáÈíÏÇÛæÌíÉ ''. ÅãÖÇÁ
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ÎáÇá åÐå ÇáÍÕÉ íÍÖÑ ÇáÃÓÊÇÐ ÇáãÊÑÈÕ ÍÕÉ ÊÚäì ÈÇáãÚÇáÌÉ ÇáÈíÏÇÛæÌíÉ íäÔØåÇ ÇáÃÓÊÇÐ Çáãßæä.
ÚÞÈ ÇáÍÕÉ ÊÊã ÇáãäÇÞÔÉ ãä ÌãíÚ ÇáÌæÇäÈ ÇáÊÑÈæíÉ æÇáÈíÏÇÛæÌíÉ¡ æáÇÓíãÇ ÇáäÞÇØ ÇáÂÊíÉ:
- ßíÝíÉ ÇáÅÚÏÇÏ áÍÕÉ '' ÇáãÚÇáÌÉ ÇáÈíÏÇÛæÌíÉ''
- ßíÝíÉ ÊäÔíØ åÐå ÇáÍÕÉ .
- ÇáÇåÊãÇã ÈÇáÝæÇÑÞ ÇáÝÑÏíÉ
- ÇáÊÞæíã ÞÕÏ ÇáÊËÈÊ ãä ÊÍÞíÞ ÈáæÛ ÇáÃåÏÇÝ ÇáãÓØÑÉ.
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ãáÇÍÙÉ åÇãÉ: íØáÈ ãä ÇáÃÓÊÇÐ ÇáãÊÑÈÕ ÅÚÏÇÏ ÍÕÉ "ÇáãÚÇáÌÉ ÇáÈíÏÇÛæÌíÉ" áÊäÔíØåÇ .
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ÇáÍÕÉ ÇáÑÇÈÚÉ ÚÔÑ: ÊäÔíØ ÍÕÉ "ÇáãÚÇáÌÉ ÇáÈíÏÇÛæÌíÉ"
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ÎáÇá åÐå ÇáÍÕÉ íäÔØ ÇáÃÓÊÇÐ ÇáãÊÑÈÕ ÑÝÞÉ ãÌãæÚÉ ãä ÇáÊáÇãíÐ ÍÕÉ ''ÇáãÚÇáÌÉ ÇáÈíÏÇÛæÌíÉ''
ãáÇÍÙÇÊ ÇáÃÓÊÇÐ Çáãßæä Íæá:
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- äÞÇØ ÇáÖÚÝ Ýí ÅÏÇÑÉ åÐå ÇáÍÕÉ æÊäÔíØåÇ:......................................... .......................
ãáÇÍÙÇÊ ÃÎÑì æÊæÌíåÇÊ:......................................... .....................................
ãáÇÍÙÉ åÇãÉ: íØáÈ ãä ÇáÃÓÊÇÐ Çáãßæä ÊÍÖíÑ ÈÍË Íæá "ÃåãíÉ ÅÏÑÇÌ ÇáãÚáæãÇÊíÉ Ýí ÊÏÑíÓ ÇáãÇÏÉ"
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íÞÏã ÇáÃÓÊÇÐ ÇáãÊÑÈÕ ÚÑÖÇ Íæá ÇáÈÍË ÇáÐí ÃäÌÒå.
ÊÊã ãäÇÞÔÉ ÇáãæÖæÚ ãä ãÎÊáÝ ÌæÇäÈå ãÚ ÊÈíÇä ÃåãíÉ ÅÏÑÇÌ ÇáãÚáæãÇÊíÉ Ýí ÊÏÑíÓ ãÎÊáÝ ÇáãæÇÏ
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íÞÏã ÇáÃÓÊÇÐ Çáãßæä ÃãËáÉ æÇÞÚíÉ æãáãæÓÉ ãä ÇáãäåÇÌ .
ãáÇÍÙÇÊ æÊæÌíåÇÊ ÇáÃÓÊÇÐ Çáãßæä: .................................................. ......................................
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(ÇáãÄÓÓÉ ÇáÊí ÊãÊ ÝíåÇ ÚãáíÉ ÇáãÑÇÝÞÉ)
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ÇáãÝÊÔ ÇáãÔÑÝ:........................................... ..............ÇáãÇÏÉ: .................................................. ...............
ÇáÍÕÉ ÇáÃæáì : ÇáÊÚÑÝ Úáì æËÇÆÞ ÇáÃÓÊÇÐ
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ÊÚÞÏ ÌáÓÉ Èíä ÇáÃÓÊÇÐ Çáãßæä æÇáÃÓÊÇÐ ÇáãÊÑÈÕ ÈÛÑÖ ÇáÊÚÑÝ Úáì æËÇÆÞ Úãá ÇáÃÓÊÇÐ æ ßÐÇ ÇáÓäÏÇÊ ÇáÑÓãíÉ áÇÓíãÇ: ÇáãäåÇÌ¡ ÇáæËíÞÉ ÇáãÑÇÝÞÉ¡ ÇáßÊÇÈ ÇáãÏÑÓí¡ Ïáíá ÇáßÊÇÈ ÇáãÏÑÓí¡ ÇáãÐßÑÉ ÇáÈíÏÇÛæÌíÉ¡ ßÑÇÓ ÇáÊäÞíØ¡ ÇáÊæÒíÚ ÇáÓäæí¡ÏÝÊÑ ÇáãÑÇÓáÉ¡ ßÔÝ ÇáäÞÇØ ÇáÝÕáí¡ ...ÅáÎ
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ÊÚÞÏ ÌáÓÉ Èíä ÇáÃÓÊÇÐ Çáãßæä æÇáÃÓÊÇÐ ÇáãÊÑÈÕ ÈÛÑÖ ÇáÊÚÑÝ Úáì ßíÝíÉ ÇÓÊÛáÇá ÇáÓäÏÇÊ ÇáÊÑÈæíÉ áÊÍÖíÑ ''æÖÚíÉ ÊÚáãíÉ" (ÏÑÓ) æáÇÓíãÇ: ÇáãäåÇÌ æÇáæËíÞÉ ÇáãÑÇÝÞÉ æßÐÇ ÇáßÊÇÈ ÇáãÏÑÓí æÏáíá ÇáÃÓÊÇÐ.
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ÊÚÞÏ ÌáÓÉ Èíä ÇáÃÓÊÇÐ Çáãßæä æÇáÃÓÊÇÐ ÇáãÊÑÈÕ ÈÛÑÖ ÇáÊÚÑÝ Úáì ßíÝíÉ ÊÍÖíÑ ãÐßÑÉ ÈíÏÇÛæÌíÉ (ÈØÇÞÉ ÊÓííÑ ÍÕÉ) æÝÞ ãÇ ÊÞÊÖíå ÇáãÞÇÑÈÉ ÇáãÚÊãÏÉ (ÇáãÞÇÑÈÉ ÈÇáßÝÇÁÇÊ) ¡ ãÚ ÊÞÏíã äãÇÐÌ ãÎÊáÝÉ.
ãáÇÍÙÇÊ ÇáÃÓÊÇÐ Çáãßæä:........................................... .................................................. .........
• ãáÇÍÙÉ: íØáÈ ãä ÇáÃÓÊÇÐ ÇáãÊÑÈÕ ÊÍÖíÑ ÈØÇÞÉ ÊÓííÑ ÍÕÉ (ãÐßÑÉ ÏÑÓ)
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ÎáÇá åÐå ÇáÍÕÉ ÊÊã ãäÇÞÔÉ ÈØÇÞÉ ÊÓííÑ ÇáÍÕÉ (ÇáãÐßÑÉ ÇáÈíÏÇÛæÌíÉ (ÇáãäÌÒÉ ãä ØÑÝ ÇáÃÓÊÇÐ ÇáãÊÑÈÕ áÇÓíãÇ ÊäÙíã ÎØæÇÊ ÇáÍÕÉ¡ ãäåÌíÉ ÇáÊÞÏíã ¡ ÅÏÑÇÌ ÇáÊÞæíã ÈÃäæÇÚå¡ ...ÅáÎ
ãáÇÍÙÇÊ ÇáÃÓÊÇÐ Çáãßæä:
• ÇáäÞÇØ ÇáÅíÌÇÈíÉ Ýí ÊÍÖíÑ ÇáÍÕÉ:............................................ ......................................
• ÇáäÞÇØ ÇáÊí ÊÓÊæÌÈ ÇáÊÍÓíä:.......................................... .............................................
ãáÇÍÙÇÊ ÇÎÑì:............................................. .................................................. ...................
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ÇáÊÇÑíÎ: ...........................................ÇáÝÊÑÉ: ãä ÇáÓÇÚÉ:...................Åáì ÇáÓÇÚÉ:.....................
ÚäæÇä ÇáÍÕÉ:...............................äæÚ ÇáäÔÇØ : ........................ ÇáÞÓã:.................................
íÞæã ÇáÃÓÊÇÐ Çáãßæä ÈÊäÔíØ "æÖÚíÉ ÊÚáãíÉ" ÈÍÖæÑ ÇáÃÓÊÇÐ ÇáãÊÑÈÕ.
ÎáÇá åÐå ÇáÍÕÉ ÊÊã ãäÇÞÔÉ ÇáæÖÚíÉ ÇáÊÚáãíÉ ãä ÌãíÚ ÌæÇäÈåÇ¡ ãÚ ÇáÊÑßÒ Úáì: ãÑÇÍáåÇ¡ ÇáæÞÊ ÇáãÎÕÕ áßá ãÑÍáÉ¡ ÃåãíÉ ÇáÊÞæíã ÇáÊßæíäí¡ ÃåãíÉ ÇáÊÓÌíá Úáì ÇáÓÈæÑÉ¡ ãÇ íßÊÈå ÇáÊáÇãíÐ Úáì ßÑÇÑíÓåã¡ ÇÓÊÛáÇá ÇáæÓÇÆá ÎáÇá ÇáÍÕÉ.....ÅáÎ
ãáÇÍÙÇÊ ÇáÃÓÊÇÐ Çáãßæä:........................................... .................................................. ..........
• ãáÇÍÙÉ åÇãÉ: íØáÈ ãä ÇáãÊÑÈÕ ÊÍÖíÑ "ãæÖæÚ ÇáÍÕÉ (ÇáÏÑÓ) ÇáÞÇÏãÉ. ÅãÖÇÁ
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ÇáÍÕÉ ÇáÓÇÏÓÉ: ãÊÇÈÚÉ ''æÖÚíÉ ÊÚáãíÉ"(ÏÑÓ) æãäÇÞÔÊåÇ (2)
ÇáÊÇÑíÎ: ...........................................ÇáÝÊÑÉ: ãä ÇáÓÇÚÉ:...................Åáì ÇáÓÇÚÉ:......................
ÚäæÇä ÇáÍÕÉ:...............................äæÚ ÇáäÔÇØ : ........................ ÇáÞÓã:.................................
ÈÚÏ ãÊÇÈÚÉ ÇáÍÕÉ ÇáÊí íäÔØåÇ ÇáÃÓÊÇÐ Çáãßæä ÊÊã ÇáãäÇÞÔÉ ßÇáÂÊí:
- ãÞÇÑäÉ ãÇ ÍÖÑå ÇáãÊÑÈÕ ãÚ ãÇ ÍÖÑå ÇáÃÓÊÇÐ Çáãßæä ãÊÈæÚÇ ÈãäÇÞÔÉ ãÓÊÝíÖÉ.
- ãäÇÞÔÉ ÇáÍÕÉ ãä ÌãíÚ ÌæÇäÈåÇ¡ ãÚ ÇáÊÑßÒ Úáì : ãÑÇÍáåÇ¡ ÇáæÞÊ ÇáãÎÕÕ áßá ãäåÇ¡ ÃåãíÉ ÇáÊÞæíã ÇáÊßæíäí¡ ÃåãíÉ ÇáÊÓÌíá Úáì ÇáÓÈæÑÉ ¡ ãÇ íßÊÈå ÇáÊáÇãíÐ Úáì ßÑÇÑíÓåã¡ ÇÓÊÛáÇá ÇáæÓÇÆá ÇáÊÚáíãíÉ ÎáÇá ÇáÍÕÉ¡ .....ÅáÎ.
ãáÇÍÙÇÊ ÇáÃÓÊÇÐ Çáãßæä: .................................................. .................................................. ....
.ãáÇÍÙÉ åÇãÉ: íØáÈ ãä ÇáãÊÑÈÕ ÊÍÖíÑ ''æÖÚíÉ ÊÚáãíÉ" áÊÞÏíãåÇ ÃãÇã ÇáÃÓÊÇÐ Çáãßæä
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ÚäæÇä ÇáÍÕÉ:...............................äæÚ ÇáäÔÇØ : ........................ ÇáÞÓã: ...............................
ÈÚÏ ãÊÇÈÚÉ ÇáÍÕÉ ÇáÊí íäÔØåÇ ÇáÃÓÊÇÐ ÇáãÊÑÈÕ ÊÊã ÇáãäÇÞÔÉ ßÇáÂÊí:
- ãÞÇÑäÉ ãÇ ÍÖÑå ÇáãÊÑÈÕ ãÚ ãÇ ÍÖÑå ÇáÃÓÊÇÐ Çáãßæä¡ ãÊÈæÚÉ ÈãäÇÞÔÉ ãÓÊÝíÖÉ.
-ãäÇÞÔÉ ÇáÍÕÉ ãä ÌãíÚ ÌæÇäÈåÇ¡ ãÚ ÇáÊÑßÒ Úáì: ãÑÇÍá ÇáÍÕÉ¡ ÇáæÞÊ ÇáãÎÕÕ áßá ãäåÇ¡ ÃåãíÉ ÇáÊÞæíã ÇáÊßæíäí¡ ÃåãíÉ ÇáÊÓÌíá Úáì ÇáÓÈæÑÉ ¡ ãÇ íßÊÈå ÇáÊáÇãíÐ Úáì ßÑÇÑíÓåã¡ ÇÓÊÛáÇá ÇáæÓÇÆá .
ãáÇÍÙÇÊ Çáãßæä:........................................... .................................................. .............
ãáÇÍÙÉ åÇãÉ: íØáÈ ãä ÇáãÊÑÈÕ ÊÍÖíÑ "æÖÚíÉ ÊÚáãíÉ (ÏÑÓ) áÊäÔíØåÇ ÃãÇã ÇáÃÓÊÇÐ Çáãßæä
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ÇáÍÕÉ ÇáËÇãäÉ: ÊÍÖíÑ'' æÖÚíÉ ÊÚáãíÉ" æÊäÔíØåÇ(2)
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ÚäæÇä ÇáÍÕÉ:...............................äæÚ ÇáäÔÇØ : ........................ ÇáÞÓã: ................................
ÈÚÏ ãÊÇÈÚÉ ÇáÍÕÉ ÇáÊí äÔØåÇ ÇáãÊÑÈÕ ¡ ÊÊã ãäÇÞÔÊåÇ ãä ÌãíÚ ÇáÌæÇäÈ æáÇÓíãÇ:ÇáÑÈØ Èíä ÇáßÝÇÁÇÊ ÇáãÓÊåÏÝÉ æ ÇáãÖãæä ¡ ÇáäÔÇØÇÊ ÇáãÎÊÇÑÉ æ ãÏì ÊÍÞíÞåÇ ááÃåÏÇÝ ÇáãÓÊåÏÝÉ ¡ ÃåãíÉ ÇáÊÎØíØ ááÏÑÓ¡ ãßÇäÉ ÇáÊÞæíã Ýí ÇáÝÚá ÇáÊÚáíãí/ÇáÊÚáãí¡ ãÏì ÌÚá ÇáÊáãíÐ ãÍæÑ ÇáÚãáíÉ ÇáÊÚáíãíÉ/ÇáÊÚáãíÉ¡ ...ÅáÎ
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ÈÚÏ ãÊÇÈÚÉ ÇáÍÕÉ ÇáÊí äÔØåÇ ÇáÃÓÊÇÐ ÇáãÊÑÈÕ :
ÊÊã ãäÇÞÔÊåÇãä ÌãíÚ ÇáÌæÇäÈ æáÇÓíãÇ : ÊäÙíã ÇáÃÝæÇÌ ¡ ÊÞæíã ÃÚãÇá ÇáÊáÇãíС ãÑÇÞÈÉ ßÑÇÑíÓ ÇáÊáÇãíС ÇÓÊÛáÇá æÇÓÊÚãÇá ÇáæÓÇÆá ÇáÈíÏÇÛæÌíÉ¡ ÇáÇåÊãÇã ÈÇáÝæÇÑÞ ÇáÝÑÏíÉ¡ ...ÅáÎ.
• ÇáäÞÇØ ÇáÅíÌÇÈíÉ:........................................ .................................................. ...............
• ÇáäÞÇØ ÇáÊí ÊÓÊæÌÈ ÇáÊÍÓíä:.......................................... .............................................
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ãáÇÍÙÉ: íØáÈ ãä ÇáÃÓÊÇÐ ÇáãÊÑÈÕ ÊÍÖíÑ ÈÍË ÞÕíÑ Íæá ÃåãíÉ ÇáÊÞæíã æÃäæÇÚå ææÓÇÆáå
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ÇáÊÇÑíÎ: ...........................................ÇáÝÊÑÉ: ãä ÇáÓÇÚÉ:...................Åáì ÇáÓÇÚÉ:.....................
Ýí åÐÇ ÇááÞÇÁ íäÇÞÔ ÇáÃÓÊÇÐ Çáãßæä ÑÝÞÉ ÇáÃÓÊÇÐ ÇáãÊÑÈÕ ãæÖæÚ ''ÇáÊÞæíã ''¡ æáÇÓíãÇ:
• ÇáÊÞæíã ßÚäÕÑ ãä ÚäÇÕÑ ÇáãäåÇÌ
• ÇáÊÞæíã ÌÒÁ áÇ íÊÌÒà ãä ÇáÝÚá ÇáÊÚáíãí/ ÇáÊÚáãí
• ÃäæÇÚ ÇáÊÞæíã : ÇáÊÔÎíÕí¡ ÇáÊßæíäí¡ ÇáÊÍÕíáí
• ÃåãíÉ ÇáÊÞæíã ÇáãÓÊãÑ – ÞÑÇÁÉ ÇáãäÔæÑ ÇáÎÇÕ ÈÇáÊÞæíã ÇáãÓÊãÑ æÊÍáíáå -
• ÞÑÇÁÉ áßÔÝ ÇáäÞÇØ æßíÝíÉ ÍÓÇÈ ãÚÏá ÇáãÇÏÉ æ ÇáãÚÏá ÇáÓäæí.
ãáÇÍÙÇÊ ÇáÃÓÊÇÐ Çáãßæä Íæá ÇáäÞÇØ ÇáæÇÌÈ ÅËÇÑÊåÇ áÊáÈíÉ ÍÇÌÇÊ ÇáãÊÑÈÕ ÝíãÇ íÎÕ ãæÖæÚ ÇáÊÞæíã
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ãáÇÍÙÉ: íØáÈ ãä ÇáÃÓÊÇÐ ÇáãÊÑÈÕ ÊÍÖíÑ ãæÖæÚ ÝÑÖ ááÊáÇãíÐ (ÊÚííä ÇáãÓÊæì).
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ÇáÍÕÉ ÇáÍÇÏíÉ ÚÔÑ: ãäÇÞÔÉ ãæÖæÚ ÇáÝÑÖ
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Ýí åÐÇ ÇááÞÇÁ íäÇÞÔ ÇáÃÓÊÇÐ Çáãßæä ''ÇáÝÑÖ'' ÇáãÍÖÑ ãä ØÑÝ ÇáÃÓÊÇÐ ÇáãÊÑÈÕ ÈØÑÍ ãÌãæÚÉ ÇáÃÓÆáÉ:
- åá Êã ÅÈÑÇÒ ÇáßÝÇÁÇÊ ÇáãÑÇÏ ÊÞæíãåÇ æßÐÇ ÇáãÍÊæì ÇáÚáãí ¿
- åá ÛØì ãæÖæÚ ÇáÝÑÖ ÌÒÁÇ ãä ÇáãäåÇÌ ÇáÏÑÇÓí ÇáãÞÑÑ¿
- åá ßÇä ãäÓÌãÇ ãÚ ááæÞÊ ÇáãÎÕÕ áå¿
- åá ßÇä ãäÇÓÈÇ áãÓÊæì ÇáÊáÇãíп
- åá ßÇäÊ ÇáÃÓÆáÉ æÇÖÍÉ æ ãÍÏÏÉ ÇáãØáæÈ æÛíÑ ÞÇÈáÉ ááÊÃæíá¿
- åá ÎáÊ ÇáÃÓÆáÉ ãä ÇáÃÎØÇÁ ÇááÛæíÉ æÇáÚáãíÉ¿
- åá ßÇäÊ ÇáÈíÇäÇÊ æÇáÑÓæã æÇÖÍÉ (Ýí ÍÇáÉ ÊæÝÑåÇ)
ÊäÈíå: íÌÈ ãäÇÞÔÉ ÇáÅÌÇÈÉ ÇáäãæÐÌíÉ ÇáãÞÊÑÍÉ ãä ÇáÃÓÊÇÐ ÇáãÊÑÈÕ æÊÍáíáåÇ æßÐÇ Óáã ÇáÊäÞíØ.
ÊæÌíåÇÊ ÇáÃÓÊÇÐ Çáãßæä: .................................................. .................................................. ....
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ãáÇÍÙÉ åÇãÉ: íÓáã ÇáÃÓÊÇÐ Çáãßæä áÒãíáå ÇáãÊÑÈÕ ãÌãæÚÉ ÃæÑÇÞ ÅÌÇÈÉ ÇáÊáÇãíÐ (ÝÑÖ ãäÒáí Ãæ ÝÑÖ ãÍÑæÓ) æíØáÈ ãäå ÊÕÍíÍåÇ æÝÞ äãæÐÌ ÇáÅÌÇÈÉ æ ÇáÓáã ÇáãÊÝÞ ÚáíåãÇ.
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ÇáÊÇÑíÎ: ...........................................ÇáÝÊÑÉ: ãä ÇáÓÇÚÉ:...................Åáì:.................... ......
ÎáÇá åÐå ÇáÍÕÉ íÑÇÌÚ ÇáÃÓÊÇÐ Çáãßæä ÑÝÞÉ ÇáÃÓÊÇÐ ÇáãÊÑÈÕ ãÌãæÚÉ ãä ÃæÑÇÞ ÇáÅÌÇÈÇÊ¡ æ íÔÑÍ áå ßíÝíÉ ÇÓÊäÊÇÌ ÇáäÞÇÆÕ ÇáæÇÌÈ ãÚÇáÌÊåÇ æßÐÇ ØÑÇÆÞ ÇáãÚÇáÌÉ ÇáãÞÊÑÍÉ.
ãáÇÍÙÉ: íØáÈ ÇáÃÓÊÇÐ Çáãßæä ãä ÇáãÊÑÈÕ ÅÚÏÇÏ ÈÍË ÞÕíÑ Íæá '' ãÝåæã ÇáãÚÇáÌÉ ÇáÈíÏÇÛæÌíÉ ''. ÅãÖÇÁ
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ÇáÍÕÉ ÇáËÇáËÉ ÚÔÑ : ÅÏÇÑÉ ÍÕÉ '' ÇáãÚÇáÌÉ ÇáÈíÏÇÛæÌíÉ''
ÇáÊÇÑíÎ: ...........................................ÇáÝÊÑÉ: ãä ÇáÓÇÚÉ:...................Åáì:.................... ......
ÎáÇá åÐå ÇáÍÕÉ íÍÖÑ ÇáÃÓÊÇÐ ÇáãÊÑÈÕ ÍÕÉ ÊÚäì ÈÇáãÚÇáÌÉ ÇáÈíÏÇÛæÌíÉ íäÔØåÇ ÇáÃÓÊÇÐ Çáãßæä.
ÚÞÈ ÇáÍÕÉ ÊÊã ÇáãäÇÞÔÉ ãä ÌãíÚ ÇáÌæÇäÈ ÇáÊÑÈæíÉ æÇáÈíÏÇÛæÌíÉ¡ æáÇÓíãÇ ÇáäÞÇØ ÇáÂÊíÉ:
- ßíÝíÉ ÇáÅÚÏÇÏ áÍÕÉ '' ÇáãÚÇáÌÉ ÇáÈíÏÇÛæÌíÉ''
- ßíÝíÉ ÊäÔíØ åÐå ÇáÍÕÉ .
- ÇáÇåÊãÇã ÈÇáÝæÇÑÞ ÇáÝÑÏíÉ
- ÇáÊÞæíã ÞÕÏ ÇáÊËÈÊ ãä ÊÍÞíÞ ÈáæÛ ÇáÃåÏÇÝ ÇáãÓØÑÉ.
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ãáÇÍÙÉ åÇãÉ: íØáÈ ãä ÇáÃÓÊÇÐ ÇáãÊÑÈÕ ÅÚÏÇÏ ÍÕÉ "ÇáãÚÇáÌÉ ÇáÈíÏÇÛæÌíÉ" áÊäÔíØåÇ .
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ÇáÍÕÉ ÇáÑÇÈÚÉ ÚÔÑ: ÊäÔíØ ÍÕÉ "ÇáãÚÇáÌÉ ÇáÈíÏÇÛæÌíÉ"
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ÎáÇá åÐå ÇáÍÕÉ íäÔØ ÇáÃÓÊÇÐ ÇáãÊÑÈÕ ÑÝÞÉ ãÌãæÚÉ ãä ÇáÊáÇãíÐ ÍÕÉ ''ÇáãÚÇáÌÉ ÇáÈíÏÇÛæÌíÉ''
ãáÇÍÙÇÊ ÇáÃÓÊÇÐ Çáãßæä Íæá:
- ÇáäÞÇØ ÇáÅíÌÇÈíÉ Ýí ÇáÊÍÖíÑ:.......................................... ............................................
- ÇáäÞÇØ ÇáÓáÈíÉ Ýí ÇáÊÍÖíÑ:.......................................... ..............................................
- äÞÇØ ÇáÞæÉ Ýí ÅÏÇÑÉ åÐå ÇáÍÕÉ æÊäÔíØåÇ.......................................... .............................
- äÞÇØ ÇáÖÚÝ Ýí ÅÏÇÑÉ åÐå ÇáÍÕÉ æÊäÔíØåÇ:......................................... .......................
ãáÇÍÙÇÊ ÃÎÑì æÊæÌíåÇÊ:......................................... .....................................
ãáÇÍÙÉ åÇãÉ: íØáÈ ãä ÇáÃÓÊÇÐ Çáãßæä ÊÍÖíÑ ÈÍË Íæá "ÃåãíÉ ÅÏÑÇÌ ÇáãÚáæãÇÊíÉ Ýí ÊÏÑíÓ ÇáãÇÏÉ"
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íÞÏã ÇáÃÓÊÇÐ ÇáãÊÑÈÕ ÚÑÖÇ Íæá ÇáÈÍË ÇáÐí ÃäÌÒå.
ÊÊã ãäÇÞÔÉ ÇáãæÖæÚ ãä ãÎÊáÝ ÌæÇäÈå ãÚ ÊÈíÇä ÃåãíÉ ÅÏÑÇÌ ÇáãÚáæãÇÊíÉ Ýí ÊÏÑíÓ ãÎÊáÝ ÇáãæÇÏ
æãÏì ãÓÇåãÊåÇ Ýí ÊÍÞíÞ ÇáÃåÏÇÝ ÇáãÓØÑÉ áÍÕÉ ÊÑÈæíÉ Ãæ ãÌãæÚÉ ÍÕÕ.
íÞÏã ÇáÃÓÊÇÐ Çáãßæä ÃãËáÉ æÇÞÚíÉ æãáãæÓÉ ãä ÇáãäåÇÌ .
ãáÇÍÙÇÊ æÊæÌíåÇÊ ÇáÃÓÊÇÐ Çáãßæä: .................................................. ......................................
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