Form DNR

 

 

]WKBJ \BDHQ WKWK MWIO\W MBIAWIO  EBIOBI @BDWDBI ]G\W\HQB\H ( AF IFQ ]G\W\HQBQG) Ahhsh f`gj ASES / Afdtgr Bibstgsh / Afdtgr Dfkhtg Kgahd If

Egihs hinfrkbsh

2

Ahboifshs

=

B`bsbi AI]

<

Qbtb lbrb

1

Queubi

7

]hshdf

>

Srfoifshs

?

@bhi-`bhi

Qbiabtbiobi Sbshgi/wb`h

Hsh hinfrkbsh

\byb kgiybtbdbi mbjwb sbyb tg`bj kgkmgrhdbi pgieg`bsbi kgiogibh jb`-jb` ybio tgrtu`hs ah btbs sglbrb mgibr abi eg`bs, sbyb kgkmgrhdbi dgsgkpbtbi uitud mgrtbiyb.

Qbiabtbiobi afdtgr

\byb kgiybtbdbi mbjwb sbyb tg`bj kgigrhkb pgieg`bsbi kgiogibh jb`-jb` ybio tgrtu`hs ah btbs, abi tg`bj kgkbjbkhiyb.

Qbiabtbiobi pbshgi(*)

(*) mh`b pbshgi thabd dfkpgtgi btbu thabd abpbt kgigrhkb hinfrkbsh, kbdb pgigrhkb hinfrkbsh bab`bj dg`ubrob pbshgi btbu wb`hiyb ybio dfkpgtgi. \byb ybio mgrtbiabtbiobi ah mbwbj hih 5 Ibkb (*)

5 ………………………………………………………………………………………………………………… 

B`bkbt

5 ………………………………………………………………………………………………………………… 

Dg`bkhi

5 @bdh-`bdh / Sgrgkpubi (**), Wshb

5 ………………………………………………………… 

Agiobi hih kgiybtbdbi EBIOBI @BDWDBI ]G\W\HQB\H tgrjbabp 5 Ibkb

5 ………………………………………………………………………………………………………………… 

B`bkbt

5 ………………………………………………………………………………………………………………… 

Dg`bkhi

5 `bdh-`bdh / Sgrgkpubi (**), Wshb

5 ……………………………………………………… 

\byb kgkbjbkh abi kgiobkmh` dgputusbi hih agiobi sbabr abi tbipb pbdsbbi, tgrkbsud rHshdf ybio kuiodhi thkmu`, sgmbobhkbi ybio tg`bj aheg`bsdbi dgpbab sbyb. \byb kgybdhih mbjwb dgjhaupbi mgohtu euob dgkbthbi jbiyb`bj btbs hzhi Qujbi Xbio Kbjb Gsb. Mbiauio, tbioob` ………, Mu`bi ……………………………, Qbjui ……………, Sudu` ……………….._HM   Xbio kgkmubt pgriybtbbi

\bdsh 2

( ……………………………………..) 

(…………………………..)

\bdsh =

Afdtgr

(…………………………..) 

(..………………………….) 

(**) Lfrgt sb`bj sbtu

Ahmubt rbiodbp aub