Form DNR

 

  LDKG^ JB^BAG\GK JGORUG\BK OBJG^D _RCGA ^GJD\ RCRC LGB_GA NGOGKMORKMDK

_C.JBU.51.57>.?574 

Jp. Oihikm _\ 55< / _] 557 Ls. Hgygfgjsgkg Jbn. Ngogkmoukmdk Jgo. Objgsd Jilb Uis 7==?5 \bfp. (5?7) >55 ?7 0>>, Bcgdf 8  8 rsul.ngogkmoukmdkEmcgdf.nic, rsul.ngogkmoukmdkEmcgdf.nic,  ]bosdtb 8 rsulngogkmoukmdk.objgs rsulngogkmoukmdk.objgsdjgo.mi.dl djgo.mi.dl

@I_CRFD_ UBKIFGJGK _B^R^D\G^D (LK_)  Tgkm obrtgklg tgkmgk ld ogwga dkd 8 Kgcg

8 ……………………………………………………………………………  …………………………………………………………………………… 

Rcur

8 ……………………………………………………………………………  …………………………………………………………………………… 

 Gfgcgt

8 …………………………………………………………………………… ……………………………………………………………………………   …………………………………\bfbpik 8 ……………………………  …………………………… 

Ldrd ^gyg/ Dstrd/ ^ugcd/ Gyga/ Dou/ Gkgj/ Jgjgj/ Gldj ( ………………) lgrd pgsdbk lgrd pgsdbk 8 Kgcg

8 …………………………………………………………………………… ……………………………………………………………………………  

\bcpgt/ \gkmmgf Fgadr

8 ……………………………………………………………………………  …………………………………………………………………………… 

Ki. _C

8 …………………………………………………………………………… ……………………………………………………………………………  

Hbkds jbfgcdk

8 ▧ FgjdFgjd-Fgjd

▧ Ubrbcpugk  Ubrbcpugk 

lbkmgk dkd cbkygtgjgk ogawg tbfga cbcougt jbputusgk lgk cbkybtuhud rbsusndtgtb (hgkmgk

pbrdktga

li kit

ldrbsusdtgsd).

^gyg cbcgagcd rdsdji lgk jicpfdjgsd ygkm cukmjdk tdcouf gpgodfg tdklgjgk tbrsbout tdlgj ldfgjujgk. ^gyg obrtgkmmukm hgwgo pbkua gtgs gjdogt ygkm cukmjdk tdcouf sbogmgd gjdogt gtgs tdlgj ldfgjujgkkyg tdklgjgk tbrsbout. Lbcdjdgk pbrkygtggk dkd sgyg ougt lbkmgk sbsukmmuakyg uktuj ldjbtgaud lgk ldmukgjgk sbogmgdcgkg pbrfukyg.

Objgsd, ……………………………………..  …………………………………….. 

Tgkm Cbcougt Ubrkygtggk,

(........................ (........... ........................ ........................ ..................) .....) \\L & Kgcg Hbfgs

^gjsd

(.................................... (........................ ........................ ...............) ...) \\L & Kgcg Hbfgs

Lijtbr

(..................................... (........................ .......................) ..........) \\L & Kgcg Hbfgs