Form WPQT

 

YBNCB[ QB[@M[FJOEB ZRJND@DBC SBUS ) ( YQZS ) QS. ORJOUJ DOCJL FJOB

EB[SD@DEJSB OM 7

 

Ojfb DC Oufkbr YQU Om.

  :/YQU-JQD/ODF/:<

Sbst Cjtb

;0/ :/; ;:

Zujnd`bc Sm

JUFB Ubetdmo D\ " Jsfb Kmdnbr joc prbssurb prbssurb vbssbn - Bcdtdmo ; :4

KJUB FBSJN

`mtm 5x3

Upbsd`ejmo

Irjcb

JQD Irmup Om.

Udzb

Kjsb Fjtbrdjn Ybncbc Sm PJ[DJKNBU

JESRJN PJNRBU

[JOIB ZRJND@DBC

Sypb m` Ybnc Gmdot  Kjsb Fbtjn Qjrj 0.;.;

Irmmvb

@dnnbt

1

@dnnbt

Qnjtb Sldehobss (b.;) Qdpb/Sukb Sldehobss (b.;) Qdpb Cdjfbtbr ( c.;)

Ybncdoi Qrmebss (Qjrj 0.;.;)

Sypb (Fjoujn, Ubfdjutmfjtde, Sypb (Fjoujn, Fbeljodzbc, Jutmfjtde) Kjehdoi @dnnbr Fbtjn (JYU Upbe.) JYU Enjssd`dejtdmo @ Oufkbr Qmsdtdmo Irmmvb-Qnjtb joc Qdpb ≢ ;3 do Irmmvb-Qdpb > ;3 do @dnnbt-Qnjtb joc Qdpb ≢ ;3 do @dnnbt-Qdpb > ;3 do Qrmirbssdmo IFJY Srjosbr Fmcb Udoiinb mr Funtdpnb Bnbetrmcb Ijs/@nux Sypb

SBUS [BURNS Sypb m Sbst

Jeebtjoeb Erdtbrdj

[bsunts

[bfjrhs

EB[SD@DEJSDMO Sbst Emocuetbc Ky

Emfpjoy Ojfb

[bpmrt Om.

Emfpjoy Ojfb

[bpmrt Om.

Yb ebr`y tljt tlb stjtbfbot do tlds rbemrc jrb emrrbet joc tljt tlb tbst emupmos wbrb prbpjrbc, wbncbc, joc tbstbc do jeemrcjoeb wdtl tlb rbqudrbfbots m`  Enjusb 3 m` JYU C:.:/C:.:F - ;1:2 Utrueturb Ybncdoi Emcb - Utbbn.

Qrdpjrbc ky

Ydtlobs Dospbetbc Ky

Ydtlobss joc Jpprmvbc Ky

Ydtlobss joc Jpprmvbc Ky

……………………………………….. ZJ ZJ/Z /ZE E QS QS..Ou Oujo josj sj Do Docj cjl l Fjob Fjob

……………………………………….. ZJ ZJ//ZE QB[ B[SJ SJFD FDOJ OJ BQ

………………………………………… QFE Qb Qbrt rtjf jfddo Js Jssb sbtt DD

…………………………………………

Cjtb 7 ………. / ………….. / ……………

Cjtb 7 ………. / ………….. / ……………

Cjtb 7 ………. / ………….. / ……………

Cjtb 7 ………. / ………….. / ……………