ŪĮйŬď₧şŪ˝˝ņįОď

ďijЊ ⅜₤Ĝ ŪĮйņΉ˝℮Ūij

3
ĵ˝ŏĠ‗ʼnЕ₣₤НеŁũЮŢйŪ⅜ŎŷЋǻ◦
ņ˝Ð‗к˝ņŊŁũņРŲĠŪij˝ņįОď


ŁŲĠũЋЮş¯◦аĕĵ˝ŏĠ‗ʼn₣
Е şНйаℓĞ◦Б ........... ЯŠ ........... ĂĖеƯƠ......

ơ. ĮњijхŌĕũĠ₤сļÐБЮ₤ĖЧ₤НеŁũЮŢйŪ⅜Ŏ ŷЋǻ◦
 ũРĠŷĕʼnĠÐ
Н Ų
ð
ЮýijʼnĜņ ĕЊ₣Ĝņ ...................................................... Юķ◦ .............. Ю˝ЧijаℓĞ◦Б ................ ЯŠ ................. ĂĖе ..................

₤ŔąijЊ ..............................ЮŲŠΒijʼn₤Ŕň‗Ġњ‗‼ ιŲЊŠЊijđų₣Яřĕ.........................................ņНŠũĠũ.............................

Ζ₤ŎŢťĕ .............................................................................................................................................................................

ЮŲŠ◦Рũ₤ĮĀ.....................................................................................................ΒНБЯņлŲ.............................................................
 ĕБijĠ
Њ Ð
Н Ų
ð
Ĝņ˝ũ‗ч.................................................................................................................................................................................
ЮŲŠşНйĠŃą БŪ˝₤У₣ĵ‗ЊĄą˝ņŊ........................................................ŁŲĠũЋЮş¯◦şНйĠŃą Б....................................................

ЮŲŠΖďńĠ‗‼ ЮĊſЧΖĄБŷ˝ņŊ (ŪĠ₤ЊĕЮĠЧŌĕ) .....................................................................................................................

ŁŲĠũЋЮş¯◦ .........................................................ЮşŀЮŢŎ ..............................................................................................

Ζ₤ŎŢťĕ..............................................................................................................................................................................
ЮŲŠ◦Рũ₤ĮĀ.............................................................................................◦Рũ⅜ũ......................................................................
ΒНБЯņлŲ........................................................................................ЮÐ΅◦еĮњũ..............................................................................
 ΒĖ˝ijе₧₣ĕБijĠ
Њ Ð
Н Ų
ð (ŪĠ₤ЊĕЮĠЧŌĕ)
ЮýijʼnĜņ ĕЊ₣Ĝņ...........................................................Юķ◦......................Ю˝ЧijаℓĞ◦Б..............ЯŠ.............ĂĖе............
₤ŔąijЊ.................ЮŲŠΒijʼn₤Ŕň‗Ġњ‗‼ ιŲЊŠЊijđų₣Яřĕ.....................................................ņНŠİũ................................
Ζ₤ŎŢťĕ .............................................................................................................................................................................

ЮŲŠ◦Рũ₤ĮĀ.....................................................................................................ΒНБЯņлŲ............................................................

Ư. ĮњijхŌĕũĠ₤сļÐБĄЮŌųйŌš ₣Ю◦Ьij
 ũРĠŷĕʼnĠÐ
Н Ų
ð
ЮýijʼnĜņ ĕЊ₣Ĝņ ...................................................... Юķ◦ .............. Ю˝ЧijаℓĞ◦Б ................ ЯŠ ................. ĂĖе ..................

₤ŔąijЊ ..............................ЮŲŠΒijʼn₤Ŕň‗Ġњ‗‼ ιŲЊŠЊijđų₣Яřĕ.........................................ņНŠũĠũ.............................

Ζ₤ŎŢťĕ .............................................................................................................................................................................

ЮŲŠ◦Рũ₤ĮĀ.....................................................................................................ΒНБЯņлŲ.............................................................
  ĕБijĠ
Њ Ð
Н Ų
ð

Ĝņ˝ũ‗ч.................................................................................................................................................................................

ЮŲŠşНйĠŃą БŪ˝₤У₣ĵ‗ЊĄą˝ņŊ........................................................ŁŲĠũЋЮş¯◦şНйĠŃą Б....................................................

ЮŲŠΖďńĠ‗‼ ЮĊſЧΖĄБŷ˝ņŊ (ŪĠ₤ЊĕЮĠЧŌĕ) .....................................................................................................................

ŁŲĠũЋЮş¯◦ .........................................................ЮşŀЮŢŎ ..............................................................................................

Ζ₤ŎŢťĕ..............................................................................................................................................................................

ЮŲŠ◦Рũ₤ĮĀ.............................................................................................◦Рũ⅜ũ......................................................................

ΒНБЯņлŲ........................................................................................ЮÐ΅◦еĮњũ..............................................................................

 ΒĖ˝ijе₧₣ĕБijĠ
Њ Ð
Н Ų
ð (ŪĠ₤ЊĕЮĠЧŌĕ)

ЮýijʼnĜņ ĕЊ₣Ĝņ...........................................................Юķ◦......................Ю˝ЧijаℓĞ◦Б..............ЯŠ.............ĂĖе............

₤ŔąijЊ.................ЮŲŠΒijʼn₤Ŕň‗Ġњ‗‼ ιŲЊŠЊijđų₣Яřĕ.....................................................ņНŠİũ................................

Ζ₤ŎŢťĕ .............................................................................................................................................................................

ЮŲŠ◦Рũ₤ĮĀ.....................................................................................................ΒНБЯņлŲ...........................................................

ư. ĮњijхŌĕĵ˝сĮњĕċĕЕ₣ ŷЋǻ◦

ư.ơ.˝ņŊŷij□ОаĕŁũĈņĈũ .......................................................................................................

ư.Ư.ijаņų˝ņŊŷij□ОаĕŁũĈņĈũ ..................................................................................................

ư.ư.ЮijЧΒĖ˝ēųĠсģĕ ι˝еĮН₣Ţ˝сĵ˝ŏĠ‗ʼnЕ₣Юĉ៖

˝.ņĄęijʼnŁũ Š.ijНŵŁũ

ņЊĕēųĠс ņЊĕēųĠс
ēųĠс ₤РņĠŔą˝сŁŲĠũЋЮş¯◦ .......................... ēųĠс ₤РņĠŔą˝сŁŲĠũЋЮş¯◦ ........................
ĕЊ₣ļąĠсņ˝ĕРŷЮ₤ş˝ʼnБĄРĕřе‗Е₣ΒеĮБņĄęijʼn˝ņŊℓijşņų₣ ĕЊ₣ļąĠсņ˝ĕРŷĵ˝ŏĠ‗ʼnЕ₣ ĕЊ₣Ġİ˛ ĕсаřĠ₣сŪģ˝сŪĠŢĠс

˝ʼnБℓijşņų₣

ư.̉. ŁŲĠũЋЮş¯◦аĕ˝е‗ijсЮ΅ijНņЊĕ₤йďЮŲЧ ŷЋǻ◦ЯřŲЮşŀЮŢŎΒĖ˝ĩ℮йĩ⅝ŷЋǻ◦ũĠ₤с Ð.ņ.˝. ..............

̉.υ˝⅜ũļąĠсĄРĕ Ð.ņ.˝.

ơ.˝е‗ijсЮ΅ijНĩ℮йĩ⅝ņЊĕ₤йď

Ư.ŲЊŠij
Њ ЮĩĀũ₤Њ◦Њ₤
ċ ŪŌĠсΒĖ˝ijе₧₣ (ŪĠ₤ЊĕЮĠЧŌĕ)

ư.Ю₤ş˝ʼnБĄĕ
Р řе‗Е₣ΒеĮБņĄęijʼn˝ņŊ /ĵ˝ŏĠ‗ʼnЕ₣ЮĝijНŵŁũ ĕЊ₣Ġİ˛ ĕсаřĠ₣сŪģ˝сŪĠŢĠс˝ʼnБ (ŪĠ₤ЊĕЮĠЧŌĕ)

̉.Юĩ℮₣ៗ (₤РņĠŔą˝с) ............................................................................................................

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

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

2
Ю₤ş˝ʼnБЯℓų₣

О ŲсŪĮņĜеŎ˝ŷЋǻ◦ĄРĕÐ‗к˝ņŊŁũņРŲĠŪij˝ņįОď (Ð.ņ.˝.) ЮřЧņġБЮŢйŪ⅜ŎŷЋǻ◦ ĕЊ₣ЮýũĮ″ņşĤĠс

ŠńеŎ

Ġ◦ĠġŃňijʼnЊ ĕЊ₣ŷЋēĕĵ˝сĮњĕċĕЕ₣ŁũЮŢйŪ⅜ŎŷЋǻ◦˝ĖО₣ŷЋ₤њŎņРŲĠŪij ŪĮņĈе₣ũ˝⅝Łũ₤ŌĞijсĵ˝сĮњĕċĕЕ₣ŬŲсĮњijŌ

х ĕ

ŁũЮđųЧŎđų₣ ⅜ũЮΒΌЊşŪijСĕЊş ЮũЩ₣Ŭм ŷЯřŲģĕĮЊļ˝⅝ Ю₤ş˝ʼnЮБ ₤Ė Ч ˝е‗ijсЮ΅ijН ĕЊ₣υ˝⅜ũĵ˝сĮĕ

њ ċЮĩ℮₣Ю◦Ьij ЮŢŎ

ņЊĕŪijСŷЮĠЧ˝ĠİΆŀ ιĠ˝Ū⅜Ŏ ιŎ˝Юĉĩ℮Įſĩ⅝Ŏď⅜ēũ‗к ЮĈйЮĊſЧЮΌЧ₣″ņũŎкŁũĕЊŗŎ˝ʼnБ ιŁũ₤еЯř₣˝ʼnБ

ιЮŪŁņũРĠ ļĮ₧ņУ Ŏ˝єЮŢŎ¤ Šńе₤

О РņĠŔą˝с▫ ŬŲсĮњijхŌĕ ĕЊ₣υ˝⅜ũ ЯřŲģĕĠеЮĮŀ˝ĖО₣ĵ˝ŏĠ‗ʼnЕ₣Юĕй

ĕЊ₣ĩʼnŲсĄРĕ Ð.ņ.˝. ĮЊijďŪijЕņŪijСŷ¤ ŠńеŎ

О ŲсŪĮņĩʼnŲсĄРĕ Ð.ņ.˝. ĕРŷυ˝⅜ũ ιĮњijхŌĕĠЯĕ□ņĵ˝сĮњĕċĕЕ₣ĵ˝ŏĠ‗ʼn₣
Е

Ю₤Ė Ч₤НеŁũЮŢйŪ⅜ŎŷЋǻ◦Юĕй ŪĮņĈе₣ļąĠсņ˝ďņУŎυ˝⅜ũĠ˝ЯŪĠďļ⅜ũЯŠŊũ ˝ĖО₣˝ũ‗Бυ˝⅜ũşĤĠсЮřЧņď

ļ⅜ĠũЮ◦₤¤
΅ij□ЮŲž ĕЊ₣/ι⅜ĖņŪŌņаřũĠ₤сļÐБЮ₤Ė ₤
Ч Не