REPUBURIKA Y’URWANDA kuwa…………/…………./……….

INTARA Y’IBURASIRAZUBA

AKARERE KA BUGESERA

UMURENGE WA GASHORA

AKAGARI KA …………..

ICYEMEZO CY’IMICO N’IMYIFATIRE

Ubuyobozi bw’umudugudu wa ……………………………………….buramenyesha ko uyu……………………………………

ufite ID………………………………………………Mwene………………………………………… na
………………………………………………………………….ari umuturage wo mu mudugudu
wa…………………………………..akaba ari indacyemwa mu mico no mumyifatire

Umuyobozi w’umudugudu wa………………………………………….

Amazina Umukono

ICYEMEZO CY’IMICO N’IMYIFATIRE

Ubuyobozi bw’Akagari ka ……………………………………….bushingiye ku makuru aturuka mu mudugudu wa

……………………………….......................................................buramenyesha ko uyu……………………………………
ufite ID………………………………………………Mwene………………………………………… na
………………………………………………………………….ari umuturage wo mu mudugudu
wa…………………………………..akaba ari indacyemwa mu mico no mumyifatire

Umuyobozi w’akagari ka………………………………………….

Amazina Umukono

ICYEMEZO CY’IMICO N’IMYIFATIRE

Ubuyobozi bw’umurenge wa……………………………………….bushingiye kumakuru aturuka mukagari

ka…………………………………………………..buramenyesha ko uyu……………………………………ufite
ID………………………………………………Mwene………………………………………… na
………………………………………………………………….ari umuturage wo mu mudugudu
wa…………………………………..akaba ari indacyemwa mu mico no mumyifatire

Umuyobozi w’umurenge wa………………………………………….

Amazina Umukono