ymt¥m¾ c’É ¼dNb¾¼

WK?Ç lØ` : _____________________________________

V}` lØ` : _____________________________________

‰c= lØ` : _____________________________________

ªeƒ“ lØ` :__________________________ ¾"X lØ`:___________________________

”w[ƒ’~ ¾ ¾J’ ´`´\ ŸLÃ ¾}Ökc¨< }iŸ`"] k” ¯.M. u¡MM ¨[Ç

M¿ eS< _________________________u}vK x ታ uÅ[cuƒ ›ÅÒ U¡”Áƒ y_g êUWN k?BrT x!N¹#‰NS x.¥ ቀሪ
25% yµœ KFà w`_____________________________________________________ eK}kuMŸ<&u²=I ›ÅÒ UŸ”Áƒ
MNM xYnT t=¥¶ "X ŸQw[ƒ ›=”g<^”e ›T ¾TMÖÃp SJ’@” u}KSŨ< ò`TÂ/ò`T‹” ›[ÒÓ×KG</“[ÒÓ×K”::

k” _______________________________ ò`T _______________________

እ T™‹
_________________________________ ò`T _______________________

________________________________ ò`T ______________________

__________________________________ ò`T _______________________