‫ﺟﺎﻣﻌﺔ ﺍﻟﻤﺮﻗﺐ ‪ -‬ﺍﻟﺨﻤﺲ‬

‫ﻛﻠﻴﺔ ﺍﻟﻘﺎﻧﻮﻥ‬
‫ﻗﺴـﻢ ﺍﻟﻌﺎﻡ‬

‫ﺑﻄﺎﻗﺔ ﺍﻟﻤﻌﻠﻮﻣﺎﺕ ﺍﻟﺸﺨﺼﻴﺔ ﻟﻠﻄﺎﻟﺐ‬

‫‪223153318‬‬ ‫ﻣﻌﻠﻮﻣﺎﺕ ﺍﺳﺎﺳﻴﺔ‬

‫ﺍﻟﺠﻨﺴﻴﺔ ‪ :‬ﻟﻴﺒﻴﺔ‬ ‫ﺭﻗﻢ ﺍﻟﻘﻴﺪ ‪223153318 :‬‬ ‫ﺍﻻﺳﻢ ﺍﻟﻌﺮﺑﻲ ‪ :‬ﻧﻮﺭﺍﻟﻬﺪﻯ ﻣﻴﻼﺩ ﺃﺣﻤﺪ ﺍﻫﺪﻳﻮﻩ‬

‫ﺍﻟﺤﺎﻟﺔ ﺍﻻﺟﺘﻤﺎﻋﻴﺔ ‪ :‬ﺍﻋﺰﺏ‬ ‫ﺍﻟﺠﻨﺲ ‪ :‬ﺍﻧﺜﻰ‬ ‫ﺍﻻﺳﻢ ﺍﻻﻧﺠﻠﻴﺰﻱ ‪NOUR MELAD EHDIWA :‬‬

‫ﺍﻟﺒﻠﺪ ‪ :‬ﻟﻴﺒﻴﺎ‬ ‫ﻣﻜﺎﻥ ﺍﻟﻤﻴﻼﺩ ‪ :‬ﻃﺮﺍﺑﻠﺲ‬ ‫ﺗﺎﺭﻳﺦ ﺍﻟﻤﻴﻼﺩ ‪2005-04-26 :‬‬

‫ﺭﻗﻢ ﻭﺭﻗﺔ ﺍﻟﻌﺎﺋﻠﺔ ‪7185 :‬‬ ‫ﺭﻗﻢ ﻗﻴﺪ ﺍﻟﻌﺎﺋﻠﺔ ‪196952 :‬‬ ‫ﺭﻗﻢ ﻛﺘﻴﺐ ﺍﻟﻌﺎﺋﻠﺔ ‪887809 :‬‬

‫ﺭﻗﻢ ﺍﻟﻬﺎﺗﻒ* ‪ 0920855611 :‬ﺍﻟﺒﺮﻳﺪ ﺍﻻﻟﻜﺘﺮﻭﻧﻲ* ‪:‬‬ ‫ﺍﻟﺮﻗﻢ ﺍﻟﻮﻃﻨﻰ ﺃﻭ ﺟﻮﺍﺯ ﺍﻟﺴﻔﺮ ﻟﻠﻤﻐﺘﺮﺑﻴﻦ* ‪:‬‬
‫‪nonehdewa@gmail.com‬‬ ‫‪220050571721‬‬

‫ﻋﻨﻮﺍﻥ ﺍﻟﺴﻜﻦ ‪ :‬ﺍﻟﺨﻤﺲ‬ ‫ﻧﻮﻉ ﺍﻟﺴﻜﻦ ‪ :‬ﺧﺎﺭﺟﻲ‬ ‫ﺭﻗﻢ ﺑﻄﺎﻗﺔ ﺍﻟﻤﻨﺤﺔ* ‪00000000 :‬‬

‫ﺳﻨﺔ ﺍﻻﻟﺘﺤﺎﻕ ‪2024/2023 :‬‬ ‫ﺍﻟﺸﻌﺒﺔ ‪ :‬ﺷﻌﺒﺔ ﻋﺎﻣﺔ‬ ‫ﻗﺴـﻢ ‪ :‬ﺍﻟﻌﺎﻡ‬

‫ﺑﻴﺎﻧﺎﺕ ﺛﺎﻧﻮﻳﺔ‬
‫ﺍﻟﻤﻬﻨﺔ ‪ :‬ﻣﻌﻠﻢ‬ ‫ﺃﻗﺮﺏ ﺍﻷﻗﺎﺭﺏ ‪ :‬ﻣﻴﻼﺩ ﺍﻫﺪﻳﻮﻩ‬

‫ﻭﻇﻴﻔﺔ ﺍﻻﻡ ‪ :‬ﻣﻌﻠﻤﻪ‬ ‫ﺇﺳﻢ ﺍﻻﻡ ‪ :‬ﺧﻴﺮﻳﺔ ﻣﺤﻤﻮﺩ ﻋﻤﺮ ﺍﻟﻤﻨﺸﺎﺯ‬

‫ﺍﻟﻌﻨﻮﺍﻥ ﺍﻭ ﺭﻗﻢ ﺍﻟﻬﺎﺗﻒ ‪0928907657 :‬‬ ‫ﺷﺨﺺ ﺁﺧﺮ ﻳﻤﻜﻦ ﺍﻻﺗﺼﺎﻝ ﺑﻪ ‪ :‬ﻣﻴﻼﺩ ﺍﻫﺪﻳﻮﻩ‬

‫ﺃﻗﺮ ﺑﺎﻥ ﻛﻞ ﺍﻟﺒﻴﺎﻧﺎﺕ ﺍﻟﻮﺍﺭﺩﺓ ﻓﻲ ﺍﻟﺒﻄﺎﻗﺔ ﺻﺤﻴﺤﺔ ﻭﻫﻲ ﻣﻄﺎﺑﻘﺔ ﻟﻠﻤﺴﺘﻨﺪﺍﺕ ﺍﻟﺮﺳﻤﻴﺔ ﻭﺍﻟﻤﻌﺘﻤﺪﺓ‪.‬‬

‫ﺗﻮﻗﻴﻊ ﺍﻟﻄﺎﻟﺐ ‪..........................................:‬‬

‫ﻣﺴﺠﻞ ﺍﻟﻜﻠﻴﺔ‬

‫ﺍﻟﺘـﺎﺭﻳـﺦ ‪2024-01-23:‬ﻡ‬
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