/Esteshh

‫ﺗﺎﺭﻳﺦ ﺗﻜﻤﻴﻞ ﺍﺳﺘﺸﻬﺎﺩﻳﻪ ‪:‬‬ ‫ﻧﻮﻉ ﺷﻨﺎﺳﻨﺎﻣﻪ ﻣﻔﻘﻮﺩﻩ‪:‬‬

‫ﺍﺳﺘﺸﻬﺎﺩﻳﻪ ﻭ ﺩﺭﺧﻮﺍﺳﺖ ﺻﺪﻭﺭ‬ ‫ﺷﻨﺎﺳﺘﺎﻣﻪ ﻣﺠﺪﺩ ﺩﺭ ﻗﺒﺎﻝ ﻓﻘﺪﺍﻥ‬

‫ﻧﻤﻮﻧﻪ ﻗﺪﻳﻢ‬

‫ﺑﺎﺭ ﺍﻭﻝ‬

‫ﻧﻤﻮﻧﻪ ﺟﺪﻳﺪ‬

‫ﺑﺎﺭ ﺩﻭﻡ‬

‫ﻣﺤﻞ‬ ‫اﻟﺼﺎق‬ ‫ﻋﻜﺲ‬

‫ﻣﺸﺨﺼﺎﺕ‬

‫ﺻﺎﺣﺐ ﺷﻨﺎﺳﻨﺎﻣﻪ‬

‫ﻣﺸﺨﺼﺎﺕ ﺩﺭﺧﻮﺍﺳﺖ ﻛﻨﻨﺪﻩ‬

‫ﺑﺎﺭ ﺳﻮﻡ‬ ‫ﺍﻳﻨﺠﺎﻧﺐ ‪ ..................‬ﻧﺎﻡ ﺧﺎﻧﻮﺍﺩﮔﻲ ‪ .....................‬ﻧﺎﻡ ﭘﺪﺭ‪ ...............‬ﺷﻤﺎﺭﻩ ﺷﻨﺎﺳﻨﺎﻣﻪ ‪ /‬ﻣﻠﻲ‪.....................‬‬ ‫ﺗﺎﺭﻳﺦ ﺗﻮﻟﺪ‪ ...................‬ﻣﺤﻞ ﺻﺪﻭﺭ‪.......................‬‬ ‫ﻧﺸﺎﻧﻲ‪...............................................................................:‬‬

‫ﺍﺻﺎﻟﺘﺎ‬

‫ﻛﺪ ﭘﺴﺘﻲ‪ ...........................‬ﺗﻠﻔﻦ ‪.....................................‬‬

‫ﻭﻛﺎﻟﺘﺎ‬

‫ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻓﻘﺪﺍﻥ ﺷﻨﺎﺳﻨﺎﻣﻪ ﺷﻤﺎﺭﻩ‪ .........................‬ﻭ ﮔﻮﺍﻫﻲ ﮔﻮﺍﻫﺎﻥ ﺫﻳﻞ‬

‫ﻭﻻﻳﺘﺎ‬

‫ﺗﻘﺎﺿﺎﻱ ﺻﺪﻭﺭ ﺷﻨﺎﺳﻨﺎﻣﻪ ﻣﺠﺪﺩ ﺭﺍ ﺩﺍﺭﻡ ‪.‬‬ ‫ﺍﻣﻀﺎﺀ‬ ‫ﻧﺎﻡ‪ .....................‬ﻧﺎﻡ ﺧﺎﻧﻮﺍﺩﮔﻲ ‪ .......................‬ﻧﺎﻡ ﭘﺪﺭ ‪ ....................‬ﺷﻤﺎﺭﻩ ﺷﻨﺎﺳﻨﺎﻣﻪ‪ /‬ﻣﻠﻲ‪.....................‬‬ ‫ﺗﺎﺭﻳﺦ ﺗﻮﻟﺪ‪ .......................‬ﻣﺤﻞ ﺻﺪﻭﺭ‪.....................‬ﻛﺪ ﭘﺴﺘﻲ ‪.............................‬ﺗﻠﻔﻦ ‪.............................‬‬ ‫ﻧﺸﺎﻧﻲ ﻣﺤﻞ ﺳﻜﻮﻧﺖ‪....................................................................................................................................‬‬

‫ﺑﺎ ﺍﻃﻼﻉ ﺍﺯ ﻋﻮﺍﻗﺐ ﺷﻬﺎﺩﺕ ﻛﺬﺏ ﺻﺤﺖ ﺍﻇﻬﺎﺭﺍﺕ ﻣﺘﻘﺎﺿﻲ ﺗﺎﻳﻴﺪ ﻣﻲ ﮔﺮﺩﺩ‪.‬‬ ‫ﮔﻮﺍﻩ ﺍﻭﻝ‪ :‬ﻧﺎﻡ‪ .....................‬ﻧﺎﻡ ﺧﺎﻧﻮﺍﺩﮔﻲ‪ .....................‬ﻧﺎﻡ ﭘﺪﺭ‪ .................‬ﺷﻤﺎﺭﻩ ﺷﻨﺎﺳﻨﺎﻣﻪ‪/‬ﻣﻠﻲ‪............‬‬ ‫ﻣﺸﺨﺼﺎﺕ ﮔﻮﺍﻫﺎﻥ‬

‫ﺗﺎﺭﻳﺦ ﺗﻮﻟﺪ‪ ........................‬ﻣﺤﻞ ﺻﺪﻭﺭ‪.........................‬ﺷﻐﻞ‪......................‬‬ ‫ﻧﺸﺎﻧﻲ ﻣﺤﻞ ﺳﻜﻮﻧﺖ‪..................................................................................................................................‬‬ ‫ﻛﺪ ﭘﺴﺘﻲ‪ .....................................‬ﺗﻠﻔﻦ‪................................‬‬

‫ﺍﻣﻀﺎﺀ‬

‫ﮔﻮﺍﻩ ﺩﻭﻡ ‪ :‬ﻧﺎﻡ ‪ ..................‬ﻧﺎﻡ ﺧﺎﻧﻮﺍﺩﮔﻲ‪ .....................‬ﻧﺎﻡ ﭘﺪﺭ‪ ..................‬ﺷﻤﺎﺭﻩ ﺷﻨﺎﺳﻨﺎﻣﻪ‪/‬ﻣﻠﻲ‪.............‬‬ ‫ﺗﺎﺭﻳﺦ ﺗﻮﻟﺪ‪ ............................‬ﻣﺤﻞ ﺻﺪﻭﺭ‪ ..........................‬ﺷﻐﻞ ‪......................‬‬ ‫ﻧﺸﺎﻧﻲ ﻣﺤﻞ ﺳﻜﻮﻧﺖ‪...................................................................................................................................‬‬

‫ﻣﺤﻞ ﺗﺎﻳﻴﺪ ﻧﻤﺎﻳﻨﺪﮔﻲ‬

‫ﻛﺪ ﭘﺴﺘﻲ ‪.......................................‬ﺗﻠﻔﻦ‪...............................‬‬

‫ﺍﻣﻀﺎﺀ‬

‫ﺍﻣﻀﺎﻱ ﺧﺎﻧﻢ‪/‬ﺁﻗﺎﻱ ‪ ...........................‬ﻛﻪ ﺑﺎ ﻋﻼﻣﺖ)×( ﻣﺸﺨﺺ ﻭ ﺑﺎ ﺷﻤﺎﺭﻩ ‪...................‬ﺗﺎﺭﻳﺦ ‪...................‬‬ ‫ﺛﺒﺖ ﺷﺪﻩ ﻣﻮﺭﺩ ﮔﻮﺍﻫﻲ ﺍﺳﺖ‪.‬‬ ‫ﺻﺤﺖ ﺍﻣﻀﺎﺀ ﮔﻮﺍﻫﺎﻥ ﻣﻮﺭﺩ ﺗﺎﻳﻴﺪ ﻣﻲ ﺑﺎﺷﺪ‪.‬‬ ‫ﻣﺮﺍﺗﺐ ﻓﻘﺪﺍﻥ ﺷﻨﺎﺳﻨﺎﻣﻪ ﻣﺘﻘﺎﺿﻲ ﻣﻮﺭﺩ ﺗﺎﻳﻴﺪ ﻣﻲ ﺑﺎﺷﺪ‪.‬‬ ‫ﻣﻄﺎﻟﺐ ﭘﺸﺖ ﺻﻔﺤﻪ ﺑﻪ ﺩﻗﺖ ﻣﻄﺎﻟﻌﻪ ﺷﻮﺩ‬

‫ﺧﻮﺍﻫﺸﻤﻨﺪ ﺍﺳﺖ ﻗﺒﻞ ﺍﺯ ﺗﻜﻤﻴﻞ ﭘﺮﺳﺸﻨﺎﻣﻪ ﺑﻪ ﻧﻜﺎﺕ ﺯﻳﺮ ﺗﻮﺟﻪ ﻓﺮﻣﺎﺋﻴﺪ‪.‬‬ ‫ ﻛﺴﺎﻧﻴﻜﻪ ﺑﺎ ﺩﺍﺷﺘﻦ ﺷﻨﺎﺳﻨﺎﻣﻪ ﺍﻗﺪﺍﻡ ﺑﻪ ﺍﺧﺬ ﺷﻨﺎﺳﻨﺎﻣﻪ ﻣﺠﺪﺩ ﻧﻤﺎﻳﻨﺪ ﻣﺠـﺮﻡ ﻣﺤـﺴﻮﺏ ﻭ ﺑﺮﺍﺑـﺮ‬‫ﻗﺎﻧﻮﻥ ﻣﺠﺎﺯﺍﺕ ﺧﻮﺍﻫﻨﺪ ﺷﺪ‪.‬‬ ‫ ﺩﺭﻳﺎﻓﺖ ﻛﻨﻨﺪﮔﺎﻥ ﺷﻨﺎﺳﻨﺎﻣﻪ ﻣﺠﺪﺩ ﻣﻜﻠﻒ ﺍﻧﺪ ﺩﺭ ﺻﻮﺭﺕ ﭘﻴﺪﺍ ﺷﺪﻥ ﺷﻨﺎﺳـﻨﺎﻣﻪ ﺍﺻـﻠﻲ ﻇـﺮﻑ‬‫ﻣﺪﺕ ‪ 10‬ﺭﻭﺯ ﻧﺴﺒﺖ ﺗﺤﻮﻳﻞ ﺁﻥ ﺑﻪ ﻛﻨﺴﻮﻟﻲ ﺳﻔﺎﺭﺕ ﺍﻗﺪﺍﻡ ﻧﻤﺎﻳﻨﺪ‪.‬‬

‫ﺗﻌﻬﺪ ﻧﺎﻣﻪ‬

‫ﻧﻤﺎﻳﻨﺪﮔﻲ ﺟﻤﻬﻮﺭﻱ ﺍﺳﻼﻣﻲ ﺍﻳﺮﺍﻥ‪-‬ﻛﻮﺍﻻﻻﻣﭙﻮﺭ‬ ‫ﺑﺎ ﺳﻼﻡ‬

‫ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻣﻄﺎﻟﺐ ﻓﻮﻕ ﺍﻳﻨﺠﺎﻧﺐ ﻣﺘﻌﻬﺪ ﻣﻲ ﺷﻮﻡ ﺩﺭ ﺻﻮﺭﺕ ﭘﻴﺪﺍ ﺷـﺪﻥ ﺷﻨﺎﺳـﻨﺎﻣﻪ‬

‫ﻗﺒﻠﻲ ﻧﺴﺒﺖ ﺑﻪ ﺗﺤﻮﻳﻞ ﺁﻥ ﺍﻗﺪﺍﻡ ﻧﻤﺎﻳﻢ‪.‬‬

‫ﻧﺎﻡ ﻭ ﻧﺎﻡ ﺧﺎﻧﻮﺍﺩﮔﻲ‬ ‫ﺍﻣﻀﺎﺀ‬

‫ﻣﺪﺍﺭﻙ ﻣﻮﺭﺩ ﻧﻴﺎﺯ ‪:‬‬ ‫ ﺗﻜﻤﻴﻞ ﭘﺮﺳﺸﻨﺎﻣﻪ‬‫ ﺗﺼﻮﻳﺮ ﺷﻨﺎﺳﻨﺎﻣﻪ ﺻﺎﺣﺐ ﺳﻨﺪ ؛ ﻫﻤﺴﺮ؛ ﻓﺮﺯﻧﺪﺍﻥ ﻭ ﻭﺍﻟﺪﻳﻦ‬‫ ‪ 3‬ﻗﻄﻌﻪ ﻋﻜﺲ ﺟﺪﻳﺪ ﺑﺮﺍﻱ ﺍﻓﺮﺍﺩ ﺑﺎﻻﻱ ‪ 15‬ﺳﺎﻝ ) ﻋﻜﺲ ﻓﻮﺭﻱ ﻗﺎﺑﻞ ﻗﺒﻮﻝ ﻧﻤﻲ ﺑﺎﺷﺪ (‬‫ ﺗﺼﻮﻳﺮ ﻣﺪﺭﻙ ﻋﻜﺴﺪﺍﺭ ﻣﻌﺘﺒﺮ ﺍﻳﺮﺍﻧﻲ ﺍﺯ ﻗﺒﻴﻞ ﻛﺎﺭﺕ ﺷﻨﺎﺳـﺎﻳﻲ ﻣﻠـﻲ ؛ ﮔﺬﺭﻧﺎﻣـﻪ ؛ ﮔﻮﺍﻫﻴﻨﺎﻣـﻪ‬‫ﺭﺍﻧﻨﺪﮔﻲ ؛ ﻣﺪﺭﻙ ﺗﺤﺼﻴﻠﻲ ﻭ ‪،،،،‬‬ ‫ ﺍﺻﻞ ﻓﻴﺶ ﺑﺎﻧﻜﻲ ﻫﺰﻳﻨﻪ ﻣﺮﺑﻮﻃﻪ‬‫ ﺗﺼﻮﻳﺮ ﺻﻔﺤﻪ ﺍﻭﻝ ﺷﻨﺎﺳﻨﺎﻣﻪ ﻭ ﻳﺎ ﮔﺬﺭﻧﺎﻣﻪ ﮔﻮﺍﻫﺎﻥ‬‫ﺗﻮﺿﻴﺤﺎﺕ ﻧﻤﺎﻳﻨﺪﮔﻲ ) ﺩﺭ ﻣﻮﺍﺭﺩﻱ ﻛﻪ ﻣﺮﺍﺗﺐ ﻓﻘﺪﺍﻥ ﻣﺴﺘﻘﻴﻤﺎ ﺗﺎﻳﻴﺪ ﻣﻲ ﮔﺮﺩﺩ( ‪:‬‬