http://www.iran2malaysia.com/Portals/0/Images/Pages/Embassy%20Application%20Forms-25-03-2010/Sabte_E

‫ﺑﺴﻤﻪ ﺗﻌﺎﻟﻲ‬ ‫ﻧﻤﺎﻳﻨﺪﮔﻲ ﺟﻤﻬﻮﺭﻱ ﺍﺳﻼﻣﻲ ﺍﻳﺮﺍﻥ ﻛﻮﺍﻻﻻﻣﭙﻮﺭ‬

‫ﭘﺮﺳﺸﻨﺎﻣﻪ ﺩﺭﺧﻮﺍﺳﺖ ﺛﺒﺖ ﺍﺯﺩﻭﺍﺝ‬ ‫ﺧﻮﺍﻫﺸﻤﻨﺪ ﺍﺳﺖ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻣﺪﺍﺭﻙ ﺿﻤﻴﻤﻪ ﻧﺴﺒﺖ ﺑﻪ ﺛﺒﺖ ﺍﺯﻭﺍﺝ ﺭﺳﻤﻲ‬ ‫ﺍﻳﻨﺠﺎﻧﺒﺎﻥ ﺑﺎ ﻣﺸﺨﺼﺎﺕ ﺫﻳﻞ ﺍﻗﺪﺍﻣﺎﺕ ﻻﺯﻡ ﻣﻌﻤﻮﻝ ﻧﻤﺎﻳﻨﺪ‪:‬‬

‫ﺯﻭﺝ‪) :‬ﺷﻮﻫﺮ(‬

‫ﻧﺎﻡ‬ ‫ﺷﻤﺎﺭﻩ ﺷﻨﺎﺳﻨﺎﻣﻪ‬ ‫ﻣﺘﻮﻟﺪ ‪....../....../.....‬‬

‫ﺯﻭﺟﻪ‪) :‬ﺯﻥ(‬

‫ﻧﺎﻡ ﺧﺎﻧﻮﺍﺩﮔﻲ‬ ‫ﻣﺤﻞ ﺻﺪﻭﺭ‪ :‬ﺣﻮﺯﻩ‬ ‫ﻣﺤﻞ ﺗﻮﻟﺪ‬

‫ﻧﺎﻡ ﺧﺎﻧﻮﺍﺩﮔﻲ‬ ‫ﻧﺎﻡ‬ ‫ﻣﺤﻞ ﺻﺪﻭﺭ‪ :‬ﺣﻮﺯﻩ‬ ‫ﺷﻤﺎﺭﻩ ﺷﻨﺎﺳﻨﺎﻣﻪ‬ ‫ﻣﺤﻞ ﺗﻮﻟﺪ‬ ‫ﻣﺘﻮﻟﺪ ‪......./....../....‬‬ ‫ﻧﺸﺎﻧﻲ ﻭ ﺷﻤﺎﺭﻩ ﺗﻠﻔﻦ ﻣﺤﻞ ﺳﻜﻮﻧﺖ‪:‬‬

‫ﺍﻣﻀﺎ ﺯﻭﺝ‬

‫ﺍﻣﻀﺎ ﺯﻭﺟﻪ‬

‫ﻓﺮﺯﻧﺪ‬ ‫ﺷﻬﺮ‬

‫ﻓﺮﺯﻧﺪ‬ ‫ﺷﻬﺮ‬

‫ﺗﺎﺭﻳﺦ‬