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‫ﺳﻔﺎﺭﺕ ﺟﻤﻬﻮﺭﯼ ﺍﺳﻼﻣﯽ ﺍﻳﺮﺍﻥ ‪ -‬ﮐﻮﺍﻻﻻﻣﭙﻮﺭ‬

‫ﺑﺮﮒ ﺷﻤﺎﺭﻩ ‪ 7‬ﺗﺤﻘﻴﻘﺎﺕ ﻣﺤﻠﯽ )ﻣﺘﻘﺎﺿﻴﺎﻥ ﻣﻌﺎﻓﻴﺖ ﮐﻔﺎﻟﺖ(‬ ‫ﺷﻤﺎﺭﻩ ‪:‬‬ ‫ﺗﺎﺭﻳﺦ ‪:‬‬ ‫ﺍﻟﻒ( ﻣﺸﺨﺼﺎﺕ ﻣﺸﻤﻮﻝ ‪:‬‬ ‫ﻧﺎﻡ ‪:‬‬

‫ﻧﺎﻡ ﭘﺪﺭ‬

‫ﺷﻬﺮﺕ‬

‫ﺷﻤﺎﺭﻩ ﺷﻨﺎﺳﻨﺎﻣﻪ‬ ‫ﻣﺤﻞ ﺗﻮﻟﺪ‪:‬‬

‫ﻣﺤﻞ ﺻﺪﻭﺭ‪ :‬ﺑﺨﺶ‪/‬ﺷﻬﺮ‪:‬‬

‫ﺗﺎﺭﻳﺦ ﺗﻮﻟﺪ‪:‬‬ ‫ﻣﻴﺰﺍﻥ ﺗﺤﺼﻴﻞ ‪:‬‬

‫ﻧﺸﺎﻧﯽ ‪:‬‬ ‫ﮐﺪﭘﺴﺘﯽ‪ ___________________:‬ﺗﻠﻔﻦ‪ ______________________:‬ﮐﺪ ﺗﻠﻔﻦ_________________‬ ‫ﺏ(ﻣﺸﺨﺼﺎﺕ ﺑﺴﺘﮕﺎﻥ ﻣﺸﻤﻮﻝ ﻭﻇﻴﻔﻪ‪:‬‬ ‫ﻧﺴﺒﺖ ﺑﺎ‬ ‫ﻣﺸﻤﻮﻝ‬

‫ﻧﺎﻡ‬

‫ﺷﻬﺮﺕ‬

‫ﭘﺪﺭ‬

‫ﻣﺎﺩﺭ‬

‫ﺷﻤﺎﺭﻩ‬

‫ﻣﺤﻞ‬

‫ﺗﺎﺭﻳﺦ‬

‫ﺷﻨﺎﺳﻨﺎﻣﻪ‬

‫ﺻﺪﺭﻭﺷﻨﺎﺳﻨﺎﻣﻪ‬

‫ﺻﺪﻭﺭ‬

‫ﺗﺎﺭﻳﺦ ﺗﻮﻟﺪ‬

‫ﻭﺿﻌﻴﺖ‬ ‫ﺗﺎﻫﻞ‬

‫ﭘﺪﺭ‬ ‫ﻣﺎﺩﺭ‬ ‫ﺑﺮﺍﺩﺭ‬ ‫ﺑﺮﺍﺩﺭ‬ ‫ﺑﺮﺍﺩﺭ‬ ‫ﺑﺮﺍﺩﺭ‬ ‫ﺑﺮﺍﺩﺭ‬ ‫ﺧﻮﺍﻫﺮ‬ ‫ﺑﺮﺍﺩﺭ‬ ‫ﺑﺮﺍﺩﺭ‬ ‫ﺝ( ﺗﺤﻘﻴﻘﺎﺕ ﺑﺎﻻ ﺑﺎ ﺗﻮﺟﻪ ﺑﻪ ﻣﻔﺎﺩ ‪ 60‬ﻭ ‪ 61‬ﻗﺎﻧﻮﻥ ﻭﻇﻴﻔﻪ ﻋﻤﻮﻣﯽ ﺑﻪ ﻋﻤﻞ ﺁﻣﺪﻩ ﺍﺳﺖ ﻭ ﻣﺮﺍﺗﺐ ﻣﺬﮐﻮﺭ ﻣﻮﺭﺩ ﺗﺎﺋﻴﺪ ﻣﻴﺒﺎﺷﺪ‪.‬‬

‫ﺳﻴﺪ ﺣﻤﻴﺪ ﻧﻮﺭ‬ ‫ﻣﺴﺌﻮﻝ ﺍﻣﻮﺭ ﮐﻨﺴﻮﻟﯽ‬