Ԧɫɢɟɬ ɛɨɣɵɧɲɚ ɦԝɪɚԑɚ ԕԝԕɵԕ ɬɭɪɚɥɵ ɤɭԥɥiɤ

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Ɇɟɧɲiɤ ԕԝԕɵԑɵ ɬɭɪɚɥɵ ɤɭԥɥiɤ 

____________________________________ԕɚɥɚɫɵ (ɤɟɧɬi, ɚɭɵɥɵ, ɨɛɥɵɫɵ)

__________________________________________________________________
(ɤԛɧi, ɚɣɵ, ɠɵɥɵ)
Ɇɟɧ,___________________________________________,___________________
(ɦɟɦɥɟɤɟɬɬiɤ ɧɨɬɚɪɢɚɬ ɤɟԙɫɟɫiɧiԙ ɚɬɚɭɵ ɧɟɦɟɫɟ ɠɟɤɟɲɟ ɧɨɬɚɪɢɭɫ
__________________________________________________________________
ɥɢɰɟɧɡɢɹɫɵɧɵԙ ɧԧɦiɪi ɦɟɧ ɤԛɧi)
__________________________________________________________________
ɧɨɬɚɪɢɭɫɵ
__________________________________________________________________
(Ɍ.Ⱥ.Ԥ.)
ԔɊ «ɇɟɤɟ ɠԥɧɟ ɨɬɛɚɫɵ (ɫɭɩɪɭɠɟɫɬɜɟ) ɬɭɪɚɥɵ» Ʉɨɞɟɤɫiɧiԙ ______ ɛɚɛɵɧɵԙ
ɧɟɝiɡiɧɞɟ ɠԥɧɟ
ɚɡ.ɚɡ._____________________________________________________________
(ɟɪɥi-ɡɚɣɵɩɬɵɥɚɪɞɵԙ Ɍ.Ⱥ.Ԥ ɠԥɧɟ ɨɥɚɪɞɵԙ ɬԝɪԑɵɥɵԕɬɵ ɠɟɪi)
__________________________________________________________________
ɚɪɵɡɞɚɪɵɧɚ ɫԥɣɤɟɫ ɟɪɥi-ɡɚɣɵɩɬɵɥɚɪɞɵԙ ɧɟɤɟɞɟ ɬԝɪԑɚɧ ɤɟɡiɧɞɟ ɠɢɧɚԑɚɧ
ɨɪɬɚԕ ɦԛɥɤiɧɞɟ ɦɟɧɲiɤ ԕԝԕɵԑɵ _______________________________________
(ɟɪɥi-ɡɚɣɵɩɬɵɥɚɪɞɵԙ ԕɚɣɫɵɫɵɧɚ ɨɪɬɚԕ ɦԛɥiɤɬɟɧ ԛɥɟɫ ɠɚɬɚɬɵɧɵ ɤԧɪɫɟɬiɥɟɞi)
ԕɚɧɞɚɣ __________________________________ ɠɚɬɚɬɵɧɵɧ ɤɭԥɥɚɧɞɵɪɚɦɵɧ.
Ⱥɬɚɥԑɚɧ ɟɪɥi-ɡɚɣɵɩɬɵɥɚɪɞɵԙ ɚɬɚɥԑɚɧ ԛɥɟɫɬɟ ɦɟɧɲiɤ ԕԝԕɵԑɵ
ɤɭԥɥɚɧɞɵɪɵɥԑɚɧ ɨɪɬɚԕ ɛiɪɥɟɫɤɟɧ ɦԛɥɤi ɦɵɧɚɞɚɣ ɡɚɬɬɚɪɞɚɧ ɬԝɪɚɞɵ:______
__________________________________________________________________
(ɦɟɧɲiɤ ԕԝԕɵԑɵ ɬɭɪɚɥɵ ɤɭԥɥiɤ ɛɟɪiɥɝɟɧ ɦԛɥiɤ ɤԧɪɫɟɬiɥɟɞi, ɨɥ ɤiɦɧiԙ
__________________________________________________________________
ɚɬɵɧɞɚ ɛɨɥɞɵ ɧɟɦɟɫɟ ɛԝɪɵɧ ɤiɦɧiԙ ɚɬɵɧɚ ɬiɪɤɟɥɞi)
ʋ _______ɬiɡiɥiɦɞɟ ɬiɪɤɟɥɞi
Ɇɟɦɥɟɤɟɬɬiɤ ɛɚɠ ԧɧɞiɪiɥɞi
ɧɟɦɟɫɟ ɠɟɤɟɲɟ ɧɨɬɚɪɢɭɫԕɚ
ɬԧɥɟɧɝɟɧ ɫɨɦɚ ________
ɦԧɪ ɇɨɬɚɪɢɭɫ ___________________

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