ẺõǨʶҹ
СͺâʹԹǡѺâ͢ࢵ
ҹСͺԨûл

(Ѻ˹ҷӹѡҹѾҡùҤ)

ѵػʧ ͵ǨͺººŨԧ㹾鹷Ѻŵ͡÷Сͺ͢ʹԹ

1. ѧԵӻлҢͧкԵӻл §͡ѺͧâͧࢵҹѺࢵҹ͢

[  ] § к .......................................................
[  ] § к ......................................................

2. աѧԵӻл

[  ] кآҴѧüԵ ....................................................
[  ]

3. óշʹԹçաáҧкԵк¹ӻл㹺dzç º

3.1 ѧdzкԵӻлբҴ ٻҧ е˹

[  ] ١ͧ仵ẺŹ
[  ] ١ͧ к ............................................

3.2 ͧСͺͧкԵӻл ҤüԵӻл ѧ Ͷѧ٧ к

[  ] ١ͧ úǹ 仵ẺŹ
[  ] ١ͧ úǹ ẺŹ к ......................................

3.3 ͧСͺͧк¹ӻл ԴТҴͨ¹ ǴѺԧ

[  ] ١ͧ úǹ 仵ẺŹ
[  ] ١ͧ úǹ ẺŹ к ........................................

3.4 ÷ͺклҷк

[  ] öҹ
[  ] ҹ кآ͢Ѵͧ .......................................

4. óշʹԹç ѧաáҧкԵк¹ӻл㹺dzç

4.1 ԹѴҧѧdz кԵӻлբҴ ٻҧ е˹

[  ] ١ͧ 仵ẺŹ
[  ] ١ͧ к ..........................................

4.2 觹ӷԵӻл

. 觹ӼǴԹ

[  ] .................................
[  ] ͧ .................................
[  ] ˹ͧ ֧ 纹 .............................
     Ҵ (ҧ x x ֡) .. x . x .
     ع .. ١ȡ
[  ] 觹 к ...............................
[  ] ١ͧ çѺẺŹʴ鹷ٻѴҧ ͡÷Сͺ
[  ] ١ͧ к ..............................

. 觹ӺҴ

պͺҴ ӹǹ ...
ͷ 1 Ҵ鹼ٹҧͧ .. ҳӪ ١ȡ
          ͹حҵѹ .. ١ȡ
ͷ 2 Ҵ鹼ٹҧͧ ...... ҳӪ ... ١ȡ
          ͹حҵѹ .. ١ȡ
ͷ 3 Ҵ鹼ٹҧͧ ... ҳӪ . ١ȡ
          ͹حҵѹ ... ١ȡ

[  ] ١ͧ çẺŹ͹حҵ
[  ] ١ͧ к ................

4.3 Ҿ仢ͧ觹 (§, ) ..................................................

 

(ŧ) .
( ..... )
˹ ..
ѹ .. ͹ ......... .. ..
Ǩʶҹ