ẺõǨʶҹ
СͺâʹԹǡѺâ͹حҵԴ˹¹
(Ѻ˹ҷӹѡҹѾҡùҤ)

ѵػʧ ͵ǨͺººŨԧ㹾鹷ѺŵѧdzûлмѧСͺԨûл

1. dzûл աáҧкԵк¹ӻл㹺dzç ѧ

1.1. ѧdzкԵӻлբҴ ٻҧ е˹

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

1.2 ͧСͺͧкԵӻл ҤüԵӻл ѧ Ͷѧ٧ к

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

1.3 ͧСͺͧк¹ӻл ԴТҴͨ¹ ǴѺԧ

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

1.4 ÷ͺклҷк

[  ] öҹẺŹ
[  ] ҹ кآ͢Ѵͧ ...............................

1.5 觹ӷԵӻл

. 觹ӼǴԹ

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

. 觹ӺҴŶ١ͧ

[  ] çẺŹѺҹ
[  ] ١ͧ к .......................................


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Ǩʶҹ