(Êã) ÇãÊÍÇä ÊÌÑíÈí ááÊÑÈíÉ ÇáÇÓáÇãíÉ - ÊÇÓÚ 2009
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æÒÇÑÉ ÇáÊÑÈíÉ æÇáÊÚáíã
ãäØÞÉ ÇáÝÌíÑÉ ÇáÊÚáíãíÉ
ÞÓã ÇáÅÏÇÑÉ ÇáÊÑÈæíÉ
ÇáÊÑÈíÉ ÇáÇÓáÇãíÉ ááÕÝ ÇáÊÇÓÚ
ÇãÊÍÇä ÊÌÑíÈí áäåÇíÉ ÇáÝÕá ÇáÏÑÇÓí ÇáËÇäí – ãÇíæ – 2009ã
ÇáãÍØÉ ÇáÃæáì:-
Ãßãá ÇáÂíÇÊ ÇáÞÑÂäíÉ ÇáÊÇáíÉ ãä ÓæÑÉ ( íÓ )
ÞÇá ÊÚÇáì : (( æíÞæáæä ãÊì åÐÇ ÇáæÚÏ Åä ßäÊã ÕÇÏÞíä*........................................... .................................................. ............. .................................................. .................................................. .................................................. .................................................. .................................... *Åä ßÇäÊ ÅáÇ ÕíÍÉ æÇÍÏÉ ÝÅÐÇ åã ÌãíÚ áÏíäÇ ãõÍúÖóÑõæä * ))
ÞÇá ÊÚÇáì: (( Ãæáã íÑæÇ ÃäÇ ÎáÞäÇ áåã ããÇ ÚãáÊ ÃíÏíäÇ ÃäÚÇãÇ Ýåã áåÇ ãÇáßæä *........................................................................ .................................................. .................................................. .... .................................................. ..................*ÝáÇ íÍÒäß Þæáåã ÅäÇ äÚáã ãÇ íÓÑæä æãÇ íÚáäæä ))
Ãßãá ßÊÇÈÉ ÇáÍÏíË ÇáÔÑíÝ :
ÞÇá ÑÓæá Çááå Õáì Çááå Úáíå æÓáã ( ÑÝÚ ÇáÞáã Úä ËáÇËå : Úä ÇáäÇÆã .............................................................................
.................................................. .................................................. .............................)
Ãßãá ßÊÇÈÉ ÃÍÏ ÇáÍÏíËíä ÇáÔÑíÝíä :
1-Úä ÓÝíÇä ÇáËÞÝí ÑÖí Çááå Úäå ÞÇá ÞáÊ íÇÑÓæá Çááå ÍÏËäí ÈÃãÑ ÃÚÊÕã Èå ÞÇá : Þá ÑÈí ..................................................
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2-ÞÇá ÑÓæá Çááå Õáì Çááå Úáíå æÓáã ( íÇ ÃíåÇ ÇáäÇÓ ÃáÇ Åä ÑÈßã æÇÍÏ æÅä ÃÈÇßã æÇÍÏ ÃáÇ áÇ ÝÖá áÚÑÈí Úáì .................................................. ............................................. .................................................. .............)
ÇáãÍØÉ ÇáËÇäíÉ :-
ÅÞÑà ÇáÂíÇÊ ÇáßÑíãÉ ÇáÊÇáíÉ ãä ÓæÑÉ (íÓ) Ëã ÃÌÈ Úä ÇáÃÓÆáÉ ÇáÊí ÊáíåÇ :-
ÞÇá ÊÚÇáì : (( æóÂíóÉñ áóåõãú ÇáÃóÑúÖõ ÇáúãóíúÊóÉõ ÃóÍúíóíúäóÇåóÇ æóÃóÎúÑóÌúäóÇ ãöäúåóÇ ÍóÈøÇð Ýóãöäúåõ íóÃúßõáõæäó *æóÌóÚóáúäóÇ ÝöíåóÇ ÌóäóøÇÊò ãöäú äóÎöíáò æóÃóÚúäóÇÈò æóÝóÌóøÑúäóÇ ÝöíåóÇ ãöäú ÇáúÚõíõæäö *áöíóÃúßõáõæÇ ãöäú ËóãóÑöåö æóãóÇ ÚóãöáóÊúåõ ÃóíúÏöíåöãú ÃóÝóáÇ íóÔúßõÑõæäó *ÓõÈúÍóÇäó ÇáóøÐöí ÎóáóÞó ÇáÃóÒúæóÇÌó ßõáóøåóÇ ãöãóøÇ ÊõäúÈöÊõ ÇáÃóÑúÖõ æóãöäú ÃóäÝõÓöåöãú æóãöãóøÇ áÇ íóÚúáóãõæäó *æóÂíóÉñ áóåõãú Çááóøíúáõ äóÓúáóÎõ ãöäúåõ ÇáäóøåóÇÑó ÝóÅöÐóÇ åõãú ãõÙúáöãõæäó *æóÇáÔóøãúÓõ ÊóÌúÑöí áöãõÓúÊóÞóÑòø áóåóÇ Ðóáößó ÊóÞúÏöíÑõ ÇáúÚóÒöíÒö ÇáúÚóáöíãö *æóÇáúÞóãóÑó ÞóÏóøÑúäóÇåõ ãóäóÇÒöáó ÍóÊóøì ÚóÇÏó ßóÇáúÚõÑúÌõæäö ÇáúÞóÏöíãö *áÇ ÇáÔóøãúÓõ íóäúÈóÛöí áóåóÇ Ãóäú ÊõÏúÑößó ÇáúÞóãóÑó æóáÇ Çááóøíúáõ ÓóÇÈöÞõ ÇáäóøåóÇÑö æóßõáñø Ýöí Ýóáóßò íóÓúÈóÍõæäó ))
1- ãÇ ÇáãÞÕæÏ ÈÜÜÜÜÜ
( ÃíÉ:..............................)
( äÓáÎ :...........................)
(ÇáÚÑÌæä :.........................)
(ÇáÝáß ÇáãÔÍæä:....................................)
2- ãÇ ÐÇ íÝíÏ ÇáÇÓÊÝåÇã Ýí Þæáå ÊÚÇáì ( ÃÝáÇ íÔßÑæä ) ¿
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3- Èã ÔÈå Çááå ÊÚÇáì ÇáÞãÑ æåæ åáÇá ¿
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4- Úáá ÊÎÕíÕ ÇáäÎíá æÇáÇÚäÇÈ ÈÇáÐßÑ¿
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5- ãÊì ÓíÎÊá äÙÇã Çáßæä æíÊæÞÝ ÌÑíÇä ßá ÔíÁ¿
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6- ÞÇá ÊÚÇáì (ÓÈÍÇä ÇáÐí ÎáÞ ÇáÃÒæÇÌ ßáåÇ ããÇ ÊäÈÊ ÇáÇÑÖ æãä ÃäÝÓåã æããÇ áÇ íÚáãæä )
- ãÇ ÇáÝÆÇÊ ÇáÊí ÝÕáÊ ÇáÂíÉ ÇáßÑíãÉ ÈæÌæÏ ÙÇåÑÉ ÇáÒæÌíÉ ÝíåÇ ¿
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7- ÍÏÏ ãä ÇáÇíÉ ãÇ íÝíÏ ÇáãÚÇäí ÇáÊÇáíÉ :
1- ÇáÇÕá Ýí ÇáÇÑÖ åæ ÇáÙáÇã ÃãÇ ÇáäæÑ Ýåæ ÚÇÑÖ.
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2- ÌÑíÇä ÇáßæÇßÈ æÇáäÌæã Ýí Çáßæä ÈÊÞÏíÑ ãä ÇáÎÇáÞ ÇáÚÙíã.
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8- ãÇ ÇáÐí ÊÝíÏå ßáãÉ ÚÇÏ Ýí ÇáÂíÉ { ÍÊì ÚÇÏ ßÇáÚÑÌæä ÇáÞÏíã } ¿ .................................................. .................................................. ..
ÇáãÍØÉ ÇáËÇáËÉ:
ÞÇá ÊÚÇáì (( æÇãÊÇÒæÇ Çáíæã ÃíåÇ ÇáãÌÑãæä * Ãáã ÃÚåÏ Åáíßã íÇÈäí ÂÏã Ãä áÇ ÊÚÈ쾂 ÇáÔíØÇä Åäå áßã ÚÏæ ãÈíä * æÃä ÇÚÈÏæäí åÐÇ ÕÑÇØ ãÓÊÞíã * æáÞÏ ÃÖá ãäßã ÌÈáÇ ßËíÑÇ ÃÝáã ÊßæäæÇ ÊÚÞáæä * åÐå Ìåäã ÇáÊí ßäÊã ÊæÚÏæä * ÇÕáæåÇ Çáíæã ÈãÇ ßäÊã ÊßÝÑæä ))
1- ãÇ ÇáãÞÕæÏ È ( ÇãÊÇÒæÇ :.................
ÃÚåÏ :............................
ÌÈáÇ :.............................
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2- Èã ÊÚáá æÕÝ ÇáßÝÇÑ ÈÇáãÌÑãíä ¿
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3- ãÇ ÇáãÞÕæÏ ÈÚÈÇÏÉ ÇáÔíØÇä ¿
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4- Çáì Çíä íÕá ãä íÊÈÚ ÎØæÇÊ ÇáÔíØÇä ¿
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5- ãÇ æÓíáÉ ÇáÔíØÇä Ýí ÇÖáÇá Èäí ÂÏã¿
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6- ãÇ æÓÇÆá ÇáÇäÓÇä Ýí ãæÇÌåÉ ÅÖáÇá ÇáÔíØÇä ¿
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7- Èíä ÏáÇáÉ ÝÚá ÇáÇãÑ (ÇÕáæåÇ) ¿
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8- Úáá ÊäÒíå ÇáÞÑÂä ÇáßÑíã ãä Ãä íßæä ÔÚÑÇ ¿
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9-ÍÏÏ ãä ÇáÂíÇÊ ãÇ íÝíÏ Ãä ÚÏÇæÉ ÇÈáíÓ áÇ ÊÎÝì Úáì ÇáÚÞáÇÁ¿
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10 – ÞÇÑä Èíä ÂËÇÑ ( ÇáÇíãÇä – æÇáßÝÑ ) ÈÇáíæã ÇáÂÎÑ ãä ÍíË ÊæÌíå ÇáÓáæß æãÏì ÇáÇáÊÒÇã ÈÇáØÇÚÉ
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ÇáãÍØÉ ÇáÑÇÈÚÉ :-
ÅÞÑà ÇáÂíÇÊ ÇáßÑíãÉ ãä ÓæÑÉ ÇáÅÓÑÇÁ Ëã ÃÌÈ Úä ÇáÃÓÆáÉ ÇáÊí ÊáíåÇ :
ÞÇá ÊÚÇáì : (( æóÞóÖóì ÑóÈøõßó ÃóáÇøó ÊóÚúÈõÏõæÇú ÅöáÇøó ÅöíøóÇåõæóÈöÇáúæóÇáöÏóíúäö ÅöÍúÓóÇäðÇÅöãøóÇ íóÈúáõÛóäøó ÚöäÏóßó ÇáúßöÈóÑóÃóÍóÏõåõãóÇ Ãóæú ßöáÇóåõãóÇ ÝóáÇó ÊóÞõá áøóåõãó ÃõÝøò æóáÇó ÊóäúåóÑúåõãóÇ æóÞõááøóåõãóÇ ÞóæúáÇð ßóÑöíãðÇ . æóÇÎúÝöÖú áóåõãóÇ ÌóäóÇÍó ÇáÐøõáøö ãöäó ÇáÑøóÍúãóÉöæóÞõá ÑøóÈøö ÇÑúÍóãúåõãóÇ ßóãóÇ ÑóÈøóíóÇäöí ÕóÛöíÑðÇ . ÑøóÈøõßõãú ÃóÚúáóãõ ÈöãóÇÝöí äõÝõæÓößõãú Åöä ÊóßõæäõæÇú ÕóÇáöÍöíäó ÝóÅöäøóåõ ßóÇäó áöáÃóæøóÇÈöíäóÛóÝõæÑðÇ. æÁÇÊ ÐÇ ÇáÞÑÈì ÍÞå æÇáãÓßíä æÇÈä ÇáÓÈíá æáÇ ÊÈÐÑ ÊÈÐíÑÇ )) (ÇáÅÓÑÇÁ/23-25(
ÇÓÊÎÑÌ ãä ÇáÂíÇÊ :-
1- ÞáÞáÉ ÕÛÑì :
2- ÇÙåÇÑ ÍáÞí:
3- ÇÏÛÇã äÇÞÕ(ÈÛäÉ ):
4-ÇÎÝÇÁ:
5-ÇÙåÇÑ ÔÝæí:
6-ãÏ ÚæÖ:
7- ãÏ ÕáÉ ÕÛÑì :
8-ãÏ æÇÌÈ ãäÝÕá:
ãÇ Íßã áÇã áÝÙ ÇáÌáÇáÉ Çááå :-
1-( áÇ íÚÕæäó Çááå ) :
2-(ÈÓã Çááå ) :
3- (ÇáÍãÏ áöáå ) :
ÇÎÊÑ ÇáÇÌÇÈÉ ÇáÕÍíÍÉ :-
1- Íßã ÇáÑÇÁ Ýí ßáãÉ ( ßÑöíãÇ ) :
1- ãÝÎãÉ 2- ãÑÞÞÉ 3- ÌæÇÒ ÇáæÌåíä ãÚÇ
2- Íßã ÇáÑÇÁ Ýí ßáãÉ ( ÑóÈß ) :
1- ãÝÎãÉ 2- ãÑÞÞÉ 3- ÌæÇÒ ÇáæÌåíä ãÚÇ
3-äæÚ ÇáÇÏÛÇã Ýí ( ÊÞá áåãÇ ):
1- ÇÏÛÇã ãÊãÇËáíä 2- ÇÏÛÇã ãÊÌÇäÓíä 3 ÇÏÛÇã ãÊÞÇÈáíä
4- äæÚ ÇáãÏ Ýí ßáãÉ ( æÁÇÊ )
1- ãÏ ÚÇÑÖ ááÓßæä 2- ãÏ Çááíä 3- ãÏ ÈÏá
5- ÚáÇãÉ ÇáæÞÝ (Ì) ÊÚäí ÇáæÞÝ ÌÇÆÒ :
1- ÌæÇÒÇ ãÓÊæí ÇáØÑÝíä
2- ãÚ ßæä ÇáæÕá Ãæáì
3- ãÚ ßæä ÇáæÞÝ Ãæáì
6- ÇÑÊÝÇÚ ÇááÓÇä ÚäÏ ÇáäØÞ ÈÇáÍÑÝ Çáì ÇáÍäß ÇáÇÚáì íÓãì :
1- ÇáÇØÈÇÞ 2- ÇáÇÓÊÚáÇÁ 3- ÇáÇÓÊÝÇá
ÇáãÍØÉ ÇáÎÇãÓÉ :-
1- ÚÑÝ ÇáãÕØáÍÇÊ ÇáÊÇáíÉ :-
1- ÊÏæíä ÇáÓäÉ :................................................. ................
2- ÇáãÓÇäíÏ :................................................. ....................
3- ÇáÌæÇãÚ:.......................................... .............................
4- ÇáÝØÑÉ:........................................... ...........................
5- ÇáÊÚÕÈ:........................................... ........................
6- ÍÑíÉ ÇáÇÚÊÞÇÏ:......................................... ..................
Ãßãá ãÇíáí :-
1- ÇáÇäÓÇä ãÓÄæá áÃäå ......................æáÇ ãÓÄæáíÉ ÅáÇ .......................
2- ãä ÇáÎÏãÇÊ ÇáÊí ÞÏãåÇ ÓÚíÏ Èä ÌÈíÑ ááãÓáãíä
..........................æ....................... ........
3- ãä ÇáØÑÇÆÞ ÇáÊí ÞÇã ãä ÎáÇáåÇ ÇáÚáãÇÁ ÈÊÕäíÝ ÇáÇÍÇÏíË ÇáäÈæíÉ
....................................æ............. .....................
4- ãä ÃÓÈÇÈ ÇáÊÚÕÈ .................................æ................ ....................
5- ãä ÝæÇÆÏ ÇáÌÈÇá ááÇäÓÇä ..................................æ............... .................
6- ãä ÃÓÇáíÈ ÇáäÈí Õáì Çááå Úáíå æÓáã ÇáÊÑÈæíÉ
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7- ãä ÕÝÇÊ Ãã ÚãÇÑ ÑÖí Çááå ÚäåÇ
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8-ãä ãÙÇåÑ ÅåÊãÇã ÇáÕÍÇÈÉ ÈÇáÓäÉ
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9 -ÃÔåÑ ßÊÈ ÇáÓäÉ ÇáÊí Êã ÊÏæíäåÇ Ýí ÇáÞÑä ÇáËÇáË ÇáÌÇãÚ ÇáÕÍíÍ ááÈÎÇÑí
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ãÇÐÇ ÊÊæÞÚ Ãä íÍÏË áæ :-
1- áã íÊã ÊÏæíä ÇáÓäÉ ÇáäÈæíÉ Ýí ÚåÏ ÇáÊÇÈÚíä ¿
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2-ÞáÊ äÓÈÉ ãáæÍÉ ÇáÈÍÑ¿
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3-ÃßÑå ÑÌá Úáì ÇÚÊäÇÞ ÇáÇÓáÇã ¿
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4- ØÈÞ ãÈÏà ÍÑíÉ ÇáÇÚÊÞÇÏ Ýí ÌãíÚ ÇáÏæá ÇáãÓáãÉ æÛíÑ ÇáãÓáãÉ ¿
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5- ÈÞí ÇáÓÍÇÈ ãÚáÞÇ Ýí ÇáåæÇÁ Ïæä Çä íãØÑ ¿
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Úáá ßáÇ ããÇ íáí :-
1- ÊßÑÇÑ ÇáÞÑÃä ÇáßÑíã ááÂíÇÊ ÇáßæäíÉ ¿
-.................................................. ....................................
2- ÇãÊäÚ ÚãÑ Èä ÇáÎØÇÈ tÚä ÊÏæíä ÇáÃÍÇÏíË ÊÏæíäÇ ãäÊÙãÇÝí ÚåÏå ¿
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3- ãÈÇÏÆ ÇáÝØÑÉ æÇÍÏÉ ÚäÏ ÌãíÚ ÇáÈÔÑ¿
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4--ÞÊá ÇáÍÌøÇÌ ÓÚíÏ Èä ÌÈíÑ ÑÖí Çááå Úäå ¿
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ÖÚ ÚáÇãÉ ( /) ÃãÇã ÇáÚÈÇÑÉ ÇáÕÍíÍÉ æÚáÇãÉ (× ) ÃãÇã ÇáÚÈÇÑÉ ÇáÎØÃ :-
1- ßÇä ÇáÊÏæíä ÇáÑÓãí ááÓäÉ ÇáäÈæíÉ Ýí ÚåÏ ÇáÎáíÝÉ ÚãÑ Èä ÇáÎØÇÈ ÑÖí Çááå Úäå( )
2- áã íäÊÞá ÇáÑÓæá Õáì Çááå Úáíå æÓáã Çáì ÌæÇÑ ÑÈå ÅáÇ æÞÏ ÃÐä ÈßÊÇÈÉ ÇáÍÏíË( )
3- ãä ÕÝÇÊ ÓÚíÏ Èä ÌÈíÑ ÇáÐßÇÁ æÇáÝØäÉ æÇáÔÌÇÚÉ Ýí Þæá ÇáÍÞ( )
4- ÇáãÑÇÍá ÇáÊí ãÑ ÈåÇ ÊÏæíä ÇáÓäÉ ( ÇáßÊÇÈÉ – ÇáÊÏæíä – ÇáÊÕäíÝ ) ( )
5- ßÇä ÊÑÊíÈ Ãã ÚãÇÑ Ýí ÇáÇÓáÇã åæ ÇáÓÇÏÓ ( )
- ãíøÒ ÇáÚãá ÇáÐí íÍÇÓÈ Úáíå ÇáÚÈÏ æÇáÚãá ÇáÐíáÇ íÍÇÓÈ Úáíå
1- äÓí ÎÇáÏ ÔÑÇÁ ÇáÎÈÒ ÇáÐí ØáÈÊå æÇáÏÊå ãäå ( )
2- ÓÑÞ ãÌäæä ØÚÇãÇ ãä ãÍá ÈíÚ ÇáãæÇÏ ÇáÛÐÇÆíÉ æåÑÈ ( )
3- ØáÈ ÇáÒæÌ ãä ÒæÌÊå ÅÚÏÇÏ ØÚÇã ÇáÅÝØÇÑ áå ÝÑÝÖÊ ( )
- ßíÝ ÊÑÏ Úáì ãä íÞæá
1- åÐÇ Çáßæä æÌÏ ÕÏÝÉ . ............................................... .
2- ãÚ Çááå ÂáåÉ ÃÎÑì.......................................................
Èíä ÑÃíß Ýí ÇáãæÇÞÝ ÇáÊÇáíÉ :-
1- ÔÎÕ íÊäÞá ãä Ïíä Çáì ÂÎÑ æÝÞ ÑÛÈÇÊå æÇåæÇÆå ÇáÔÎÕíÉ ¿...................
2- ÑÌá íÚíä ÒæÌÊå Úáì ÇáÙáã ¿........................................
ÍÏÏ ÏáÇÆá ßá ÂíÉ :-
1-ÞÇá ÊÚÇáì ( áÇÅßÑÇå Ýí ÇáÏíä ) ÇáÏáÇáÉ :............................................
2- ÞÇá ÊÚÇáì ( æáÇ ÊÝÓ쾂 Ýí ÇáÇÑÖ ) ÇáÏáÇáÉ :.....................................
ÇÓÊäÊÌ ÇáãäåÌ ÇáäÈæí ÇáÊÑÈæí ÇáÐí ÇÊøÈÚå ÇáÑÓæá Úáíå ÇáÕáÇÉ æÇáÓáÇã Ýí ÇáãæÇÞÝ ÇáÊÇáíÉ:
ÞÇá ÇÈä ãÓÚæÏ t ( ßÇä ÇáÑÌá ãäøÇ ÅÐÇ ÊÚáøã ÚÔÑ ÂíÇÊ áã íÌÇæÒåä ÍÊì íÚÑÝ ãÚÇäíåä æÇáÚãá Èåä)
ÓÃáÊ ÚÇÆÔÉ ÑÖí Çááå ÚäåÇ Úä ÎáÞ ÑÓæá Çááå r .ÝÞÇáÊ : ßÇä ÎáÞå ÇáÞÑÂä)
Úä ÇáäÈí r ÞÇá: (( íÓøÑæÇ æáÇ ÊÚÓøÑæÇ æÈÔøÑæÇ æáÇ ÊäÝøÑæÇ))
ÞÇá ÑÓæá Çááå r ( íÇ ÛáÇã Óãø ÈÇááå æßá Èíãíäß æßá ããÇ íáíß)
ãÚ ÊãäíÇÇÇÇÇÇÊí ááÌãíÚ ÈÇáÊæÝíÞ æÇáäÌÇÇÇÇÇÍ
ãÚáã ÇáÞÑä