ɏȺȺɅȽȺ ɐɈɇɏ ɋɍɍɅȽȺɋȺɇ ȻɗɏɗɅɋɗɇ ȺɄɌ

ʋ

20.........ɨɧɵ..........ɫɚɪɵɧ.......... ԧɞԧɪ

...............................................................ɚɣɦɚɝ, ɯɨɬ ...............................................................-ɧɞ

ɛɚɪɶɠ ɛɚɣɝɚɚ ..............................................................................................................ɛɚɪɢɥɝɵɧ

....................................................................ɛɥɨɤ, ɯɷɫɝɢɣɧ ɯɚɚɥɝɚ, ɰɨɧɯɧɵ ɯɚɣɪɰɝɢɣɝ ɚɠɥɵɧ

ɡɭɪɝɢɣɧ

......................................................................-ɪ ɯɭɭɞɫɚɧɞ ɡɚɚɝɞɫɚɧɵ ɞɚɝɭɭ ɫɭɭɥɝɚɠ ɛɷɯɷɥɫɷɧ

ɷɫɷɯɢɣɝ

ɝԛɣɰɷɬɝɷɝɱɢɣɧ ɬԧɥԧԧɥԧɝɱ ..........................................................................ɛɚɪɢɥɝɵɧ ɢɧɠɟɧɟɪ

..............................................................ɞɚɚɦɚɥ......................................................................ɛɢɞ

ɨɧɵ ........................ɫɚɪɵɧ ............................–ɧɞ ɝɚɡɚɪ ɞɷɷɪ ɲɚɥɝɚɯɚɞ:

1. ..............................................................................................ԛɣɥɞɜɷɪɥɷɫɷɧ ɯɚɚɥɝɚ,

/ɦɚɪɤ ɧɷɪ/

ɰɨɧɯɧɵ ɯɚɣɪɰɝɢɣɝ ɫɭɭɥɝɚɯɞɚɚ ɞɭɥɚɚɥɝɵɧ ɯԧԧɫ ɲɚɯɚɠ ɞɭɥɚɚɥɫɚɧ ɛɚɣɧɚ.

2. ..........................................................................................................................................

/ɯɚɚɥɝɚ ɰɨɧɯɧɵ ɯɚɣɪɰɝɢɣɝ ɷɝɰɢɣɝ ɬɷɝɲ ɭɫɚɚɪ ɲɚɥɝɚɯɚɞ

......................................................................................................................................................

ɹɦɚɪ ɛɨɥɫɧɵɝ ɛɢɱɧɷ/

3. ..........................................................................................................................................

/ɯɚɚɥɝɚ, ɰɨɧɯɝɵ ɫɭɭɥɝɚɥɬ,ɛɷɯɷɥɝɷɷ ɹɦɚɪ ɱɚɧɚɪɬɚɣ

......................................................................................................................................................

ɛɨɥɫɧɵɝ ɬɨɞɨɪɯɨɣɥɨɧ ɛɢɱɧɷ/

Ƚԛɣɰɷɬɝɷɝɱɢɣɧ ɬԧɥԧԧɥԧɝɱ.....................................................

Ȼɚɪɢɥɝɵɧ ɢɧɠɟɧɟɪ......................................................................

Ⱦɚɚɦɚɥ ..........................................................................................