‫ﺗﺼﺮﯾﺢ ﺑﺎﻟﺒﯿﻊ‬

‫أﻧﺎ اﻟﻤﻤﻀﻲ أﺳﻔﻠﮫ‬

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‫اﻟﻤﻮﻟﻮد ﺑﺘﺎرﯾﺦ‪....................................................................................:‬ﺑـ‪..................................................................:‬‬

‫واﻟﺤﺎﻣﻞ ﻟﺒﻄﺎﻗﺔ اﻟﺘﻌﺮﯾﻒ اﻟﻮطﻨﯿﺔ أو )ز‪.‬س( رﻗﻢ ‪..........................................................:‬‬

‫اﻟﺼﺎدرة ﺑﺘﺎرﯾﺦ ‪ ..........................................................:‬ﻋﻦ داﺋﺮة ‪.............................................................:‬‬

‫أﺻﺮح ﺑﺸﺮﻓﻲ ﺑﺄﻧﻨﻲ ﺑﻌﺖ ‪...............................................................................................................:‬‬

‫اﻟﺤﺎﻣﻠﺔ ﻟﻠﻤﻮاﺻﻔﺎت اﻟﺘﺎﻟﯿﺔ ‪:‬‬

‫اﻟﺮﻗﻢ اﻟﺘﺴﻠﺴﻠﻲ‬ ‫اﻟﻠــــــــــﻮن‬ ‫اﻟﻨـــــــﻮع‬

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‫ﻟﻠﺴﯿﺪ‬
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‫اﻟﻤﻮﻟﻮد ﺑﺘﺎرﯾﺦ‪....................................................................................:‬ﺑـ‪..................................................................:‬‬

‫واﻟﺤﺎﻣﻞ ﻟﺒﻄﺎﻗﺔ اﻟﺘﻌﺮﯾﻒ اﻟﻮطﻨﯿﺔ أو )ز‪.‬س( رﻗﻢ ‪..........................................................:‬‬

‫اﻟﺼﺎدرة ﺑﺘﺎرﯾﺦ ‪ ..........................................................:‬ﻋﻦ داﺋﺮة ‪.............................................................:‬‬

‫اﻟﻤﺼﺎدﻗﺔ‬ ‫إﻣﻀﺎء اﻟﻤﺸﺘﺮي‬ ‫إﻣﻀﺎء اﻟﺒﺎﺋﻊ‬