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‫ﺍﻟﺠﻤﻬﻮﺭﻳﺔ ﺍﻟﺠﺰﺍﺋﺮﻳﺔ ﺍﻟﺪﻳﻤﻘﺮﺍﻃﻴﺔ ﺍﻟﺸﻌﺒﻴﺔ‬

‫ﻭﺯﺍﺭﺓ ﺍﻟﺘﺮﺑﻴﺔ ﺍﻟﻮﻃﻨﻴﺔ‬

‫ﺍﺳﺘﻤﺎﺭﺓ ﺍﻟﺘﺴﺠﻴﻞ‬

‫ﺻﻔﺎﻗﺴﻲ ﻓﻮﺯﻱ‬ ‫ﺃﻧﺎ ﺍﻟﻤﻤﻀﻴ)ﺔ( ﺃﺳﻔﻠﻪ ﺍﻟﺴﻴﺪ )ﺓ( ‪:‬‬


‫ﺍﻟﻤﻮﻟﻮﺩ ﺑﺘﺎﺭﻳﺦ ‪1957-03-27 : :‬‬
‫ﺍﻟﻌﻨﻮﺍﻥ ‪:‬‬
‫ﺭﻗﻢ ﺍﻟﻬﺎﺗﻒ ‪:‬‬
‫‪Email: hichem.sfaksi@yahoo.com‬‬
‫ﺃﺻﺮﺡ ﺃﻧﻨﻲ ﻭﻟﻲ )ﺓ( ﺍﻟﺘﻠﻤﻴﺬ)ﺓ( ‪ :‬ﺻﻔﺎﻗﺴﻲ ﻣﺤﻤﺪ ﺭﺿﺎ‬
‫ﺍﻟﻤﻮﻟﻮﺩ)ﺓ( ﺑﺘﺎﺭﻳﺦ ‪ 2006-12-31 :‬ﺑـ‪ :‬ﺑﺴﻜﺮﺓ‬
‫ﺭﻗﻢ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻤﺪﺭﺳﻲ ‪1000607010730300 :‬‬
‫ﺍﻟﻤﺘﻤﺪﺭﺱ ﺑـ ‪ :‬ﻣﺘﻮﺳﻄﺔ ﻋﺮﻭﺳﻲ ﻣﺤﻤﺪ ﺍﻟﺼﺎﺩﻕ ‪-‬ﺷﺘﻤﺔ‬
‫‪1‬‬ ‫ﺑﺎﻟﻘﺴﻢ ‪ :‬ﺛﺎﻟﺜﺔ ﻣﺘﻮﺳﻂ‬
‫ﺇﻣﻀﺎﺀ ﻭﻟﻲ ﺍﻷﻣﺮ‬

‫ﻭﺻﻞ ﺍﺳﺘﻼﻡ‬
‫ﺃﻧﺎ ﺍﻟﻤﻤﻀﻲ )ﺓ( ﺃﺳﻔﻠﻪ ﺍﻟﺴﻴﺪ )ﺓ( ‪ :‬ﻣﺪﻳﺮ)ﺓ( ﻣﺘﻮﺳﻄﺔ ﻋﺮﻭﺳﻲ ﻣﺤﻤﺪ ﺍﻟﺼﺎﺩﻕ ‪-‬ﺷﺘﻤﺔ‬

‫ﺃﺻﺮﺡ ﺑﺄﻧﻪ ﺗﻢ ﺗﺄﻛﻴﺪ ﻋﻼﻗﺔ ﺍﻟﻮﻟﻲ‪ :‬ﺻﻔﺎﻗﺴﻲ ﻓﻮﺯﻱ ﺑﺎﻟﺘﻠﻤﻴﺬ)ﺓ( ﺻﻔﺎﻗﺴﻲ ﻣﺤﻤﺪ ﺭﺿﺎ‬

‫ﺭﻗﻢ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻤﺪﺭﺳﻲ ‪1000607010730300 :‬‬

‫‪1‬‬ ‫ﺍﻟﻤﺘﻤﺪﺭﺱ ﺑﺎﻟﻘﺴﻢ ‪ :‬ﺛﺎﻟﺜﺔ ﻣﺘﻮﺳﻂ‬

‫ﻓﻲ ﺍﻷﺭﺿﻴﺔ ﺍﻟﺮﻗﻤﻴﺔ ﻟﻮﺯﺍﺭﺓ ﺍﻟﺘﺮﺑﻴﺔ ﺍﻟﻮﻃﻨﻴﺔ‬

‫ﺧﺘﻢ ﻭ ﺇﻣﻀﺎﺀ ﻣﺪﻳﺮ)ﺓ( ﺍﻟﻤؤﺳﺴﺔ‬

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