‫ﺍﻟﻤﻤـــﻠﻜﺔ ﺍﻟﻤﻐﺭﺒـــﻴﺔ‬

‫ﻁﻠﺏ ﻤﻠﺨﺹ ﻤﻥ ﺍﻟﺴﺠل ﺍﻟﻌﺩﻟﻲ‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟــﻌﺩل‬

‫ﺍﻟﺒﻁﺎﻗﺔ ﺭﻗﻡ ‪3‬‬
‫ﻤﺤﻜﻤﺔ ﺍﻻﺴــﺘﺌﻨﺎﻑ‬
‫ﺍﻟﻤﺎﺩﺓ ‪ 667‬ﻤﻥ ﻗﺎﻨﻭﻥ ﺍﻟﻤﺴﻁﺭﺓ ﺍﻟﺠﻨﺎﺌﻴﺔ‬

‫ﺒــ‬
‫ﻴﻭﺠﻪ ﺍﻟﻰ ﺍﻟﺴﻴﺩ ﺭﺌﻴﺱ ﻜﺘﺎﺒﺔ ﺍﻟﻀﺒﻁ ﺒﺎﻟﻤﺤﻜﻤﺔ ﺍﻻﺒﺘﺩﺍﺌﻴﺔ‬
‫ﺏ‪........ ....................................................‬‬
‫ﺍﻟﻤﺤـﻜﻤﺔ ﺍﻻﺒـﺘﺩﺍﺌــﻴﺔ‬
‫ﺍﻻﺴﻡ ﺍﻟﻌﺎﺌﻠﻲ )‪.............................................: (1‬‬
‫ﺒــﻔﺎﺱ‬
‫ﺍﻻﺴﻡ ﺍﻟﺸﺨﺼﻲ ‪.............................................. :‬‬
‫ﺍﻟﻤﺯﺩﺍﺩﺓ ﺒﺘﺎﺭﻴﺦ ‪................................................‬‬
‫ﻤﻥ ﺃﺒﻭﻴﻪ ‪.......................‬ﻭ‪..............................‬‬
‫ﺒﻘﺒﻴﻠﺔ ‪ ..............‬ﺩﺍﺌﺭﺓ ‪................‬ﺇﻗﻠﻴﻡ ﺃﻭ ﻋﻤﺎﻟﺔ ‪.......‬‬
‫ﺍﻟﺤﺎﻟﺔ ﺍﻟﻌﺎﺌﻠﻴﺔ ‪..................................................‬‬ ‫ﻻ ﻴﻤﻜﻥ ﺃﻥ ﺘﻁﻠﺏ ﺍﻟﺒﻁﺎﻗـﺔ‬
‫ﺍﻟﺠﻨﺴﻴﺔ ‪........................................................‬‬ ‫ﺭﻗــﻡ ‪ 3‬ﺇﻻ ﻤــﻥ ﻁــﺭﻑ‬
‫ﺍﻟﺸﺨﺹ ﺍﻟﺫﻱ ﺘﻬﻤﻪ ﻭ ﺒﻌـﺩ‬
‫ﺍﻟﻤﻬﻨﺔ‪................................... .......................‬‬ ‫ﺍﻹﺩﻻﺀ ﺒﻤﺎ ﻴﺜﺒﺕ ﻫﻭﻴﺘﻪ‪.‬‬
‫ﺍﻟﺴﻜﻨﻰ ‪................................... ....................‬‬
‫ﻭ ﻻﻴﻤﻜﻥ ﺒﺤﺎل ﻤﻥ ﺍﻷﺤﻭﺍل‬
‫‪.................................................. ..............‬‬
‫ﺘﺴﻠﻴﻤﻬﺎ ﻟﺸﺨﺹ ﻏﻴـــﺭﻩ‬
‫) ﺍﻟﻤﺎﺩﺓ ‪ ( 668‬ﻤﻥ ﻗـﺎﻨﻭﻥ‬
‫ﺍﻟﻤﺴﻁﺭﺓ ﺍﻟﺠﻨﺎﺌﻴﺔ‬

‫‪ (1‬ﺘﻜﺘﺏ ﻫﺫﻩ ﺍﻟﻤﻌﻠﻭﻤﺎﺕ ﺒﺨﻁ ﻭﺍﻀﺢ‬

‫ﻭ ﺤﺭﺭ ﺒﺘﺎﺭﻴﺦ ‪....................‬‬

‫) ﺍﻹﻤﻀﺎﺀ (‬ ‫ﻨﻤﻭﺫﺝ‬
‫‪15،5 X 21‬‬