‫ﻭﺯﺍﺭﺓ ﺍﻟﺸﺆﻭﻥ ﺍﻻﺟﺘﻤﺎﻋﻴﺔ‬

‫ﻤﻁـﻠـﺏ ﻟﻠﺤـﺼـﻭل‬
‫ﻋـﻠﻰ ﻗـﺭﺽ ﺠـﺎﻤـﻌﻲ‬
‫)‪(1‬‬
‫ﺘﺠﺩﻴﺩ‬ ‫ﻷﻭل ﻤﺭﺓ‬

‫ﺍﻷﻤﺭ ﻋﺩﺩ ‪ 1544‬ﻟﺴﻨﺔ ‪ 1999‬ﺍﻟﻤﺅﺭﺥ ﻓﻲ ‪ 15‬ﺠﻭﻴﻠﻴﺔ ‪1999‬‬ ‫‪‬‬

‫ﻤﻨﺸﻭﺭ ﻭﺯﻴﺭ ﺍﻟﺸﺅﻭﻥ ﺍﻻﺠﺘﻤﺎﻋﻴﺔ ﻭﺍﻟﺘﻀﺎﻤﻥ ﻋﺩﺩ ‪ 8‬ﺍﻟﻤﺅﺭﺥ ﻓﻲ ‪ 31‬ﺠﻭﻴﻠﻴﺔ ‪.1999‬‬ ‫‪‬‬
‫ﻤﻜﺘﻭﺏ ﻭﺯﻴﺭ ﺍﻟﺸﺅﻭﻥ ﺍﻻﺠﺘﻤﺎﻋﻴﺔ ﻭﺍﻟﺘﻀﺎﻤﻥ ﻋﺩﺩ ‪ 22453‬ﺍﻟﻤﺅﺭﺥ ﻓﻲ ‪ 06‬ﺠﻭﻴﻠﻴﺔ ‪.2001‬‬ ‫‪‬‬
‫ﻤﻜﺘﻭﺏ ﻭﺯﻴﺭ ﺍﻟﺸﺅﻭﻥ ﺍﻻﺠﺘﻤﺎﻋﻴﺔ ﻭﺍﻟﺘﻀﺎﻤﻥ ﻋﺩﺩ ‪ 22024‬ﺍﻟﻤﺅﺭﺥ ﻓﻲ ‪ 12‬ﺍﻭﺕ ‪.2002‬‬ ‫‪‬‬
‫ﻤﻜﺘﻭﺏ ﻭﺯﻴﺭ ﺍﻟﺸﺅﻭﻥ ﺍﻻﺠﺘﻤﺎﻋﻴﺔ ﻭﺍﻟﺘﻀﺎﻤﻥ ﻋﺩﺩ ‪ 22791‬ﺍﻟﻤﺅﺭﺥ ﻓﻲ ‪ 28‬ﺠﻭﻴﻠﻴﺔ ‪.2003‬‬ ‫‪‬‬

‫ﻫﺎﻡ ﺠﺩﺍ‬
‫‪ ‬ﻻ ﻴﻘﺒل ﺃﻱ ﻤﻁﻠﺏ ﺒﻌﺩ ﺃﺠل ﺸﻬﺭ ﻤﻥ ﺘﺎﺭﻴﺦ ﺘﺭﺴﻴﻡ ﺍﻟﻁﺎﻟﺏ )ﺓ( ﺒﺎﻟﻤﺅﺴﺴﺔ ﺍﻟﺠﺎﻤﻌﻴﺔ؛‬

‫‪ ‬ﻴﻭﺩﻉ ﻫﺫﺍ ﺍﻟﻤﻁﻠﺏ ﻭﺠﻭﺒﺎ ﺒﺎﻗﺭﺏ ﻤﺭﻜﺯ ﺠﻬﻭﻱ ﺃﻭ ﻤﺤﻠﻲ ﻟﻠﺼﻨﺩﻭﻕ ﺍﻟﻭﻁﻨﻲ ﻟﻠﺘﻘﺎﻋﺩ ﻭﺍﻟﺤﻴﻁﺔ‬
‫ﺍﻻﺠﺘﻤﺎﻋﻴﺔ ﻟﻠﻤﻘﺭ ﺍﻷﺼﻠﻲ ﻟﻠﺴﻜﻨﻰ ﺃﻭ ﻟﻠﺩﺭﺍﺴﺔ‪.‬‬

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

‫ﻭﺼل ﺇﻴﺩﺍﻉ ﻤﻁﻠﺏ ﻟﻠﺤﺼﻭل ﻋﻠﻰ ﻗﺭﺽ ﺠﺎﻤﻌﻲ‬

‫ﺘﺠﺩﻴﺩ‬ ‫ﻷﻭل ﻤﺭﺓ‬

‫ﺍﻟﻤﻌﺭﻑ ﺍﻟﻭﺤﻴﺩ ﻟﻠﻤﻨﺨﺭﻁ‬

‫ﺍﻟﻤﻌﺭﻑ ﺍﻟﻭﺤﻴﺩ ﻟﻠﻁﺎﻟﺏ‬
‫ﺇﺴﻡ ﺍﻟﻁﺎﻟﺏ )ﺓ( ‪ ......................................................... :‬ﺭﻗﻡ ﺒﻁﺎﻗﺔ ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻭﻁﻨﻴﺔ‬
‫ﺘﺎﺭﻴﺦ ﺍﻹﻴﺩﺍﻉ‬ ‫‪.........................................................................‬‬ ‫ﻤﺭﻜﺯ ﺍﻹﻴﺩﺍﻉ ‪:‬‬
‫ﺍﻟﺴﻨﺔ‬ ‫ﺍﻟﺸﻬﺭ‬ ‫ﺍﻟﻴﻭﻡ‬

‫ﺇﻤﻀﺎﺀ ﺍﻟﻌﻭﻥ ﻭﺨﺘﻡ ﺍﻟﻤﺭﻜﺯ‬

‫)‪ ( 1‬ﺿﻊ ﻋﻼﻣﺔ )‪ ( X‬ﻓﻲ اﻟﻤﺮﺑﻊ اﻟﻤﻨﺎﺳﺐ‬

 ‫)‪Uùpoi^àà)_ç‬ـﺎﻷﺒـﻭﻴـﻥ‬
‫ﺇﺭﺸـﺎﺩﺍﺕ ﺨـﺎﺼـﺔ ﺒ‬
‫ﺇﺭﺸـﺎﺩﺍﺕ ﻤﺘﻌﻠﻘـﺔ ﺒﺎﻟﻤﻨﺨـﺭﻁ‬
‫ﺍﻟﻤﻌﺭﻑ ﺍﻟﻭﺤﻴـﺩ‬
‫ﺍﻻﺴﻡ ‪.................................................................................................................................................... :‬‬
‫ﺍﻟﻠﻘﺏ ‪................................................................................................................................................... :‬‬
‫ﻤﻜﺎﻨﻬﺎ ‪.............................................................................… :‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﻭﻻﺩﺓ‬
‫ﺍﻟﺴﻨﺔ‬ ‫ﺍﻟﺸﻬﺭ‬ ‫ﺍﻟﻴﻭﻡ‬

‫ﺍﻟﺴﻨﺔ‬ ‫ﺍﻟﺸﻬﺭ‬ ‫ﺍﻟﻴﻭﻡ‬

‫ﺘﺎﺭﻴﺦ ﺇﺼﺩﺍﺭﻫﺎ‬ ‫ﺭﻗﻡ ﺒﻁﺎﻗﺔ ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻭﻁﻨﻴﺔ‬
‫)‪(1‬‬
‫ﺃﺭﻤل )ﺓ(‬ ‫ﻤﻁﻠﻕ )ﺓ(‬ ‫ﻤﺘﺯﻭﺝ )ﺓ(‬ ‫ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺩﻨﻴﺔ ‪:‬‬
‫ﺍﻟﻤﻬﻨﺔ ‪ .................................................... :‬ﺍﻟﻤﺅﺴﺴﺔ ﺍﻟﻤﺸﻐﻠﺔ ‪........................................................................ :‬‬
‫ﻤﺘﻘﺎﻋﺩ‬ ‫ﻤﺒﺎﺸﺭ‬ ‫ﺍﻟﻭﻀﻌﻴﺔ ‪:‬‬
‫ﻋﺩﺩ ﺍﻷﺒﻨﺎﺀ ﻓﻲ ﺍﻟﻜﻔﺎﻟﺔ‬
‫ﻋﺩﺩ ﺍﻷﺒﻨﺎﺀ ﺍﻟﺫﻴﻥ ﻴﺯﺍﻭﻟﻭﻥ ﺩﺭﺍﺴﺘﻬﻡ ﺒﺎﻟﺘﻌﻠﻴﻡ ﺍﻟﻌﺎﻟﻲ‬
‫ﻋﺩﺩ ﺍﻷﺒﻨﺎﺀ ﺍﻟﺫﻴﻥ ﻴﺯﺍﻭﻟﻭﻥ ﺩﺭﺍﺴﺘﻬﻡ ﺒﺎﻟﺘﻌﻠﻴﻡ ﺍﻟﻌﺎﻟﻲ ﻭﺍﻟﺫﻴﻥ ﺘﻘﺩﻤﻭﺍ ﺒﻤﻁﺎﻟﺏ ﻟﻐﺎﻴﺔ ﺍﻟﺤﺼﻭل ﻋﻠﻰ ﻗﺭﺽ ﺠﺎﻤﻌﻲ‬
‫ﻤﻘﺭ ﺍﻹﻗﺎﻤﺔ ﺍﻷﺼﻠﻲ ‪................................................................................................................................. :‬‬
‫‪ ......................................................................................................................‬ﺍﻟﺘﺭﻗﻴﻡ ﺍﻟﺒﺭﻴﺩﻱ‬
‫ﺍﻟﻌﻨﻭﺍﻥ ﺍﻹﻟﻜﺘﺭﻭﻨﻲ ﻟﻠﻤﻨﺨﺭﻁ ‪........................................................................................................................ :‬‬

‫ﺇﺭﺸـﺎﺩﺍﺕ ﻤﺘﻌﻠﻘـﺔ ﺒﻘـﺭﻴﻥ ﺍﻟﻤﻨﺨـﺭﻁ‬

‫ﺭﻗﻡ ﺍﻻﻨﺨﺭﺍﻁ ﺒﺎﻟﺼﻨﺩﻭﻕ ﺍﻟﻭﻁﻨﻲ ﻟﻠﺘﻘﺎﻋﺩ ﻭﺍﻟﺤﻴﻁﺔ ﺍﻻﺠﺘﻤﺎﻋﻴﺔ‬
‫ﺃﻭ ﺒﺎﻟﺼﻨﺩﻭﻕ ﺍﻟﻭﻁﻨﻲ ﻟﻠﻀﻤﺎﻥ ﺍﻻﺠﺘﻤﺎﻋﻲ‬
‫ﺍﻻﺴﻡ ‪................................................................................................................................................... :‬‬
‫ﺍﻟﻠﻘﺏ ‪................................................................................................................................................... :‬‬

‫ﻤﻜﺎﻨﻬﺎ ‪................................................................................. :‬‬ ‫ﺍﻟﺴﻨﺔ‬ ‫ﺍﻟﺸﻬﺭ‬ ‫ﺍﻟﻴﻭﻡ‬

‫ﺘﺎﺭﻴﺦ ﺍﻟﻭﻻﺩﺓ‬

‫ﺍﻟﺴﻨﺔ‬ ‫ﺍﻟﺸﻬﺭ‬ ‫ﺍﻟﻴﻭﻡ‬

‫ﺘﺎﺭﻴﺦ ﺇﺼﺩﺍﺭﻫﺎ‬ ‫ﺭﻗﻡ ﺒﻁﺎﻗﺔ ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻭﻁﻨﻴﺔ‬
‫ﻭﻀﻌﻴﺎﺕ ﺃﺨﺭﻯ ‪.......................................................... :‬‬ ‫ﻤﺘﻘﺎﻋﺩ‬ ‫ﻤﺒﺎﺸﺭ‬ ‫ﺍﻟﻭﻀﻌﻴﺔ ‪:‬‬
‫ﺍﻟﻤﻬﻨﺔ ‪ ................................................. :‬ﺍﻟﻤﺅﺴﺴﺔ ﺍﻟﻤﺸﻐﻠﺔ ‪...................................................................... :‬‬

‫)‪ ( 1‬ﺿﻊ ﻋﻼﻣﺔ )‪ ( X‬ﻓﻲ اﻟﻤﺮﺑﻊ اﻟﻤﻨﺎﺳﺐ‬

 ‫ﺇﺭﺸـﺎﺩﺍﺕ ﺨـﺎﺼـﺔ ﺒﺎﻟﻁـﺎﻟﺏ‬

‫ﺍﻟﻤﻌﺭﻑ ﺍﻟﻭﺤﻴﺩ ﻟﻠﻁﺎﻟﺏ‬

‫ﺍﻻﺴﻡ ‪................................................................................................................................................... :‬‬

‫ﺍﻟﻠﻘﺏ ‪................................................................................................................................................... :‬‬

‫ﻤﻜﺎﻨﻬﺎ ‪................................................................................ :‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﻭﻻﺩﺓ‬

‫ﺍﻟﺴﻨﺔ‬ ‫ﺍﻟﺸﻬﺭ‬ ‫ﺍﻟﻴﻭﻡ‬
‫ﺘﺎﺭﻴﺦ ﺇﺼﺩﺍﺭﻫﺎ‬ ‫ﺭﻗﻡ ﺒﻁﺎﻗﺔ ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻭﻁﻨﻴﺔ‬
‫ﺍﻟﺴﻨﺔ‬ ‫ﺍﻟﺸﻬﺭ‬ ‫ﺍﻟﻴﻭﻡ‬
‫)‪(1‬‬
‫ﺃﺭﻤل )ﺓ(‬ ‫ﻤﻁﻠﻕ )ﺓ(‬ ‫ﻤﺘﺯﻭﺝ )ﺓ(‬ ‫ﺃﻋﺯﺏ‬ ‫ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺩﻨﻴﺔ ‪:‬‬
‫ﺍﻟﻤﺅﺴﺴﺔ ﺍﻟﺠﺎﻤﻌﻴﺔ ‪................................................................................................................................... :‬‬

‫ﺍﻻﺨﺘﺼﺎﺹ ‪ ................................................................... :‬ﺴﻨﺔ ﺍﻟﺩﺭﺍﺴﺔ ‪..................................................... :‬‬

‫‪-‬‬ ‫ﺍﻟﺴﻨﺔ ﺍﻟﺠﺎﻤﻌﻴﺔ ‪:‬‬

‫ﺭﺴﻭﺏ‬ ‫ﻨﺠﺎﺡ‬ ‫ﻨﺘﻴﺠﺔ ﺍﻟﺴﻨﺔ ﺍﻟﻔﺎﺭﻁﺔ ‪:‬‬
‫ﻻ‬ ‫ﻨﻌﻡ‬ ‫ﺘﻌﺎﻁﻲ ﻨﺸﺎﻁ ﻤﺅﺠﺭ‪:‬‬

‫ﻁﺭﻴﻘـﺔ ﺼﺭﻑ ﺍﻟﻘـﺭﺽ ‪:‬‬

‫ﺘﺤﻭﻴل ﺒﻨﻜﻲ‬ ‫ﺘﺤﻭﻴل ﺒﺭﻴﺩﻱ‬

‫ﺍﻟﻬﻭﻴﺔ ﺍﻟﺒﻨﻜﻴﺔ ﺃﻭ ﺍﻟﺒﺭﻴﺩﻴﺔ ﻟﻠﻁﺎﻟﺏ ‪:‬‬

‫ﺍﻟﻌﻨﻭﺍﻥ ﺒﺎﻟﺘﺩﻗﻴﻕ ‪...................................................................................................................................... :‬‬

‫‪............................................‬ﺍﻟﻤﺩﻴﻨﺔ‪ ..................................................................‬ﺍﻟﺘﺭﻗﻴﻡ ﺍﻟﺒﺭﻴﺩﻱ‬

‫ﺘـﺼـﺭﻴـﺢ‬

‫ﻨﺤﻥ ﺍﻟﻤﻤﻀﻴﺎﻥ ﺃﺴﻔﻠﻪ ﺍﻟﺴﻴﺩ )ﺓ( ‪ ……………………………………………………………………… :‬ﺒﺼﻔﺘﻲ ﻤﻨﺨﺭﻁ )ﺓ(‬

‫ﻭﺍﺒﻨﻪ ) ﺘﻪ( ﺍﻟﺴﻴﺩ )ﺓ( ‪…………………………………………………………..……………………… :‬ﺼﻔﺘﻲ ﻁﺎﻟﺏ )ﺓ(‬
‫ﻨﺸﻬﺩ ﺍﻥ ﺘﺼﺭﻴﺤﺎﺘﻨﺎ ﺍﻟﻤﻀﻤﻨﺔ ﺒﻬﺫﺍ ﺍﻟـﻤﻁﻠﺏ ﺼﺎﺩﻗﺔ ﻭﺤﻘﻴﻘﻴﺔ ﻭﺇﻨﻨﺎ ﻋﻠﻰ ﻋﻠﻡ ﺒﺄﻥ ﺃﻱ ﺘﺼـﺭﻴﺢ ﺨﺎﻁﺊ ﻴﻌﺭﺽ ﺼﺎﺤـﺒﻪ ﻟﻠﻌـﻘﻭﺒﺎﺕ‬
‫ﻭﺍﻟﺘـﺘﺒﻌﺎﺕ ﺍﻟﻘﻀﺎﺌﻴﺔ ﺇﻀـﺎﻓﺔ ﺇﻟﻰ ﺇﻟـﻐﺎﺀ ﺍﻟﻤﻁﻠﺏ ﻭ ﺇﺭﺠﺎﻉ ﺍﻟﻘﺭﺽ ﻤﻊ ﺘﺤـﻤل ﺍﻟﻔﻭﺍﺌﺽ ﺍﻟﻘﺎﻨﻭﻨﻴـﺔ ﻭﺍﻟﻤﺼﺎﺭﻴﻑ ﺍﻟﻤﻨﺠﺭﺓ ﻋﻥ ﺫﻟﻙ‪.‬‬

‫ﺤﺭﺭ ﺒـ ………………………‪ ،..‬ﻓﻲ ………………………‬

‫ﺇﻤﻀﺎﺀ ﺍﻟﻁﺎﻟﺏ‬ ‫ﺇﻤﻀﺎﺀ ﺍﻟﻤﻨﺨﺭﻁ‬

‫)‪ ( 1‬ﺿﻊ ﻋﻼﻣﺔ )‪ ( X‬ﻓﻲ اﻟﻤﺮﺑﻊ اﻟﻤﻨﺎﺳﺐ‬

 ‫ﺇﺭﺸـﺎﺩﺍﺕ ﺤﻭل ﺼﻴﻎ ﻭﺸﺭﻭﻁ ﺇﺴﻨـﺎﺩ ﺍﻟﻘﺭﺽ ﺍﻟﺠـﺎﻤﻌﻲ‬
‫‪ ( 1‬ﺸﺭﻭﻁ ﺍﻟﺤﺼﻭل ﻋﻠﻰ ﺍﻟﻘﺭﺽ‬
‫‪ -‬ﺍﻥ ﻴﻜﻭﻥ ﺍﻟﻁﺎﻟﺏ )ﺓ( ﻤﺴﺠﻼ )ﺓ( ﺒﺈﺤﺩﻯ ﺍﻟﻤﺅﺴﺴﺎﺕ ﺍﻟﻌﻤﻭﻤﻴﺔ ﻟﻠﺘﻌﻠﻴﻡ ﺍﻟﻌﺎﻟﻲ؛‬
‫‪ -‬ﺍﻥ ﻻ ﻴﺘﻤﺘﻊ ﺍﻟﻁﺎﻟﺏ )ﺓ( ﺒﻤﻨﺤﺔ ﺠﺎﻤﻌﻴﺔ ﻭﻁﻨﻴﺔ ﺃﻭ ﻤﻨﺤﺔ ﺘﻨﺩﺭﺝ ﻓﻲ ﻨﻁﺎﻕ ﺍﻟﺘﻌﺎﻭﻥ ﺍﻟﻔﻨﻲ ﺃﻭ ﻗﺭﺽ ﺠﺎﻤﻌﻲ ﻤﻥ ﻁﺭﻑ ﺍﻟﺩﻭﻟﺔ؛‬
‫‪ -‬ﺍﻥ ﻻ ﻴﺘﻌﺎﻁﻰ ﺍﻟﻁﺎﻟﺏ )ﺓ( ﻨﺸﺎﻁﺎ ﻤﺅﺠﺭﺍ؛‬
‫‪ -‬ﺍﻥ ﻻ ﺘﻘل ﺃﻗﺩﻤﻴﺔ ﺍﻻﻨﺨﺭﺍﻁ ﺍﻟﻔﻌﻠﻴﺔ ﻟﻠﻭﻟﻲ ﻋﻥ ﺜﻼﺜﻴﺘﻴﻥ ﻋﻨﺩ ﺘﺎﺭﻴﺦ ﺇﻴﺩﺍﻉ ﺍﻟﻤﻁﻠﺏ؛‬
‫‪ -‬ﺍﻥ ﻴﺘﺭﺍﻭﺡ ﺍﻟﺩﺨل ﺍﻟﺴﻨﻭﻱ ﻟﻠﻤﻨﺨﺭﻁ ﻭﻗﺭﻴﻨﻪ ﺒﻴﻥ ﻤﺭﺓ ﻭﺍﺤﺩﺓ ﻭﺃﺭﺒﻊ ﻤﺭﺍﺕ ﻭﻨﺼﻑ ﺍﻷﺠﺭ ﺍﻷﺩﻨﻰ ﺍﻟﺴﻨﻭﻱ ﺍﻟﻤﻬﻨﻲ ﺍﻟﻤﻀﻤﻭﻥ؛‬
‫‪ ( 2‬ﻤﺒﻠﻎ ﺍﻟﻘﺭﺽ ﻭﻨﺴﺒﺔ ﺍﻟﻔﺎﺌﺩﺓ‬
‫‪ -‬ﻴﺴﺎﻭﻱ ﻤﺒﻠﻎ ﺍﻟﻘﺭﺽ ﺍﻟﻤﺴﻨﺩ ‪ 500‬ﺩﻴﻨﺎﺭﺍ ﺒﺎﻟﻨﺴﺒﺔ ﻟﻜل ﻁﺎﻟﺏ؛‬
‫‪ -‬ﺘﻭﻅﻑ ﻋﻠﻰ ﻫﺫﺍ ﺍﻟﻘﺭﺽ ﻨﺴﺒﺔ ﻓﺎﺌﺩﺓ ﻗﺩﺭﻫﺎ ‪ 5‬ﺒﺎﻟﻤﺎﺌﺔ ﻓﻲ ﺍﻟﺴﻨﺔ؛‬
‫‪ ( 3‬ﻤﺩﺓ ﺍﻟﻘﺭﺽ ﻭﻁﺭﻴﻘﺔ ﺼﺭﻓﻪ‬
‫‪ -‬ﻴﺴﻨﺩ ﺍﻟﺼﻨﺩﻭﻕ ﻗﺭﻀﺎ ﺠﺎﻤﻌﻴﺎ ﺒﻌﻨﻭﺍﻥ ﻓﺘﺭﺓ ﺍﻟﺩﺭﺍﺴﺔ ﺍﻟﺠﺎﻤﻌﻴﺔ ﺍﻟﻤﺤﺩﺩﺓ ﺤﺴﺏ ﺍﻟﺘﺭﺘﻴﺏ ﺍﻟﺠﺎﺭﻱ ﺒﻬﺎ ﺍﻟﻌﻤل ﻤﻊ ﺇﻤﻜﺎﻨﻴﺔ ﺇﻀﺎﻓﺔ ﺍﻻﻨﺘﻔﺎﻉ‬
‫ﻟﻤﺭﺓ ﻭﺍﺤﺩﺓ ﻓﻲ ﺤﺎﻟﺔ ﺍﻟﺭﺴﻭﺏ؛‬
‫‪ -‬ﻴﺼﺭﻑ ﺍﻟﻘﺭﺽ ﻤﺒﺎﺸﺭﺓ ﻟﻠﻁﺎﻟﺏ ﻋﻠﻰ ﻗﺴﻁﻴﻥ؛‬
‫‪ ( 4‬ﺘﻜﻭﻴﻥ ﺍﻟﻤﻠﻑ ) ﻷﻭل ﻤﺭﺓ (‬
‫)ﺘﺴﺤﺏ ﺍﻟﻤﻁﺒﻭﻋﺔ ﻋﻥ ﻁﺭﻴﻕ ﺍﻷﻨﺘﺭﻨﺎﺕ ﻋﻠﻰ ﺍﻟﻌﻨﻭﺍﻥ ﺍﻟﺘﺎﻟﻲ‪( www.cnrps.nat.tn‬‬
‫‪ -‬ﻤﻁﺒﻭﻋﺔ ﺍﻟﻘﺭﺽ ﻤﻌﻤﺭﺓ ﺒﻜل ﺩﻗﺔ ﺘﺤﻤل ﺇﻤﻀﺎﺀ ﺍﻟﻤﻨﺨﺭﻁ ﻭﺍﻟﻁﺎﻟﺏ؛‬
‫‪ -‬ﻨﺴﺨﺔ ﻤﻥ ﺒﻁﺎﻗﺔ ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻭﻁﻨﻴﺔ ﻟﻸﺒﻭﻴﻥ ﻭﺍﻟﻁﺎﻟﺏ؛‬
‫‪ -‬ﺸﻬﺎﺩﺓ ﻓﻲ ﺍﻷﺠﺭ ﻟﻠﻤﻨﺨﺭﻁ ﻭ ﻨﺴﺨﺔ ﻤﻥ ﺍﻟﺘﺼﺭﻴﺢ ﺍﻟﻭﺤﻴﺩ ﺒﺎﻟﺩﺨل ﻟﻠﺴﻨﺔ ﺍﻟﻤﺎﻀﻴﺔ ﺒﺎﻟﻨﺴﺒﺔ ﻟﻸﺒﻭﻴﻥ؛‬
‫‪ -‬ﻭﺼل ﺘﺭﺴﻴﻡ ﻋﻥ ﺒﻌﺩ ﻋﺒﺭ ﺍﻷﻨﺘﺭﻨﺎﺕ ﺜﻡ ﺍﻹﺩﻻﺀ ﻻﺤﻘﺎ ﺒﻨﺴﺨﺔ ﻤﻁﺎﺒﻘﺔ ﻟﻸﺼل ﻤﻥ ﺸﻬﺎﺩﺓ ﺍﻟﺘﺭﺴﻴﻡ؛‬
‫‪ -‬ﻜﺸﻑ ﺤﻭل ﺍﻟﻬﻭﻴﺔ ﺍﻟﺒﺭﻴﺩﻴﺔ ﺃﻭ ﺍﻟﺒﻨﻜﻴﺔ ﻟﻠﻁﺎﻟﺏ؛‬
‫‪ -‬ﻤﻀﻤﻭﻥ ﻭﻻﺩﺓ ﺤﺩﻴﺙ ﺍﻟﻌﻬﺩ ﻟﻠﻁﺎﻟﺏ؛‬
‫ﻭﺒﺎﻟﻨﺴﺒﺔ ﻟﻠﻁﻠﺒﺔ ﺍﻟﺫﻴﻥ ﺴﺒﻕ ﻟﻬﻡ ﺃﻥ ﺘﻤﺘﻌﻭﺍ ﺒﻘﺭﺽ ﺃﻡ ﺒﻤﻨﺤﺔ ﺠﺎﻤﻌﻴﺔ ﻤﻥ ﻗﺒل ﺍﻟﺩﻭﻟﺔ ﺘﻀﺎﻑ ﺍﻟﻭﺜﺎﺌﻕ ﺍﻟﺘﺎﻟﻴﺔ‪:‬‬
‫‪ -‬ﺸﻬﺎﺩﺓ ﻓﻲ ﻋﺩﻡ ﺍﻻﻨﺘﻔﺎﻉ ﺒﻤﻨﺤﺔ ﺠﺎﻤﻌﻴﺔ ﻭﻁﻨﻴﺔ ﺍﻭ ﺒﻤﻨﺤﺔ ﺘﻨﺩﺭﺝ ﻓﻲ ﻨﻁﺎﻕ ﺍﻟﺘﻌﺎﻭﻥ ﺍﻟﻔﻨﻲ ﺍﻭ ﻗﺭﺽ ﺠﺎﻤﻌﻲ ﻤﻥ ﻗﺒل ﺍﻟﺩﻭﻟﺔ؛‬
‫‪ -‬ﺸﻬﺎﺩﺓ ﻨﺠﺎﺡ ﺒﻌﻨﻭﺍﻥ ﺍﻟﺴﻨﺔ ﺍﻟﺠﺎﻤﻌﻴﺔ ﺍﻟﻔﺎﺭﻁﺔ؛‬
‫‪ ( 5‬ﺘﻜﻭﻴﻥ ﺍﻟﻤﻠﻑ ) ﺘﺠﺩﻴﺩ ﺍﻟﻘﺭﺽ (‬
‫‪ -‬ﻤﻁﺒﻭﻋﺔ ﺍﻟﻘﺭﺽ ﻤﻌﻤﺭﺓ ﺒﻜل ﺩﻗﺔ ﺘﺤﻤل ﺇﻤﻀﺎﺀ ﺍﻟﻤﻨﺨﺭﻁ ﻭﺍﻟﻁﺎﻟﺏ؛‬
‫‪ -‬ﺸﻬﺎﺩﺓ ﻓﻲ ﺍﻷﺠﺭ ﻟﻠﻤﻨﺨﺭﻁ ﻭ ﻨﺴﺨﺔ ﻤﻥ ﺍﻟﺘﺼﺭﻴﺢ ﺍﻟﻭﺤﻴﺩ ﺒﺎﻟﺩﺨل ﻟﻠﺴﻨﺔ ﺍﻟﻤﺎﻀﻴﺔ ﺒﺎﻟﻨﺴﺒﺔ ﻟﻸﺒﻭﻴﻥ؛‬
‫‪ -‬ﻭﺼل ﺘﺭﺴﻴﻡ ﻋﻥ ﺒﻌﺩ ﻋﺒﺭ ﺍﻷﻨﺘﺭﻨﺎﺕ ﺜﻡ ﺍﻹﺩﻻﺀ ﻻﺤﻘﺎ ﺒﻨﺴﺨﺔ ﻤﻁﺎﺒﻘﺔ ﻟﻸﺼل ﻤﻥ ﺸﻬﺎﺩﺓ ﺍﻟﺘﺭﺴﻴﻡ؛‬
‫‪ -‬ﻜﺸﻑ ﺤﻭل ﺍﻟﻬﻭﻴﺔ ﺍﻟﺒﺭﻴﺩﻴﺔ ﺃﻭ ﺍﻟﺒﻨﻜﻴﺔ ﻟﻠﻁﺎﻟﺏ؛‬
‫‪ -‬ﻤﻀﻤﻭﻥ ﻭﻻﺩﺓ ﺤﺩﻴﺙ ﺍﻟﻌﻬﺩ ﻟﻠﻁﺎﻟﺏ؛‬
‫‪ ( 6‬ﺇﺒﺭﺍﻡ ﻋﻘﺩ ﺍﻟﻘﺭﺽ‬
‫ﺒﻌﺩ ﻤﻭﺍﻓﻘﺔ ﺍﻟﺼﻨﺩﻭﻕ ﻴﺘﻡ ﺇﺒﺭﺍﻡ ﻋﻘﺩ ﺍﻟﻘﺭﺽ ) ﺃﻭ ﻤﻠﺤﻕ ﻓﻲ ﺤﺎﻟﺔ ﺍﻟﺘﺠﺩﻴﺩ( ﺒﻴﻥ ﺍﻷﻁﺭﺍﻑ ﺍﻟﻤﻌﻨﻴﺔ ﻭﺇﻴﺩﺍﻉ ﻨﺴﺨﺔ ﻤﻨﻪ ﺒﺎﻟﻤﺭﻜﺯ ﺍﻟﺠﻬﻭﻱ ﺃﻭ‬
‫ﺍﻟﻤﺤﻠﻲ ﻟﻠﺼﻨﺩﻭﻕ ﺍﻟﻭﻁﻨﻲ ﻟﻠﺘﻘﺎﻋﺩ ﻭﺍﻟﺤﻴﻁﺔ ﺍﻻﺠﺘﻤﺎﻋﻴﺔ ﺒﻌﺩ ﺇﺠﺭﺍﺀﺍﺕ ﺍﻟﺘﻌﺭﻴﻑ ﺒﺎﻹﻤﻀﺎﺀ‪.‬‬

‫ﻤﻼﺤﻅﺔ‪ :‬ﻻ ﻴﺴﻨﺩ ﺇﻻ ﻗﺭﺽ ﻭﺍﺤﺩ ﻟﻠﺯﻭﺠﻴﻥ ﺍﻟﻤﻀﻤﻭﻨﻴﻥ ﺍﻻﺠﺘﻤﺎﻋﻴﻴﻥ ﺒﻌﻨﻭﺍﻥ ﻨﻔﺱ ﺍﻟﻁﺎﻟﺏ ﻭﻨﻔﺱ ﺍﻟﺴﻨﺔ ﺍﻟﺠﺎﻤﻌﻴﺔ‬
‫ﺧﺎص ﺑﺎﻟﻤﺮﻛـﺰ اﻟﺠﮭـﻮي أو اﻟﻤﺤﻠـﻲ ﻟﻠﺼﻨـﺪوق‬

‫ﺘﺎﺭﻴﺦ ﺍﻟﻤﺭﺍﻗﺒﺔ ﺍﻹﻋﻼﻤﻴﺔ ‪....................................... :‬‬ ‫ﺘﺎﺭﻴﺦ ﺍﻟﻤﺴﻙ ﺍﻹﻋﻼﻤﻲ ‪......................................... :‬‬
‫ﺇﺴﻡ ﺍﻟﻌﻭﻥ ‪…..……………………………………………… :‬‬ ‫ﺇﺴﻡ ﺍﻟﻌﻭﻥ ‪…..……………………………………………… :‬‬

‫ﺍﻹﻤﻀﺎﺀ‬ ‫ﺍﻹﻤﻀﺎﺀ‬

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