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‫ﺷﻬﺎﺩﺓ ﺍﻟﻬﻮﻳﺔ ‪ -‬‏ﺍﻟﻤﻐﺮﺏ‏‬

‫ﺃﻗﺮ ﺃﻧﺎ‪ ،‬ﺍﻟﺸﺎﻫﺪ ﺍﻟﻤﺤﻠَّﻒ ﻓﻲ ﻫﺬﻩ ﺍﻟﻮﺛﻴﻘﺔ‪ ،‬ﻣﻊ ﺣﻠﻒ ﺍﻟﻴﻤﻴﻦ‪ ،‬ﺑﻤﺎ ﻳﻠﻲ‪:‬‬

‫‪ .1‬ﺍﺳﻤﻲ ﺍﻟﻘﺎﻧﻮﻧﻲ ﻫﻮ ‏______________________________________________________‏ )ﺍﻻﺳﻢ ﺍﻟﻘﺎﻧﻮﻧﻲ ﺑﺎﻟﻜﺎﻣﻞ ﻟﻠﺸﺎﻫﺪ‬

‫ﺍﻟﻤﺤﻠَّﻒ(‬

‫‪ .2‬ﺗﺎﺭﻳﺦ ﻣﻴﻼﺩﻱ ﻫﻲ ‏______________________________________________________‏ )ﺗﺎﺭﻳﺦ ﻣﻴﻼﺩ ﺍﻟﺸﺎﻫﺪ ﺍﻟﻤﺤﻠَّﻒ(‬

‫‪ .3‬ﻫﺬﻩ ﺍﻟﺸﻬﺎﺩﺓ ﺇﻗﺮﺍﺭ ﻹﺛﺒﺎﺕ ﻫﻮﻳﺘﻲ‪.‬‬

‫‪ .4‬ﻟﻘﺪ ﻗﺪﻣﺖ ‏______________________________________________________‏ )‏ﻣﺴﺘﻨﺪ ﺍﻟﻬﻮﻳﺔ ﺍﻟﻤﻌﺘﻤَﺪ‏ ﻟﻠﺸﺎﻫﺪ ﺍﻟﻤﺤﻠَّﻒ(‬

‫ﻟﻠﺸﻬﺮ ﺍﻟﻌﻘﺎﺭﻱ‪ ،‬ﻛﺈﺛﺒﺎﺕ ﻟﻬﻮﻳﺘﻲ‪.‬‬

‫ﻳﺸﻴﺮ ‏ﻣﺴﺘﻨﺪ ﺍﻟﻬﻮﻳﺔ ﺍﻟﻤﻌﺘﻤَﺪ‏ ﺇﻟﻰ ﺃﻱ ﻣﺴﺘﻨﺪ ﺗﺤﺪﻳﺪ ﻫﻮﻳﺔ ﻳﺤﺘﻮﻱ ﻋﻠﻰ ﺻﻮﺭﺓ ﺷﺨﺼﻴﺔ ﺗﻢ ﺇﺻﺪﺍﺭﻩ ﺑﻮﺍﺳﻄﺔ ﺣﻜﻮﻣﺔ ﺍﻟﻤﻐﺮﺏ ﺃﻭ ﻛﻴﺎﻥ ﺣﻜﻮﻣﻲ ﻫﻨﺎﻙ‪.‬‬

‫ﺃﻗﺮ ﺑﺄﻧﻨﻲ ﻗﺮﺃﺕ ﻭﻓﻬﻤﺖ ﻣﺤﺘﻮﻳﺎﺕ ﻫﺬﻩ ﺍﻟﺸﻬﺎﺩﺓ ﺍﻟﻤﻮﻗﻌﺔ ﺑﻮﺍﺳﻄﺘﻲ ﻭﺃﻗﺮ ﺑﺪﻗﺔ ﻭﺻﺤﺔ ﺍﻟﺒﻴﺎﻧﺎﺕ‪.‬‬

‫ﺍﻟﺘﺎﺭﻳﺦ‬ ‫ﺗﻮﻗﻴﻊ ﺍﻟﺸﺎﻫﺪ ﺍﻟﻤﺤﻠَّﻒ‬

‫ﺃﻗﺮ ﺃﻧﺎ‪ ،‬‏______________________________________________________‏ )ﺍﻻﺳﻢ ﺍﻟﻘﺎﻧﻮﻧﻲ ﻟﻠﻜﺎﺗﺐ ﺍﻟﻌﺪﻝ(‪ ،‬ﻛﺎﺗﺐ ﻋﺪﻝ ﻗﺎﻧﻮﻧﻲ‪،‬‬
‫ﻧﻴﺎﺑﺔً ﻋﻦ ﺩﻭﻟﺔ ﺍﻟﻤﻐﺮﺏ ﺃﻭ ﻛﻴﺎﻥ ﺣﻜﻮﻣﻲ ﻫﻨﺎﻙ‪ ،‬ﻓﻲ ﻫﺬﺍ ﺍﻟﻤﺴﺘﻨﺪ ﺑﺄﻥ ﺻﺎﺣﺐ ﺍﻹﻓﺎﺩﺓ‪،‬‬
‫‏______________________________________________________‏ )ﺍﻻﺳﻢ ﺍﻟﻘﺎﻧﻮﻧﻲ ﺍﻟﻜﺎﻣﻞ ﻟﺼﺎﺣﺐ ﺍﻹﻓﺎﺩﺓ( ﺣﻀﺮ ﺑﺼﻔﺔ‬
‫ﺷﺨﺼﻴﺔ ﺃﻣﺎﻣﻨﺎ ﻓﻲ ‏__________________________________________________________________________________‏‬
‫)ﻋﻨﻮﺍﻥ ﺗﻮﻗﻴﻊ ﺻﺎﺣﺐ ﺍﻹﻓﺎﺩﺓ(‪ ،‬ﻭﻫﻮ ﺍﻟﻤﻮﻗﻊ ﺍﻟﻔﻌﻠﻲ ﺩﺍﺧﻞ ﺣﺪﻭﺩ ﺩﻭﻟﺔ ﺍﻟﻤﻐﺮﺏ‪ ،‬ﻓﻲ‬
‫‏______________________________________________________‏ )ﺗﺎﺭﻳﺦ ﺗﻮﻗﻴﻊ ﺻﺎﺣﺐ ﺍﻹﻓﺎﺩﺓ( ﻭﻗﺪّﻡ ﻟﻨﺎ ﺩﻟﻴﻼً ﻗﺎﻃﻌًﺎ ﺑﺸﺄﻥ‬
‫‏ﻣﺴﺘﻨﺪ ﺍﻟﻬﻮﻳﺔ ﺍﻟﻤﻌﺘﻤَﺪ‏ )ﻛﻤﺎ ﻫﻮ ﻣﺤﺪﺩ ﺃﻋﻼﻩ( ﻳﻔﻴﺪ ﺑﺘﺄﻛﻴﺪ ﺗﺤﺮﻳﺮﻩ ﻟﻬﺬﺍ ﺍﻟﻤﺴﺘﻨﺪ ﺑﻤﻮﺟﺐ ﺍﻟﺴﻠﻄﺔ ﺍﻟﻤﻤﻨﻮﺣﺔ ﻟﻪ‪ ،‬ﻭﺑﺼﺤﺔ ﺍﻷﻣﻮﺭ‬
‫ﺍﻟﻤﻮﺿﺤﺔ ﻓﻲ ﺍﻹﻓﺎﺩﺓ ﺣﺴﺐ ﻣﻌﻠﻮﻣﺎﺗﻪ ﻭﻣﻌﺮﻓﺘﻪ ﻭﺍﻋﺘﻘﺎﺩﻩ‪.‬‬

‫ﺗﻮﻗﻴﻊ ﺍﻟﻜﺎﺗﺐ ﺍﻟﻌﺪﻝ‬

‫ﺇﻏﻼﻕ ﺑﺎﻷﺧﺘﺎﻡ )ﺍﻟﺨﺘﻢ ﺍﻟﻤﻔﻀﻞ(‬

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