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  • Lost Statement Ar

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    Payza Dido
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    20 views1 page

    Lost Statement Ar

    Uploaded by

    Payza Dido

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    ‫تصريح بالضياع‬

    ‫أنا الممضي أسفله السيد (ة)‪..................................................................................................:‬‬

    ‫المولود (ة)‪ .................................................... :‬بتاريخ‪:‬‬


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

    ‫الساكن(ة) بـ‪......................................................................................................................... :‬‬

    ‫أصرح بشرفي أنه ضاعت مني بتاريخ‪....................................................................................... :‬‬

    ‫الوثائق التالية‪:‬‬
    ‫‪...........................................................................................................................................‬‬

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

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

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

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

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

    ‫حرر في نيويورك بـ‪.........................‬‬

    ‫إمضاء المعني‬

    ‫‪15 East 47th St New York, NY 10017, Tel: 212-486.69(30,31,32) Fax: (212)-486.6934, www.algeria-cgny.org‬‬

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