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  • ApplicationRegistrationNewMember2Rep - NR 23 28772.pdf 1678538053290

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    Mohamed Essam
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    This document is a request to register Dr. Mohamed Issam Hazem Elhassanein in the general register of the Doctors Syndicate. It provides his personal details like name, gender, religion, nationality, birthdate, address and contact information. It also includes his educational qualifications, the faculty and year he graduated from medical school, and his work information. At the bottom is space for payment details and signatures of the doctor and relevant official.

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    ApplicationRegistrationNewMember2Rep_NR-23-28772.pdf-1678538053290

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    This document is a request to register Dr. Mohamed Issam Hazem Elhassanein in the general register of the Doctors Syndicate. It provides his personal details like name, gender, religion, nationality, birthdate, address and contact information. It also includes his educational qualifications, the faculty and year he graduated from medical school, and his work information. At the bottom is space for payment details and signatures of the doctor and relevant official.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
    10 views1 page

    ApplicationRegistrationNewMember2Rep - NR 23 28772.pdf 1678538053290

    Uploaded by

    Mohamed Essam
    This document is a request to register Dr. Mohamed Issam Hazem Elhassanein in the general register of the Doctors Syndicate. It provides his personal details like name, gender, religion, nationality, birthdate, address and contact information. It also includes his educational qualifications, the faculty and year he graduated from medical school, and his work information. At the bottom is space for payment details and signatures of the doctor and relevant official.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Flag for inappropriate content
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    ‫ﺍﻟﻨﻘﺎﺑﻪ ﺍﻟﻌﺎﻣﻪ ﻟﻼﻃﺒﺎﺀ‬

    ‫ﻃﻠﺐ ﻗﻴﺪ ﺑﺎﻟﺠﺪﻭﻝ ﺍﻟﻌﺎﻡ‬


    ‫ﻣﺤﻤﺪ ﻋﺼﺎﻡ ﺣﺎﺯﻡ ﺍﻟﺤﺴﺎﻧﻴﻦ‬ ‫ﺍﻻﺳﻢ‪:‬‬
    ‫‪Name:‬‬ ‫‪Mohamed Issam Hazem Elhassanein‬‬

    ‫ﺫﻛﺮ‬ ‫ﺍﻟﻨﻮﻉ‪:‬‬

    ‫ﺍﻹﺳﻼﻡ‬ ‫ﺍﻟﺪﻳﺎﻧﺔ‪:‬‬ ‫ﻣﺼﺮﻱ‬ ‫ﺍﻟﺠﻨﺴﻴﺔ‪:‬‬

    ‫ﻣﻴﺖ ﺍﻟﻌﺎﻣﻞ ﻣﺮﻛﺰ ﺍﺟﺎ ﺍﻟﺪﻗﻬﻠﻴﺔ‬ ‫ﻣﺤﺎﻓﻈﺔ ﺍﻟﻤﻴﻼﺩ‪:‬‬ ‫‪1997-04-19‬‬ ‫ﺗﺎﺭﻳﺦ ﺍﻟﻤﻴﻼﺩ‪:‬‬

    ‫‪29704191200159‬‬ ‫ﺍﻟﺮﻗﻢ ﺍﻟﻘﻮﻣﻰ‪:‬‬

    ‫ﻣﺤﺎﻓﻈﺔ‪ :‬ﺍﻟﺪﻗﻬﻠﻴﺔ‬ ‫ﺍﺟﺎ‬ ‫ﺻﺎﺩﺭ ﻣﻦ ﻗﺴﻢ‪/‬ﻣﺮﻛﺰ‪:‬‬

    ‫ﺷﺎﺭﻉ ﺍﻟﺤﺮﻳﺔ‬ ‫ﺷﺎﺭﻉ‪:‬‬ ‫‪1‬‬ ‫ﺍﻟﻤﻘﺮﺍﻟﺪﺍﺋﻢ ﻟﻺﻗﺎﻣﺔ‪ :‬ﺭﻗﻢ ﻣﻨﺰﻝ‪:‬‬

    ‫ﺍﻟﺪﻗﻬﻠﻴﺔ‬ ‫ﻣﺤﺎﻓﻈﺔ‪:‬‬ ‫ﺍﺟﺎ‬ ‫ﻣﺮﻛﺰ‪/‬ﻗﺮﻳﺔ‪:‬‬

    ‫ﻣﻴﺖ ﺍﻟﻌﺎﻣﻞ ﻣﺮﻛﺰ ﺍﺟﺎ ﺍﻟﺪﻗﻬﻠﻴﺔ‬ ‫ﺍﻟﻌﻨﻮﺍﻥ‪:‬‬

    ‫ﺕ ﺍﻟﻤﺤﻤﻮﻝ )‪01551686085 :(٢‬‬ ‫ﺕ ﺍﻟﻤﺤﻤﻮﻝ )‪01063106500 :(١‬‬ ‫ﺕ ﺍﻟﻤﻨﺰﻝ‪0504328005 :‬‬

    ‫‪Email:‬‬ ‫‪mohamedissamelshahidi@gmail.com‬‬

    ‫ﺕ ﺍﻟﻌﻤﻞ‪:‬‬ ‫ﺟﻬﺔ ﺍﻟﻌﻤﻞ )ﺍﻟﺘﻜﻠﻴﻒ(‪:‬‬

    ‫ﺗﻘﺪﻳﺮ‪ :‬ﻣﻤﺘﺎﺯ ﻣﻊ ﻣﺮﺗﺒﺔ‬ ‫ﻛﻠﻴﺔ ﻃﺐ‪ :‬ﻛﻠﻴﺔ ﻃﺐ ﺍﻟﻤﻨﺼﻮﺭﺓ‬ ‫ﺳﻨﺔ‪2021 :‬‬ ‫ﻧﻮﻓﻤﺒﺮ‬ ‫ﺍﻟﺒﻜﺎﻟﻮﺭﻳﻮﺱ‪:‬ﺷﻬﺮ‪:‬‬

    ‫ﺍﻟﻤﺎﻧﻲ‬ ‫ﺍﻟﻠﻐﺔ ﺍﻟﺜﺎﻧﻴﺔ‪:‬‬ ‫ﺍﻟﻠﻐﺔ ﺍﻷﺟﻨﺒﻴﺔ ‪ :‬ﺍﻟﻐﺔ ﺍﻷﻭﻟﻰ‪ :‬ﺍﻧﺠﻠﻴﺰﻱ‬

    ‫ﺗﻮﻗﻴﻊ ﺍﻟﻄﺒﻴﺐ‪....................................................... :‬‬ ‫‪2023/03/11‬‬ ‫ﺗﺤﺮﻳﺮﺍً ﻓﻰ ‪:‬‬

    ‫ﺟﻨﻴﻪ‬ ‫ﻗﺮﺵ‬
    ‫‪..........................‬‬

    ‫ﻗﻴﻤﺔ ﺭﺳﻢ ﺍﻟﻘﻴﺪ ﻭ ﺍﺷﺘﺮﺍﻙ ﺳﻨﺔ ﺑﺎﻟﻨﻘﺎﺑﺔ ﻭ ﺍﻟﻤﺼﺎﺭﻳﻒ ﺍﻹﺩﺍﺭﻳﺔ‬

    ‫‪/‬‬ ‫‪/‬‬ ‫ﺳﺪﺍﺩ ﺑﺈﻳﺼﺎﻝ ﺭﻗﻢ‪ ......................:‬ﺑﺘﺎﺭﻳﺦ‪:‬‬

    ‫ﺗﻮﻗﻴﻊ ﺍﻟﻤﻮﻇﻒ ﺍﻟﻤﺨﺘﺺ‪.................................. :‬‬

    ‫ﺍﻟﻜﻮﺩ‪/‬ﺍﻟﻤﺪﺧﻞ‬ ‫ﺍﻟﻤﺮﺍﺟﻊ‬
    ‫‪..............................‬‬ ‫‪..............................‬‬

    ‫‪eservices.ems.org.eg‬‬

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