IFISHI 14.

a
V.05 Edition Mutarama 2023

IFISHI ISABA IHEREREKANYA RY’UBURENGANZIRA KU BUTAKA

RISHINGIYE KU IGURANA
Umwirondoro (w’impande zombi)
Uruhande rwa mbere:
Njyewe/Twebwe: .....…………………………………………………………………………………………………………………...........
Indangamuntu/Pasiporo: …………………..………………………………………………………………………………………..........
Aderesi: Akarere ka…………………….…. Umurenge wa ……………………………Akagari ka…………………….............
Umudugudu wa ………………................Telefoni : ……………………………………E-mail: …………………………................
Uruhande rwa kabiri
Njyewe/Twebwe: .....…………………………………………………………………………………………………………………...........
Indangamuntu/Pasiporo: …………………..………………………………………………………………………………………..........
Aderesi: Akarere ka…………………….…. Umurenge wa ……………………………Akagari ka ……………………............
Umudugudu wa ………………................Telefoni : ……………………………………E-mail: …………………………................

Turasaba ihererekanya ry’uburenganzira k’ubutaka rishingiye ku igurana

Amakuru arebana n’ikibanza/isambu ya mbere y’uruhande rwa 1:
Nimero y'ikibanza/isambu (UPI): …………………………....................................
Umujyi wa Kigali/Intara: ……………………………………….................
Akarere: …………………………………………………...
Umurenge: …………………………………….……………..
Akagari: …………………………………….……………..
Umugabane uguranwa: .......................%
gihinduranywa na
Amakuru arebana n’ikibanza/isambu ya Kabiri y’uruhande rwa 2:
Nimero y'ikibanza/isambu (UPI): …………………………..................................
Umujyi wa Kigali/Intara: ………………………………………................
Akarere: …………………………………………………...
Umurenge: …………………………………….……………..
Akagari: …………………………………….……………..
Umugabane uguranwa: .......................%
Ibisobanuro k'ubusabe………………………………………………………………………………………….....................................
……………………………………………………………………………………………………………………………….....................................
Ibyangombwa bisabwa
Ibyemezo by’irangamimerere by’abagurana
Amasezerano y’ihererekanya yashyizweho umukono n’impande zombi yakorewe imbere ya Noteri1
Ibyangombwa by’ubutaka2 busabirwa igurana
…………………………….. ………………………………………………………………………………
Itariki y’ubusabe Imikono y’abasaba
Ahagenewe gusaba guhuza imikoreshereze y’ubutaka n’igishushanyo mbonera
Ndasaba ko icyo ubutaka bwagenewe gukoreshwa gihuzwa n’igishushanyo mbonera
cy’imikoreshereze y’ubutaka( uzuza ahabugenewe)

Byakiriwe kandi bisuzumwa na: ………………………………...................................................................................................

Icyo ashinzwe:……………………………………………………………………………………………………………………………..................................
Itariki: ………………………………………………………
Signature………………………………………………………………….. Kashe…………………………………………………

1 Mu gihe ibiguranwa ari ubutaka amasezerano akorerwa imbere ya noteri mu by’ubutaka naho mu gihe ibiguranwa ari
ubutaka n’ikindi kintu amasezerano y’ihererekanya akorerwa imbere ya Noteri mu bitajyanye n’ubutaka.
2 Ibi bireba ibyangombwa byatanzwe mbere y’itariki ya 09 Mutarama 2023.