‫‪République Tunisienne‬‬ ‫ﺍﻟﺠﻤﻬﻭﺭﻴـﺔ ﺍﻟﺘﻭﻨﺴﻴـﺔ‬

‫‪Ministère des Affaires Sociales, de la Solidarité‬‬ ‫ﻭﺯﺍﺭﺓ ﺍﻟﺸﺅﻭﻥ ﺍﻻﺠﺘﻤﺎﻋﻴﺔ ﻭﺍﻟﺘﻀﺎﻤﻥ‬

‫‪et des Tunisiens à l'Etranger‬‬ ‫ﻭﺍﻟﺘﻭﻨﺴﻴﻴﻥ ﺒﺎﻟﺨﺎﺭﺝ‬

‫ﺍﻟﻤﻜﺘﺏ ﺍﻟﺠﻬﻭﻱ‪/‬ﺍﻟﻤﺤﻠﻲ……‪……………..........‬‬

‫ﺍﻟﺘﺯﺍﻡ ﺒﺨﺼﻭﺹ ﻤﻨﺤﺔ ﺍﻷﺠﺭ ﺍﻟﻭﺤﻴﺩ‬

‫ﺇﻨﻲ ﺍﻟﻤﻤﻀﻲ ﺃﺴﻔﻠﻪ ‪:‬‬

‫‪...........................................................................................................................‬‬
‫ﻤﻀﻤﻭﻥ ﺍﺠﺘﻤﺎﻋﻲ ﻤﺴﺠل ﺒﺎﻟﺼﻨﺩﻭﻕ ﺘﺤﺕ ﺭﻗﻡ ‪:‬‬
‫ﺼﺎﺤﺏ ﺒﻁﺎﻗﺔ ﺍﻟﺘﻌﺭﻴﻑ ﺭﻗﻡ ‪ ................................................................ :‬ﺍﻟﻤﺴﻠﻤﺔ ﺒـ‪...............................‬‬
‫ﺒﺘﺎﺭﻴﺦ ‪ .......................................................:‬ﻭﺍﻟﻘﺎﻁﻥ ﺒـ ‪....................................................................‬‬
‫‪.........................................................................................................................................................‬‬
‫‪ .....................................................................................................‬ﺍﻟﺘﺭﻗﻴﻡ ﺍﻟﺒﺭﻴﺩﻱ‬
‫ﺃﻋﻠﻤﻜﻡ ﺒﺄﻥ ﻗﺭﻴﻨﻲ ‪............................................................................................................................ :‬‬
‫)ﻴﺫﻜﺭ ﺍﻻﺴﻡ ﻜﺎﻤﻼ ﺤﺴﺏ ﺒﻁﺎﻗﺔ ﺍﻟﺘﻌﺭﻴﻑ ﺍﻟﻭﻁﻨﻴﺔ(‬
‫‪...........................................................‬‬ ‫ﺍﻟﻤﺴﺠل ﺒﺎﻟﺼﻨﺩﻭﻕ ﺍﻟﻭﻁﻨﻲ ﻟﻠﻀﻤﺎﻥ ﺍﻻﺠﺘﻤﺎﻋﻲ ﺘﺤﺕ ﻋﺩﺩ )*(‬
‫‪......................................................‬‬ ‫ﺍﻟﻤﺴﺠل ﺒﺎﻟﺼﻨﺩﻭﻕ ﺍﻟﻭﻁﻨﻲ ﻟﻠﺘﻘﺎﻋﺩ ﻭﺍﻟﺤﻴﻁﺔ ﺍﻻﺠﺘﻤﺎﻋﻴﺔ ﺘﺤﺕ ﻋﺩﺩ‬
‫ﻏﻴﺭ ﻤﺴﺠل ﺒﺄﻱ ﺼﻨﺩﻭﻕ‬
‫‪............................................‬‬ ‫ﻟﻡ ﻴﺘﻌﺎﻁ ﺃﻱ ﻨﺸﺎﻁ ﻤﻬﻨﻲ ﻤﻥ ﺘﺎﺭﻴﺦ ‪ ....................................................‬ﺇﻟﻰ‬

‫ﻜﻤﺎ ﺃﻟﺘﺯﻡ ﺒﺈﻋﻼﻡ ﺍﻟﺼﻨﺩﻭﻕ ﺒﻜل ﺘﻐﻴﻴﺭ ﻴﻁﺭﺃ ﻋﻠﻰ ﻫﺫﻩ ﺍﻟﺤﺎﻟﺔ ﻭﺇﻻ ﺘﻌﺭﻀﺕ ﺇﻟﻰ ﻤﻘﺘﻀﻴﺎﺕ ﺍﻟﻔﺼل ‪ 100‬ﻤﻥ‬
‫ﺍﻟﻘﺎﻨﻭﻥ ﻋﺩﺩ ‪ 30‬ﻟﺴﻨﺔ ‪ 1960‬ﺍﻟﻤﺅﺭﺥ ﻓﻲ ‪ 14‬ﺩﻴﺴﻤﺒﺭ ‪ 1960‬ﻭﺍﻟﻤﺤﺩﺙ ﻷﻨﻅﻤﺔ ﺍﻟﻀﻤﺎﻥ ﺍﻻﺠﺘﻤﺎﻋﻲ ﺍﻟﺫﻱ‬
‫ﺃﻋﺘﺭﻑ ﺒﺎﻁﻼﻋﻲ ﻋﻠﻰ ﻤﺤﺘﻭﺍﻩ‪.‬‬

‫‪......................................‬‬ ‫‪ ..................................‬ﻓﻲ‬
‫ﺍﻹﻤﻀـﺎﺀ ﻤﻌﺭﻑ ﺒﻪ‬

‫)*( ﻀﻊ ﻋﻼﻤﺔ )ْ‪ (X‬ﻓﻲ ﺍﻟﻤﺭﺒﻊ ﺍﻟﻤﻨﺎﺴﺏ‪.‬‬

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‫ﻫــﺎﻡ ‪:‬‬
‫ﻴﺠﺩﺭ ﺍﻟﺘﺫﻜﻴﺭ ﺒﺄﻥ ﺍﻟﻔﺼل ‪ 100‬ﻤﻥ ﺍﻟﻘﺎﻨﻭﻥ ﺍﻟﻤﺸﺎﺭ ﺇﻟﻴﻪ ﺒﺎﻟﻤﺭﺠﻊ ﺃﻋﻼﻩ ﻴﻨﺹ ﻋﻠﻰ ﺃﻥ ﻜل ﺃﺠﻴﺭ ﻴﺘﺴﻠﻡ ﺃﻭ ﻴﺤﺎﻭل ﺃﻥ ﻴﺘﺴﻠﻡ ﻋﻥ ﺴﻭﺀ ﻨﻴﺔ ﻤﻨﺎﻓﻊ‬
‫‪C 084‬‬

‫ﻻ ﻴﺴﺘﺤﻘﻬﺎ ﺒﻤﻘﺘﻀﻰ ﺍﻟﻘﺎﻨﻭﻥ ﺘﺴﻠﻁ ﻋﻠﻴﻪ ﺍﻟﻌﻘﻭﺒﺎﺕ ﺍﻟﺘﻲ ﺍﻗﺘﻀﺎﻫﺎ ﺍﻟﻔﺼل ‪ 291‬ﻤﻥ ﺍﻟﻘﺎﻨﻭﻥ ﺍﻟﺠﺯﺍﺌﻲ ﻤﻊ ﺍﺤﺘﻔﺎﻅ ﺍﻟﺼﻨﺩﻭﻕ ﺒﺤﻘﻪ ﻓﻲ ﺍﻟﺤﺼﻭل‬
‫ﻋﻠﻰ ﻏﺭﺍﻤﺎﺕ ﻻ ﺘﻘل ﻋﻥ ﺍﻟﻤﺒﺎﻟﻎ ﺍﻟﺘﻲ ﺩﻓﻌﻬﺎ‪.‬‬