‫ﺍﻟﻤﻤﻠﻜﺔ ﺍﻟﻤﻐﺮﺑﻴﺔ‬

‫ﻭﺯﺍﺭﺓ ﺍﻟﺪﺍﺧﻠﻴﺔ‬
‫ﺟﻬﺔ ﺗﺠﺮﻳﺒﻲ‬
‫ﻋﻤﺎﻟﺔ ﺗﺠﺮﻳﺒﻲ‬
‫ﺗﺠﺮﻳﺒﻲ‬
‫ﻣﻜﺘﺐ ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺪﻧﻴﺔ ﺗﺠﺮﻳﺒﻲ‬

‫ﺷﻬﺎﺩﺓ ﺍﻟﻌﺰﻭﺑﺔ‬

‫ﻳﺸﻬﺪ ﺍﻟﻤﻮﻗﻊ ﺃﺳﻔﻠﻪ‬

‫ﺑﻨﺎﺀ ﻋﻠﻰ ﺍﻟﻮﺛﺎﺋﻖ ﺍﻟﻤﺪﻟﻰ ﺑﻬﺎ ﻭ ﻧﺘﺎﺋﺞ ﺍﻟﺒﺤﺚ ﺍﻟﺬﻱ ﺃﺟﺮﻱ ﻣﻦ ﻃﺮﻑ ﺷﻴﺦ‬

‫ﻟﻤﻜﺘﺐ ﺍﻟﺤﺎﻟﺔ ﺍﻟﻤﺪﻧﻴﺔ ﻝ‬

‫ﺃﻥ ﺍﻟﺴﻴﺪ)ﺓ( ‪:‬‬

‫ﺍﻟﺤﺎﻣﻞ)ﺓ( ﻟﺒﻄﺎﻗﺔ ﺍﻟﺘﻌﺮﻳﻒ ﺍﻟﻮﻃﻨﻴﺔ ﺭﻗﻢ ‪:‬‬

‫ﺍﻟﻤﻮﻟﻮﺩ)ﺓ( ﻓﻲ ‪ :‬ﺑﺘﺎﺭﻳﺦ‬

‫ﻭﺍﻟﺪﻩ)ﻫﺎ( ‪:‬‬

‫ﻭﺍﻟﺪﺗﻪ)ﻫﺎ( ‪:‬‬

‫ﺍﻟﺴﺎﻛﻦ)ﺓ( ‪:‬‬

‫ﻣﻬﻨﺘﻪ)ﻫﺎ( ‪:‬‬

‫ﻟﻢ ﻳﺴﺒﻖ ﻟﻪ)ﻫﺎ( ﺃﻥ ﺗﺰﻭﺝ)ﺃﻭ ﺗﺰﻭﺟﺖ(‬

‫ﺳﻠﻤﺖ ﻫﺬﻩ ﺍﻟﺸﻬﺎﺩﺓ ﻟﻺﺩﻻﺀ ﺑﻬﺎ ﻋﻨﺪ ﺍﻟﺤﺎﺟﺔ‪.‬‬

‫ﺟﻤﺎﻋﺔ ﺗﺠﺮﻳﺒﻲ ﻓﻲ ‪2016-01-29‬‬

‫ﻋﻦ ﺭﺋﻴﺲ ﺍﻟﻤﺠﻠﺲ ﻭ ﺑﺘﻔﻮﻳﺾ ﻣﻨﻪ‪.‬‬