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‫وﻛـــــــﺎﻟــــﺔ ﺗﺗﻌﻠﻖ ﺑﺳﯾﺎﻗﺔ ﺳﯾﺎرة‬

‫أﻧﺎ اﻟﻤﻮﻗﻊ أﺳﻔﻠﮫ‪:‬‬

‫اﻟﺴﯿﺪ‪#### :‬‬

‫اﻟﺤﺎﻣﻞ ﻟﺒﻄﺎﻗﺔ اﻟﺘﻌﺮﯾﻒ اﻟﻮطﻨﯿﺔ‪ B0123456 :‬واﻟﻤﻘﯿﻢ ﺑ‬

‫ﺑﻤﻘﺘﻀﻰ ھﺬه اﻟﻮﻛﺎﻟﺔ أﺷﮭﺪ أﻧﻨﻲ وﻛﻠﺖ ﻋﻨﻲ‬

‫اﻟﺴﯿﺪ‪#### :‬‬

‫اﻟﺤﺎﻣﻞ ﻟﺒﻄﺎﻗﺔ اﻟﺘﻌﺮﯾﻒ اﻟﻮطﻨﯿﺔ‪BA1200598 :‬‬

‫واﻟﻤﻘﯿﻢ ب‬

‫وذﻟﻚ ﻟﯿﻨﻮب ﻋﻨﻲ وﯾﻘﻮم ﻣﻘﺎﻣﻲ ﻓﻲ ﺳﯿﺎﻗﺔ ﺳﯿﺎرﺗﻲ داﺧﻞ أرض اﻟﻮطﻦ ذات اﻟﻤﻮاﺻﻔﺎت اﻟﺘﺎﻟﯿﺔ‪:‬‬

‫اﻟﻨﻮع ‪ : #####‬اﻟﻌﻼﻣﺔ ‪###### :‬‬

‫‪FTY467378‬‬ ‫اﻟﻤﺴﺠﻠﺔ ﺗﺤﺖ رﻗﻢ‬

‫‪SHUDYH753T2367264‬‬ ‫رﻗﻢ اﻹطﺎر‬

‫ﺣﺮر ﺑالرغاية ﺑﺘﺎرﯾﺦ ‪01/20/2023‬‬

‫اﻹﻣﻀﺎء‬

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