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ĄБŷŪĠŷijŚ₤

Њ Ю₣šĠ rUbft ថ
4x6
3
ơ - ĜņŪij˝РŲ ĕЊ₣ĜņŠųĕ
Ф ........................................................... Юķ◦ ............
(ďΒ˝℮ũΐ″е₣ ₤Рņ₤ũЮ₤ũΒ˝℮ũĊе) ......................................................................
Ư - Ю˝ЧijЮĝаℓĞ◦Б .................................... ЯŠ ........................................ ĂĖе ...................
ư - Ю˝ЧijЮĝþНе / ₤İ˛ijс ........................Ū˝О₣ / Ū₤О˝ / Š‗Ź ..................... ЮŠijŚ / ŬĄēĕБ.........
̉ - ΰĮН˝ЮěŊй ......................................ΖŎН ............ĂĖе ņНŠũĠũĕЊ₣˝Яĕų₣ЮĊſЧŁũ................
◦БŲеЮĝ ................................................................................................................
̣ - ŌŚŎЮěŊй ...................................ΖŎН ............ĂĖе ņНŠũĠũĕЊ₣˝Яĕų₣ЮĊſЧŁũ...................
◦БŲеЮĝ ................................................................................................................
̀ - ŪĠŷijŚЊ₤Ю₣šĠаĕŁũ₤Њ˝⅝″е₣ĮБijРşũ΅РijřŲсĠşĠ
О Ć ġĕĖ
ĮБĂĖе.............řŲсĂĖе .............ЮũЬĕЮĝ........................................................ЮŠijŚ........
ĮБĂĖе.............řŲсĂĖе .............ЮũЬĕЮĝ........................................................ЮŠijŚ........
ĮБĂĖе.............řŲсĂĖе .............ЮũЬĕЮĝ........................................................ЮŠijŚ........
́ - ΒеĮБĠ₣Ġ∆ĕ
С ĠЮ₣˛Чij ( ЮěŊй Юķ◦ ĂĖе˝еЮ‗Чij ņНŠũĠũ ) ............. Ĝ˝с
ơ- ..............................................................................................................
Ư- ..............................................................................................................
ư-...............................................................................................................
̉- ...............................................................................................................
(ЮĠЧŌĕЮŪşЧĕЮŲЧ₤ĮБ ̣ Ĝ˝с ₤Рņ₤ũЮ₤ũĠĕŚ ЮĝЮŲЧ◦еĮњũž₣ЮŪŁŎ)

T - ₤ĮſаℓĞũ₤сЮĝďņУŎЮŵ˝-Юŵ˝Ū₤Б .....................................................ŪijСŷď ............


ņНŠũĠũĕЊ₣◦Б˝Яĕų₣ЮĊſЧŁũ .........................................................................................
Ζ₤ŎŢťĕĠşĠġĕĖ
ОĆ ...............................................................................................
◦Рũ₤њĮЮĀ ŲŠ ......................................................................................................
Z - ďĠс₤ŔňĠŪijņĊŏņ₤Њ˝⅝◦НijЊŎķРņЊĂĖе .........................................şе₧ijс▫Ė˝сũУņ .........
ơƠ-ņЮĊŜģŎЮĊſЧřеЮ‗Чũņ˝Łĕс ŷЋ◦Ŝ⅜□ĕ........................................................................
О ◦-Ĝ₣Šńе О ₤РņēĜ▫ ĄБŷŪĠŷijŚЊ₤Ю₣šĠĬĀŲсŠĕ
Šńеģ ųФ ž₣ЮŲЧĮЊijďŪijЕņŪijСŷΟijЯ˝ų₣ĠĕųеЮĠЧŠН₤ĮБ
ŁũĮЊij Šńеģ
О ◦-Ĝ₣Šńе О ₤Рņ◦◦УŲŠН₤ŪijСŷĈе₣Ū₤О₣ şеЮĵйņНŠşĤĠс ¤
аℓĞ.................................ЯŠ...................ĂĖеđŷųС ŪijБ₤њ˝ Į.₤.Ự̣̀
ŬĄēĕБķĖеЮĮŀ аℓĞ◦Б ............ ЯŠ ..................ĂĖеƯƠƯơ
΅ij□ЮŲžĕЊ₣ЮěŊйĕЊ₤℮Њij

D:\Owner\និស ិតពិ រ\ជីវ បវតិសេងប ទូេ .docx

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