‫ﻣـﺮﻛــﺰ ﺍﻟﺼـﻜــﻮﻙ ﺍﻟﺒــﺮﻳــﺪﻳــﺔ ﺍﻟﺠــﺰﺍﺋــﺮ‬

‫ﻃـــﻠـﺐ ﺭﺧــﺼــﺔ ﺳــﺤــﺐ ﺍﻟﻤــﻨــﻈـــﻮﺭ‬

‫ﺻﻚ ‪1-6‬‬

‫ﺍﻟﻌﻨﻮﺍﻥ ﺍﻟﻤﺒﻴﻦ ﻓﻴﻤﺎ ﻳﻠﻲ‪:‬‬

‫ﺍﻟﺤﺴﺎﺏ ﺍﻟﺒﺮﻳﺪﻱ ﺍﻟﺠﺎﺭﻱ ﺭﻗﻢ ‪ ...........................................................:‬ﺍﻟﺠﺰﺍﺋﺮ‬
‫‪Mr BENHAMED NACEREDDIN‬‬
‫‪.................................................................................:‬‬ ‫ﺍﻟﻠﻘﺐ ﻭ ﺍﻹﺳﻢ ﺃﻭ ﺗﺴﻤﻴﺔ ﺍﻟﻤﺆﺳﺴﺔ‬
‫‪...........................................................................................................................‬‬
‫‪REU EL AMIR ABD ELKADER 35 HADJAR ANNABA‬‬
‫‪...............................................................................................................:‬‬ ‫ﺍﻟﻌﻨﻮﺍﻥ‬
‫‪EL-HADJAR‬‬
‫‪...................................................:‬‬ ‫ﺃﻃﻠﺐ ﺍﻟﻤﺸﺎﺭﻛﺔ ﻓﻲ ﻣﺼﻠﺤﺔ ﺍﻟﺴﺤﺐ ﺍﻟﻤﻨﻈﻮﺭ ﺑﻤﻜﺘﺐ ﺑﺮﻳﺪ‬
‫ﺇﻧﻲ ﺃﺗﻌﻬﺪ ﺑﺄﻥ ﻻ ﺃﻗﻮﻡ ﺑﻌﻤﻠﻴﺔ ﺳﺤﺐ ﺗﻔﻮﻕ ﻣﺒﻠﻎ ﺍﻟﺮﺻﻴﺪ ﺍﻟﻤﻮﺟﻮﺩ ﻓﻲ ﺣﺴﺎﺑﻲ ﺍﻟﺒﺮﻳﺪﻱ‬
‫ﺍﻟﺠﺎﺭﻱ‪.‬‬
‫ﻛﻤﺎ ﺃﺭﺧﺺ ﻟﻠﺴﺎﺩﺓ ) ﺍﻟﻠﻘﺐ ﻭ ﺍﻹﺳﻢ (‬
‫‪........................................................-3‬‬ ‫‪......................................................-1‬‬
‫‪........................................................-4‬‬ ‫‪......................................................-2‬‬
‫ﺑﺎﻹﻣﻀﺎﺀ ﺑﺼﻔﺔ ﻣﻨﻔﺼﻠﺔ ﺑﺎﺳﻤﻲ ﻭ ﻋﻨﻲ‪ ،‬ﻣﻘﺎﺑﻞ ﺗﻘﺪﻳﻢ ﺻﻜﻮﻙ ﺍﻟﺘﺤﻮﻳﻞ )‪(1‬‬
‫ﺑـ‪ ........................................‬ﻓﻲ‪...........................................................‬‬
‫ﺍﻹﻣﻈﺎﺀ‬

‫ﺧﺘﻢ ﺍﻟﻤﻜﺘﺐ‬ ‫ﺧﺘﻢ ﻣﺮﻛﺰ‬ ‫ﺗﺄﺷﻴﺮﺓ ﻣﺼﻠﺤﺔ‬

‫ﺍﻟﻤﻜﻠﻒ ﺑﺎﻟﺪﻓﻊ‬ ‫ﺍﻟﺼﻜﻮﻙ ﺍﻟﺒﺮﻳﺪﻳﺔ‬ ‫ﺍﻟﻤﻠﻔﺎﺕ‬

‫)‪ (1‬ﻳﻨﺒﻐﻲ ﺣﺘﻤﺎ ﻋﻠﻰ ﺍﻷﺷﺨﺎﺹ ﺍﻟﺬﻳﻦ ﻳﺘﻢ ﺗﻌﻴﻴﻨﻬﻢ ﺃﻥ ﻳﻜﻮﻧﻮﺍ ﻣﻌﺘﻤﺪﻳﻦ ﻟﺪﻯ ﻣﺮﻛﺰ‬
‫ﻟﻴﺘﻤﻜﻨﻮﺍ ﻣﻦ ﺳﺤﺐ ﺍﻟﺼﻜﻮﻙ ﻋﻠﻰ ﺍﻟﺤﺴﺎﺏ ﺍﻟﺒﺮﻳﺪﻱ ﺍﻟﺠﺎﺭﻱ ﻟﻠﻄﺎﻟﺐ‪.‬‬