ﺪﻌﺑ
ﻦﻋ
ﻞﻴﻐﺸﺘﻟا
ﺮﻣاوأ
•
ﻞﻴﻐﺸﺗ
ﻞﺋﺎﺳﺮﻟا
ﻞﺋﺎﺳﺮﻟا
ﻞﻴﻐﺸﺗ
........................
7
#
ﻒﻠﺨﻠﻟ
ﻚﻳﺮﺤﺗ
/
راﺮﻜﺗ
..................
2
#
مﺎﻣﻸﻟ
ﻲﻄﺨﺗ
:
.........................
5
#
فﺎﻘﻳإ
................................
...
0
#
ﻂﻘﻓ
ةﺪﻳﺪﺠﻟا
ﻞﺋﺎﺳﺮﻟا
ﻞﻴﻐﺸﺗ
...........
6
#
)
ﻻوأ
ﻞﻴﻐﺸﺘﻟا
ﻒﻗوأ
(
•
ﻞﺋﺎﺳﺮﻟا
ﺢﺴﻣ
ةﺪﺣاو
ﻪﻟﺎﺳر
ﺢﺴﻣ
.....................
3
#
ﻞﺋﺎﺳﺮﻟا
ﻞآ
ﺢﺴﻣ
......................
3
3
#
•
ﺮﻴآﺬﺗ
ﻞﻴﺠﺴﺗ
ءﺪﺑ
................................
.....
#
ءﺎﻬﻧإ
................................
...
0
#
•
ﺪﻳﺪﺟ
ةردﺎﺻ
ﺔﻟﺎﺳر
ﻞﻴﺠﺴﺗ
ة
ءﺪﺑ
................................
.....
4
•
ﺲآﺎﻔﻟا
لﺎﺒﻘﺘﺳا
عﺎﺿوأ
ﻊﺿو
A.M.
)
ﻲﺋﺎﻘﻠﺗ
در
:(
............
8
1
#
ﻊﺿو
FAX
)
ﺲآﺎﻓ
:(
.................
8
2
#
ﻊﺿو
TEL
)
ﻒﺗﺎه
:(
.................
8
3
#
ﻊﺿو
TEL/FAX
)
ﻒﺗﺎه
/
ﺲآﺎﻓ
:(
..
8
4
#
•
ﻞﻳﻮﺤﺘﻟا
ﺔﻔﻴﻇو
ﻞﻴﻐﺸﺗ
................................
...
9
1
#
ﻞﻴﻐﺸﺗ
فﺎﻘﻳإ
...........................
9
2
#
ﺪﻳﺪﺟ
ﻞﻳﻮﺤﺗ
ﻢﻗر
.......................
9
0
#
)
ﻗر
ــ
ﻢ
ﻬﻟا
ـــ
ﺗﺎ
ـ
ﻒ
(
#
ﺳر
ﻞﻴﺠﺴﺗ
ﻞﻳﻮﺤﺘﻠﻟ
ةردﺎﺻ
ﺔﻟﺎ
........
9
3
#
ﺔﻋﺮﺴﺑ
لﺎﺼﺗﻻا
ﻊﻄﻘﻟ
.................
•
ﻂﻘﻓ
ةردﺎﺼﻟا
ﺔﻟﺎﺳﺮﻟا
ﻊﺿو
ﻞﻴﻐﺸﺗ
................................
...
1
1
#
ﻞﻴﻐﺸﺗ
فﺎﻘﻳإ
...........................
1
2
#
*
*
*
*