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Ēïï ×Üð. 2/5

Ēïï×ĂĂîčöĆêĉÜïðøąöćè ðøąÝĞćðŘÜïðøąöćè ó.ý. …. đóĉęöđêĉö

ÜćîĂĞćîü÷Öćø ÖĉÝÖøøöÝšćÜđĀöćøĆÖþćÙüćöÿąĂćé

ĀîŠü÷ÜćîìĊę×ĂÜïðøąöćè..........................................................

ĂćÙćøýćú

ĂćÙćøßčéĄ * { êčúćÖćø / { ךćøćßÖćø ÝĞćîüî .......... ĀîŠü÷ .......... ĂćÙćø

1. ĂĆêøćÖĞćúĆÜîĆÖÖćøõćøēøÜ ÝĞćîüî.................ĂĆêøć éĆÜîĊĚ
1. ßČęĂ....................................................... ÿÖčú.............................................. Ăć÷č.................ðŘ
2. ßČęĂ....................................................... ÿÖčú.............................................. Ăć÷č.................ðŘ ĄúĄ
2. óČĚîìĊęìĆĚÜĀöé×ĂÜÿĞćîĆÖÜćî ÝĞćîüî............................êćøćÜđöêø (ĀćÖöĊóČĚîìĊęđóĉęö×ċĚîēðøéøąïč)
1. óČĚîìĊęõć÷Ĕî ÝĞćîüî..............................êćøćÜđöêø öĊîĆÖÖćøøĆïñĉéßĂï ÝĞćîüî..................Ùî
2. óČĚîìĊęõć÷îĂÖ ÝĞćîüî..............................êćøćÜđöêø öĊîĆÖÖćøøĆïñĉéßĂï ÝĞćîüî..................Ùî

3. ÝĞćîüîĂćÙćø ÝĞćîüî.............................ĂćÙćø ÝĞćîüîßĆĚî×ĂÜĒêŠúąĂćÙćø ..................ßĆĚî
3. ßČęĂĀîŠü÷ÜćîìĊęĔßšĂćÙćøøŠüöĔîðŦÝÝčïĆî ĕéšĒÖŠ
1. ..................................................................................... ÝĞćîüîĂĆêøćîĆÖÖćø ............................... ĂĆêøć
2. ..................................................................................... ÝĞćîüîĂĆêøćîĆÖÖćø ............................... ĂĆêøć

ðøąđõìÖćø×ĂÜïðøąöćèđóĉęöđêĉö ( ēðøéìĞćđÙøČęĂÜĀöć÷Ĕî {)
ÖøèĊêĆĚÜÙĞć×ĂÜïðøąöćèðøąÝĞćðŘ......... ÖøèĕöêÜÙć×ĂÜïðøąöćèðøąÝćð
ÖøèĊĕöŠêĆĚÜÙĞć×ĂÜïðøąöćèðøąÝĞćðŘ............
ÖøèêÜÙć×ĂÜïðøąöćèðøąÝćð
{ ñĎšøĆïđĀöćđÿîĂøćÙćÿĎÜ×ċĚîđîČęĂÜÝćÖ.............................................. { đðŗéìĞćÖćøĔĀöŠ/÷šć÷ìĊęìĞćÖćøĔĀöŠĔîðŘÜïðøąöćè.........
{ öĊĀîŠü÷ÜćîĂČęîöćĔßšĂćÙćøøŠüö ĕéšĒÖŠ...................................... - üĆî/đéČĂî/ðŘ ìĊęđðŗéìĞćÖćøĔĀöŠ/÷šć÷ìĊęìĞćÖćø...................
- üĆî/đéČĂî/ðŘ ìĊę÷šć÷đךćöć......................................................... ÜïðøąöćèìĊę×ĂÝĆéÝšćÜ ÝĞćîüî ..........................ïćì

- ÝĞćîüîĂĆêøćîĆÖÖćø .................ĂĆêøć (øą÷ąđüúć×Ăđóĉęö........đéČĂî ÙĉéđðŨîêŠĂđéČĂî...............ïćì)
{ ĀîŠü÷ÜćîĂČęî÷šć÷ĂĂÖÝćÖĂćÙćø ĕéšĒÖŠ.................................... { ĂČęîė ..............................................
- üĆî/đéČĂî/ðŘ ìĊę÷šć÷ĂĂÖ......................................................... øć÷úąđĂĊ÷éÖćø×ĂøĆïÝĆéÿøøÜïðøąöćè
- óČĚîìĊęđóĉęö×ċĚî..............................................êćøćÜđöêø - ÖøèĊđÙ÷ÝĆéÝšćÜĒúąêĆĚÜÙĞć×ĂÜïðøąöćè
{ ÷šć÷ìĊęìĞćÖćøĔĀöŠĔîðŘÜïðøąöćè......... ÜïðøąöćèìĊęĕéšøĆïĂîčöĆêĉêšîðŘ ÝĞćîüî.........................ïćì

- üĆî/đéČĂî/ðŘ ìĊę÷šć÷ìĊęìĞćÖćø..................................................... ×ĂÜïðøąöćèđóĉęöđêĉö ÝĞćîüî ….....................ïćì
- ÖŠĂî÷šć÷ìĊęìĞćÖćøĔĀöŠđÙ÷ĔßšĂćÙćøøŠüöÖĆï............................. (øą÷ąđüúć×Ăđóĉęö........đéČĂî ÙĉéđðŨîêŠĂđéČĂî...............ïćì)
{ ĕöŠđÙ÷ÝĆéÝšćÜĒêŠêĆĚÜÙĞć×ĂÜïðøąöćèðøąÝĞćðŘ øüöđðŨîđÜĉîìĆĚÜÿĉĚî ....................................ïćì
- êĆĚÜÙĞć×ĂÜïðøąöćè ÝĞćîüî........................................ïćì

đĀêčñúðøąÖĂï........................................................................................................................................................................................................
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(ÝĞćîüîÿëĉêĉÙéĊðŘìĊęñŠćîöć ïčÙúćÖø×ĂÜĀîŠü÷Üćî ĀšĂÜóĉÝćøèćÙéĊìĊęĔßšÜćî ĂČęîė ìĊęÝĞćđðŨîđóČęĂðøąÖĂïÖćøóĉÝćøèć
*êćöøąđïĊ÷ïÙèąÖøøöÖćøïøĉĀćøýćú÷čêĉíøøö üŠćéšü÷ĂćÙćøìĊęóĆÖ×ĂÜýćú÷čêĉíøøöĔîÿŠüîõĎöĉõćÙ ó.ý. 2554

ñĎšÝĆéìĞć................................................ ñĎšĂĞćîü÷Öćø...............................................
êĞćĒĀîŠÜ.............................................. ēìøýĆóìŤ......................................................
ēìøýĆóìŤ.............................................. üĆîìĊę............................................................

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