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ȺȾɆȱɇȱɋɌɊɍȼȺɇɇə ɉɈȾȺɌɄȱȼ

Ⱦɨɞɚɬɨɤ Ɂ

ȺɄɌ ɨɩɢɫɭ ɚɤɬɢɜɿɜ, ɧɚ ɹɤɿ ɩɨɲɢɪɸɽɬɶɫɹ ɩɪɚɜɨ ɩɨɞɚɬɤɨɜɨʀ ɡɚɫɬɚɜɢ

ɜɿɞ _______ 20__ɪ. ʋ ____

ə, ɩɨɞɚɬɤɨɜɢɣ ɤɟɪɭɸɱɢɣ ______________________________________,

(ɩɪɿɡɜɢɳɟ ɬɚ ɿɧɿɰɿɚɥɢ)

ɩɪɢɡɧɚɱɟɧɢɣ ɧɚɤɚɡɨɦ __________________________________________

(ɧɚɡɜɚ ɩɨɞɚɬɤɨɜɨɝɨ ɨɪɝɚɧɭ)

ɜɿɞ ___________ ʋ ______, ɤɟɪɭɸɱɢɫɶ ɧɨɪɦɚɦɢ Ɂɚɤɨɧɭ ɍɤɪɚʀɧɢ “ɉɪɨ ɩɨɪɹɞɨɤ ɩɨɝɚɲɟɧɧɹ ɡɨɛɨɜ’ɹɡɚɧɶ ɩɥɚɬɧɢɤɿɜ ɩɨɞɚɬɤɿɜ ɩɟɪɟɞ ɛɸɞɠɟɬɚɦɢ ɬɚ ɞɟɪɠɚɜɧɢɦɢ ɰɿɥɶɨɜɢɦɢ ɮɨɧɞɚɦɢ”, ɭ ɩɪɢɫɭɬɧɨɫɬɿ ɫɥɭɠɛɨɜɨʀ ɨɫɨɛɢ

(ɫɥɭɠɛɨɜɢɯ ɨɫɿɛ) ɩɥɚɬɧɢɤɚ ɩɨɞɚɬɤɿɜ _______________________________

_____________________________________________________________

(ɧɚɡɜɚ, ɿɞɟɧɬɢɮɿɤɚɰɿɣɧɢɣ ɤɨɞ, ɦɿɫɰɟɡɧɚɯɨɞɠɟɧɧɹ ɩɥɚɬɧɢɤɚ ɩɨɞɚɬɤɿɜ)

______________________________________________________________

______________________________________________________________

(ɩɨɫɚɞɚ, ɩɪɿɡɜɢɳɟ, ɿɧɿɰɿɚɥɢ), ɣɨɝɨ ɫɥɭɠɛɨɜɨʀ ɨɫɨɛɢ (ɨɫɿɛ) ɩɪɨɜɿɜ ɨɩɢɫ ɚɤɬɢɜɿɜ, ɧɚ ɹɤɿ ɩɨɲɢɪɸɽɬɶɫɹ ɩɪɚɜɨ ɩɨɞɚɬɤɨɜɨʀ ɡɚɫɬɚɜɢ, ɿ ɹɤɿ ɡɧɚɯɨɞɹɬɶɫɹ________________________________________________

(ɚɞɪɟɫɚ, ɞɟ ɩɪɨɜɨɞɢɜɫɹ ɨɩɢɫ ɚɤɬɢɜɿɜ)

 

ɇɚɣɦɟɧɭɜɚɧɧɹ ɚɤɬɢɜɿɜ

 

 

 

 

 

(ɡ ɞɟɬɚɥɶɧɨɸ

 

 

 

 

 

ɯɚɪɚɤɬɟɪɢɫɬɢɤɨɸ

 

 

Ȼɚɥɚɧɫɨɜɚ ɜɚɪɬɿɫɬɶ

ʋ

ɤɨɠɧɨɝɨ ɩɪɟɞɦɟɬɚ: ɜɚɝɚ,

 

 

Ʉɿɥɶɤɿɫɬɶ

Ɉɞɢɧɢɰɹ

ɚɛɨ ɜɚɪɬɿɫɬɶ ɡɚ

ɦɟɬɪɚɠ, ɪɨɡɦɿɪ, ɜɢɞ,

ɩ/ɩ

ɤɨɥɿɪ, ɬɨɜɚɪɧɢɣ ɡɧɚɤ,

 

ɜɢɦɿɪɭ

ɟɤɫɩɟɪɬɧɨɸ

 

 

 

ɨɰɿɧɤɨɸ, ɝɪɧ

 

ɩɪɨɛɚ, ɜɢɪɨɛɧɢɱɚ

 

 

 

 

 

 

 

 

ɦɚɪɤɚ, ɞɚɬɚ ɜɢɩɭɫɤɭ,

 

 

 

 

 

ɫɬɭɩɿɧɶ ɡɧɨɫɭ ɬɨɳɨ)

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

271

ȾɈȾȺɌɄɂ

Ɋɚɡɨɦ ɧɚ ɡɚɝɚɥɶɧɭ ɫɭɦɭ ______________ ɝɪɢɜɟɧɶ __________ ɤɨɩɿɣɨɤ

ɉɨɞɚɬɤɨɜɢɣ ɤɟɪɭɸɱɢɣ

 

____________________

_________________________________

(ɩɿɞɩɢɫ)

(ɿɧɿɰɿɚɥɢ ɬɚ ɩɪɿɡɜɢɳɟ)

ɋɥɭɠɛɨɜɚ ɨɫɨɛɚ ɩɥɚɬɧɢɤɚ ɩɨɞɚɬɤɿɜ

____________________ _________________________________

(ɩɿɞɩɢɫ) (ɿɧɿɰɿɚɥɢ ɬɚ ɩɪɿɡɜɢɳɟ)

____________________

_________________________________

(ɩɿɞɩɢɫ)

(ɿɧɿɰɿɚɥɢ ɬɚ ɩɪɿɡɜɢɳɟ)

Ɂɚɥɭɱɟɧɿ ɩɨɧɹɬɿ ɨɫɨɛɢ

 

____________________

_________________________________

(ɩɿɞɩɢɫ)

(ɿɧɿɰɿɚɥɢ ɬɚ ɩɪɿɡɜɢɳɟ)

____________________

_________________________________

(ɩɿɞɩɢɫ)

(ɿɧɿɰɿɚɥɢ ɬɚ ɩɪɿɡɜɢɳɟ)

ɐɟɣ ɞɨɤɭɦɟɧɬ ɫɤɥɚɞɟɧɨ ɭ 2-ɯ ɩɪɢɦɿɪɧɢɤɚɯ.

ɉɪɢɦɿɬɤɚ. ɍ ɪɚɡɿ ɜɿɞɦɨɜɢ ɩɪɟɞɫɬɚɜɧɢɤɿɜ ɩɥɚɬɧɢɤɚ ɩɨɞɚɬɤɿɜ ɜɿɞ ɩɿɞɩɢɫɭ ɫɤɥɚɞɚɽɬɶɫɹ ɜɿɞɩɨɜɿɞɧɢɣ ɚɤɬ ɜɿɞɦɨɜɢ ɜɿɞ ɩɿɞɩɢɫɭ, ɚ ɚɤɬ ɨɩɢɫɭ ɚɤɬɢɜɿɜ, ɧɚ ɹɤɿ ɩɨɲɢɪɸɽɬɶɫɹ ɩɪɚɜɨ ɩɨɞɚɬɤɨɜɨʀ ɡɚɫɬɚɜɢ, ɫɤɥɚɞɚɽɬɶɫɹ ɡɚ ɭɱɚɫɬɸ ɧɟ ɦɟɧɲɟ ɧɿɠ ɞɜɨɯ ɩɨɧɹɬɢɯ.

ɍ ɪɚɡɿ ɡɞɿɣɫɧɟɧɧɹ ɨɩɟɪɚɰɿɣ ɡ ɜɿɞɱɭɠɟɧɧɹ ɚɤɬɢɜɿɜ, ɹɤɿ ɩɟɪɟɛɭɜɚɸɬɶ ɭ ɩɨɞɚɬɤɨɜɿɣ ɡɚɫɬɚɜɿ, ɛɟɡ ɨɬɪɢɦɚɧɧɹ ɩɨɩɟɪɟɞɧɶɨʀ ɡɝɨɞɢ ɩɨɞɚɬɤɨɜɨɝɨ ɨɪɝɚɧɭ, ɩɥɚɬɧɢɤ ɩɨɞɚɬɤɿɜ ɧɟɫɟ ɜɿɞɩɨɜɿɞɚɥɶɧɿɫɬɶ, ɜɫɬɚɧɨɜɥɟɧɭ ɡɚɤɨɧɨɞɚɜɫɬɜɨɦ ɍɤɪɚʀɧɢ.

272

ȺȾɆȱɇȱɋɌɊɍȼȺɇɇə ɉɈȾȺɌɄȱȼ

Ⱦɨɞɚɬɨɤ Ʉ

000 001*

ɉɊɈɌɈɄɈɅ ɩɪɨ ɬɢɦɱɚɫɨɜɟ ɡɚɬɪɢɦɚɧɧɹ ɦɚɣɧɚ

_________________________ ____ __________ 20 __ ɪ.

(ɧɚɡɜɚ ɧɚɫɟɥɟɧɨɝɨ ɩɭɧɤɬɭ)

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

(ɧɚɣɦɟɧɭɜɚɧɧɹ ɩɨɫɚɞɢ ɬɚ ɡɜɚɧɧɹ, ɩɪɿɡɜɢɳɟ, ɿɦ'ɹ ɬɚ ɩɨ ɛɚɬɶɤɨɜɿ ɫɥɭɠɛɨɜɨʀ

(ɩɨɫɚɞɨɜɨʀ) ɨɫɨɛɢ, ɹɤɚ ɩɪɨɜɟɥɚ ɡɚɬɪɢɦɚɧɧɹ)

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

(ɧɚɣɦɟɧɭɜɚɧɧɹ ɩɿɞɩɪɢɽɦɫɬɜɚ, ɭɫɬɚɧɨɜɢ, ɨɪɝɚɧɿɡɚɰɿʀ, ɞɟ ɩɪɨɜɨɞɢɬɶɫɹ ɡɚɬɪɢɦɚɧɧɹ ɦɚɣɧɚ, ɹɤɳɨ ɬɚɤɟ ɡɚɬɪɢɦɚɧɧɹ ɡɞɿɣɫɧɸɽɬɶɫɹ ɧɚ ʀɯ ɬɟɪɢɬɨɪɿʀ)

ɡɝɿɞɧɨ ɡ ɩɭɧɤɬɨɦ 94.7 ɫɬɚɬɬɿ 94 ɉɨɞɚɬɤɨɜɨɝɨ ɤɨɞɟɤɫɭ ɍɤɪɚʀɧɢ ɡɚ ɭɱɚɫɬɸ ɩɨɧɹɬɢɯ _______________________________________________

_______________________________________________________________

___________________________________________________________

(ɩɪɿɡɜɢɳɟ, ɿɦ'ɹ, ɩɨ ɛɚɬɶɤɨɜɿ, ɦɿɫɰɟ ɩɪɨɠɢɜɚɧɧɹ ɬɚ ɦɿɫɰɟ ɩɟɪɟɛɭɜɚɧɧɹ)

ɨɰɿɧɸɜɚɱɚ (ɭ ɪɚɡɿ ɩɨɬɪɟɛɢ) _____________________________________

_____________________________________________________________

_____________________________________________________________

(ɩɪɿɡɜɢɳɟ, ɿɦ'ɹ, ɩɨ ɛɚɬɶɤɨɜɿ, ɦɿɫɰɟ ɪɨɛɨɬɢ, ɧɚɣɦɟɧɭɜɚɧɧɹ ɩɨɫɚɞɢ;

_____________________________________________________________ɞɨ ɤɭɦɟɧɬɢ, ɳɨ ɩɿɞɬɜɟɪɞɠɭɸɬɶ ɩɨɜɧɨɜɚɠɟɧɧɹ)

ɡɚɬɪɢɦɚɜ ɿ ɜɢɥɭɱɢɜ ɦɚɣɧɨ ______________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

(ɩɪɿɡɜɢɳɟ, ɿɦ'ɹ, ɩɨ ɛɚɬɶɤɨɜɿ ɨɫɨɛɢ (ɨɫɿɛ), ɭ ɹɤɨʀ (ɹɤɢɯ) ɜɢɥɭɱɚɽɬɶɫɹ ɦɚɣɧɨ,

_______________________________________________________________

__________________________________________________________

ɪɿɤ ɬɚ ɦɿɫɰɟ ɧɚɪɨɞɠɟɧɧɹ, ɦɿɫɰɟ ɪɨɛɨɬɢ, ɧɚɣɦɟɧɭɜɚɧɧɹ ɩɨɫɚɞɢ,

_______________________________________________________________

___________________________________________________________

ɦɿɫɰɟ ɩɪɨɠɢɜɚɧɧɹ ɬɚ ɦɿɫɰɟ ɩɟɪɟɛɭɜɚɧɧɹ; ɩɪɟɞ'ɹɜɥɟɧɢɣ ɞɨɤɭɦɟɧɬ,

_______________________________________________________________

___________________________________________________________

ɳɨ ɩɨɫɜɿɞɱɭɽ ɨɫɨɛɭ, ɣɨɝɨ ɧɚɡɜɚ, ɫɟɪɿɹ, ɧɨɦɟɪ ɿ ɤɢɦ ɜɢɞɚɧɢɣ (ɡɚ ɧɚɹɜɧɨɫɬɿ)

273

ȾɈȾȺɌɄɂ

ɉɟɪɟɞ ɩɪɨɜɟɞɟɧɧɹɦ ɨɩɢɫɭ ɦɚɣɧɚ ɪɨɡ'ɹɫɧɟɧɨ ɩɪɚɜɚ:

ɨɫɨɛɿ (ɨɫɨɛɚɦ), ɭ ɹɤɨʀ (ɹɤɢɯ) ɜɢɥɭɱɚɽɬɶɫɹ ɦɚɣɧɨ: ɡɧɚɬɢ ɩɪɢɱɢɧɢ ɬɚ ɧɚɫɥɿɞɤɢ ɬɢɦɱɚɫɨɜɨɝɨ ɡɚɬɪɢɦɚɧɧɹ ɦɚɣɧɚ; ɩɨɞɚɜɚɬɢ ɜ ɩɨɪɹɞɤɭ, ɩɟɪɟɞɛɚɱɟɧɨɦɭ ɡɚɤɨɧɨɞɚɜɫɬɜɨɦ, ɫɤɚɪɝɢ ɧɚ ɞɿʀ ɫɥɭɠɛɨɜɨʀ (ɩɨɫɚɞɨɜɨʀ) ɨɫɨɛɢ, ɹɤɚ ɩɪɨɜɨɞɢɬɶ ɡɚɬɪɢɦɚɧɧɹ; ɞɚɜɚɬɢ ɩɨɹɫɧɟɧɧɹ, ɪɨɛɢɬɢ ɡɚɹɜɢ, ɩɨɞɚɜɚɬɢ ɳɨɞɨ ɡɦɿɫɬɭ ɩɪɨɬɨɤɨɥɭ ɡɚɭɜɚɠɟɧɧɹ, ɹɤɿ ɩɿɞɥɹɝɚɸɬɶ ɜɧɟɫɟɧɧɸ ɞɨ ɩɪɨɬɨɤɨɥɭ ɱɢ ɞɨɞɚɸɬɶɫɹ ɞɨ ɧɶɨɝɨ; ɨɫɨɛɢɫɬɨ ɨɡɧɚɣɨɦɢɬɢɫɹ ɡ ɩɪɨɬɨɤɨɥɨɦ ɬɚ ɩɿɞɩɢɫɚɬɢ ɣɨɝɨ; ɛɭɬɢ ɩɪɢɫɭɬɧɿɦ (ɩɪɢɫɭɬɧɿɦɢ) ɩɪɢ ɜɫɿɯ ɞɿɹɯ ɫɥɭɠɛɨɜɢɯ (ɩɨɫɚɞɨɜɢɯ) ɨɫɿɛ, ɩɨɜ'ɹɡɚɧɢɯ ɿɡ ɡɚɬɪɢɦɚɧɧɹɦ ɬɚ ɜɢɥɭɱɟɧɧɹɦ ɦɚɣɧɚ; ɩɨɧɹɬɢɦ: ɡɧɚɬɢ, ɞɥɹ ɭɱɚɫɬɿ ɭ ɩɪɨɜɚɞɠɟɧɧɿ ɹɤɢɯ ɞɿɣ ʀɯ ɡɚɩɪɨɲɟɧɨ; ɧɚ ɩɿɞɫɬɚɜɿ ɹɤɨʀ ɧɨɪɦɢ ɡɚɤɨɧɭ ɩɪɨɜɨɞɢɬɶɫɹ ɡɚɬɪɢɦɚɧɧɹ ɦɚɣɧɚ; ɩɨɞɚɜɚɬɢ ɡɚɭɜɚɠɟɧɧɹ ɳɨɞɨ ɞɿɣ, ɩɨɜ'ɹɡɚɧɢɯ ɿɡ ɡɚɬɪɢɦɚɧɧɹɦ ɦɚɣɧɚ, ɳɨ ɩɿɞɥɹɝɚɸɬɶ ɜɧɟɫɟɧɧɸ ɞɨ ɩɪɨɬɨɤɨɥɭ ɱɢ ɞɨɞɚɸɬɶɫɹ ɞɨ ɧɶɨɝɨ; ɨɰɿɧɸɜɚɱɭ (ɭ ɪɚɡɿ ɣɨɝɨ ɭɱɚɫɬɿ): ɡɜɟɪɬɚɬɢɫɹ ɿɡ ɡɚɩɢɬɚɧɧɹɦɢ, ɩɨɜ'ɹɡɚɧɢɦɢ ɡ

ɨɰɿɧɤɨɸ ɦɚɣɧɚ, ɞɨ ɨɫɨɛɢ (ɨɫɿɛ), ɭ ɹɤɨʀ (ɹɤɢɯ) ɜɢɥɭɱɚɽɬɶɫɹ ɦɚɣɧɨ, ɚ ɬɚɤɨɠ ɪɨɛɢɬɢ ɡɚɹɜɢ ɳɨɞɨ ʀɯ ɨɰɿɧɤɢ.

Ɉɫɨɛɿ (ɨɫɨɛɚɦ), ɭ ɹɤɨʀ (ɹɤɢɯ) ɜɢɥɭɱɚɽɬɶɫɹ ɦɚɣɧɨ, ɪɨɡ'ɹɫɧɟɧɨ ɨɛɨɜ'ɹɡɨɤ - ɧɟ ɩɟɪɟɲɤɨɞɠɚɬɢ ɜɢɤɨɧɚɧɧɸ ɫɥɭɠɛɨɜɢɦɢ (ɩɨɫɚɞɨɜɢɦɢ) ɨɫɨɛɚɦɢ ɨɛɨɜ'ɹɡɤɿɜ ɭ ɩɪɨɰɟɫɿ ɡɚɬɪɢɦɚɧɧɹ ɿ ɜɢɥɭɱɟɧɧɹ ɦɚɣɧɚ, ɚ ɩɨɧɹɬɢɦ ɬɚ ɨɰɿɧɸɜɚɱɭ (ɭ ɪɚɡɿ ɣɨɝɨ ɭɱɚɫɬɿ) - ɨɛɨɜ'ɹɡɨɤ ɡɚɫɜɿɞɱɢɬɢ ɜɿɞɩɨɜɿɞɧɿɫɬɶ ɡɚɩɢɫɿɜ

ɭɩɪɨɬɨɤɨɥɿ ɜɢɤɨɧɚɧɢɦ ɞɿɹɦ.

Ɉɩɢɫ ɪɨɡɩɨɱɚɬɨ ɨ ___ ɝɨɞ. ____ ɯɜ. Ɂɚɤɿɧɱɟɧɨ ɨ ___ ɝɨɞ. __ ɯɜ.

 

ɇɚɡɜ

Ɉɫɨɛɥɢɜɿ

 

Ʉɿɥɶɤɿɫɬɶ

ɐɿɧɚ ɡɚ

Ɂɚɝɚɥɶɧɚ

ɉɨɪɹɞɤɨɜɢ

ɚ ɬɚ

ɿɧɞɢɜɿɞɭɚɥɶ

Ɉɞɢɧɢɰ

ɜɢɥɭɱɟɧɨɝ

ɨɞɢɧɢɰɸ

ɜɚɪɬɿɫɬɶ

ɣ ɧɨɦɟɪ

ɨɩɢɫ

ɧɿ (ɪɨɞɨɜɿ)

ɹ

ɨ ɦɚɣɧɚ,

ɜɢɥɭɱɟɧɨɝ

ɜɢɥɭɱɟɧɨɝ

 

ɦɚɣɧ

ɨɡɧɚɤɢ

ɜɢɦɿɪɭ

ɝɪɧ

ɨ ɦɚɣɧɚ,

ɨ ɦɚɣɧɚ,

 

ɚ

 

 

 

ɝɪɧ

ɝɪɧ

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

_____________________________________________________________

(ɭ ɪɚɡɿ ɧɚɹɜɧɨɫɬɿ ɞɨɞɚɬɤɚ

_____________________________________________________________

ɡɪɨɛɢɬɢ ɩɨɫɢɥɚɧɧɹ ɧɚ ɰɟɣ ɞɨɞɚɬɨɤ)

ɍɫɶɨɝɨ ɨɩɢɫɚɧɨ ɦɚɣɧɚ (ɭ ɬɨɦɭ ɱɢɫɥɿ ɡɚɡɧɚɱɟɧɨɝɨ ɭ ɞɨɞɚɬɤɭ ɧɚ ɫɭɦɭ

____________________________________________________________.

(ɫɥɨɜɚɦɢ)

274

ȺȾɆȱɇȱɋɌɊɍȼȺɇɇə ɉɈȾȺɌɄȱȼ

ɉɪɢɦɿɬɤɚ. ɍ ɪɚɡɿ ɩɨɬɪɟɛɢ ɨɩɢɫ ɦɚɣɧɚ ɡɚ ɡɚɡɧɚɱɟɧɨɸ ɮɨɪɦɨɸ ɜɢɤɥɚɞɚɽɬɶɫɹ ɜ ɨɤɪɟɦɨɦɭ ɞɨɞɚɬɤɭ ɞɨ ɩɪɨɬɨɤɨɥɭ, ɹɤɢɣ ɽ ɧɟɜɿɞ'ɽɦɧɨɸ ɱɚɫɬɢɧɨɸ ɩɪɨɬɨɤɨɥɭ ɬɚ ɩɿɞɩɢɫɭɽɬɶɫɹ ɬɢɦɢ ɫɚɦɢɦɢ ɨɫɨɛɚɦɢ, ɹɤɿ ɩɿɞɩɢɫɭɸɬɶ ɩɪɨɬɨɤɨɥ.

ɉɪɢɱɢɧɢ ɡɚɬɪɢɦɚɧɧɹ ɦɚɣɧɚ ____________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

(ɤɨɧɤɪɟɬɧɿ ɡɚɤɨɧɨɞɚɜɱɿ ɧɨɪɦɢ, ɹɤɿ ɛɭɥɨ ɩɨɪɭɲɟɧɨ)

ɉɨɪɹɞɨɤ ɡɛɟɪɟɠɟɧɧɹ ɡɚɬɪɢɦɚɧɨɝɨ ɦɚɣɧɚ ɬɚ ɣɨɝɨ ɨɯɨɪɨɧɢ ___________

______________________________________________________________

____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

ɉɨɹɫɧɟɧɧɹ, ɫɤɚɪɝɢ, ɡɚɹɜɢ ɬɚ ɡɚɭɜɚɠɟɧɧɹ ɳɨɞɨ ɡɚɬɪɢɦɚɧɧɹ ɦɚɣɧɚ

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

_____________________________________________________________

(ɡɚɡɧɚɱɢɬɢ ɤɢɦ, ɹɤɿ ɩɨɹɫɧɟɧɧɹ, ɫɤɚɪɝɢ, ɡɚɹɜɢ ɱɢ ɡɚɭɜɚɠɟɧɧɹ ɡɪɨɛɥɟɧɨ;

_____________________________________________________________

_____________________________________________________________

___________________________________________________________

ɭ ɪɚɡɿ ɤɨɥɢ ɩɨɹɫɧɟɧɧɹ, ɫɤɚɪɝɢ, ɡɚɹɜɢ, ɡɚɭɜɚɠɟɧɧɹ ɞɨɞɚɸɬɶɫɹ ɞɨ ɩɪɨɬɨɤɨɥɭ,

ɡɪɨɛɢɬɢ ɜɿɞɩɨɜɿɞɧɭ ɩɨɡɧɚɱɤɭ)

Ɉɩɢɫ ɦɚɣɧɚ ɩɪɨɜɟɞɟɧɨ ɩɪɚɜɢɥɶɧɨ. ȼɫɟ ɜɢɤɥɚɞɟɧɟ ɭ ɩɪɨɬɨɤɨɥɿ ɩɿɞɬɜɟɪɞɠɭɽɦɨ:

ɩɨɧɹɬɿ ________________________

________________________

(ɩɪɿɡɜɢɳɟ)

 

(ɩɿɞɩɢɫ)

ɨɰɿɧɸɜɚɱ (ɭ ɪɚɡɿ ɣɨɝɨ ɭɱɚɫɬɿ) ________________

______________

(ɩɪɿɡɜɢɳɟ)

(ɩɿɞɩɢɫ)

ɨɫɨɛɚ (ɨɫɨɛɢ), ɭ ɹɤɨʀ (ɹɤɢɯ) ɜɢɥɭɱɟɧɨ ɨɩɢɫɚɧɟ ɦɚɣɧɨ (ɭ ɪɚɡɿ ɩɪɢɫɭɬɧɨɫɬɿ)

_____________________

_______________________

(ɩɪɿɡɜɢɳɟ)

(ɩɿɞɩɢɫ)

ɋɥɭɠɛɨɜɚ (ɩɨɫɚɞɨɜɚ) ɨɫɨɛɚ, ɹɤɚ ɫɤɥɚɥɚ ɩɪɨɬɨɤɨɥ

________________________

 

________________________

(ɩɪɿɡɜɢɳɟ)

 

(ɩɿɞɩɢɫ)

275

ȾɈȾȺɌɄɂ

Ʉɨɩɿɸ ɩɪɨɬɨɤɨɥɭ ʋ ____ ɬɚ ɞɨɞɚɬɨɤ ɞɨ ɧɶɨɝɨ ɧɚ _____ ɚɪɤ. (ɡɚ ɣɨɝɨ

ɧɚɹɜɧɨɫɬɿ) ɨɬɪɢɦɚɜ (ɥɢ)

 

________________________

________________________

(ɩɪɿɡɜɢɳɟ)

(ɞɚɬɚ ɿ ɩɿɞɩɢɫ)

________________________

________________________

(ɩɪɿɡɜɢɳɟ)

(ɞɚɬɚ ɿ ɩɿɞɩɢɫ)

________________________

________________________

(ɩɪɿɡɜɢɳɟ)

(ɞɚɬɚ ɿ ɩɿɞɩɢɫ)

* ɍɦɨɜɧɢɣ ɧɨɦɟɪ ɩɪɢɫɜɨɸɽɬɶɫɹ ɛɥɚɧɤɭ ɩɪɨɬɨɤɨɥɭ ɩɪɨ ɬɢɦɱɚɫɨɜɟ ɡɚɬɪɢɦɚɧɧɹ ɦɚɣɧɚ, ɳɨ ɜɢɝɨɬɨɜɥɹɽɬɶɫɹ ɬɚ ɨɛɥɿɤɨɜɭɽɬɶɫɹ ɡɝɿɞɧɨ ɡ ɩɨɪɹɞɤɨɦ ɜɢɝɨɬɨɜɥɟɧɧɹ ɧɨɦɟɪɧɢɯ ɛɥɚɧɤɿɜ, ɩɟɪɟɞɛɚɱɟɧɢɯ ɿɧɫɬɪɭɤɰɿɽɸ ɡ ɞɿɥɨɜɨɞɫɬɜɚ ɜɿɞɩɨɜɿɞɧɨɝɨ ɨɪɝɚɧɭ.

276

ȺȾɆȱɇȱɋɌɊɍȼȺɇɇə ɉɈȾȺɌɄȱȼ

Ⱦɨɞɚɬɨɤ Ʌ

Ɋȱɒȿɇɇə ʋ ɩɪɨ ɪɨɡɫɬɪɨɱɟɧɧɹ (ɜɿɞɫɬɪɨɱɟɧɧɹ) ɩɨɞɚɬɤɨɜɢɯ ɡɨɛɨɜ’ɹɡɚɧɶ (ɛɨɪɝɭ)

(ɧɟɩɨɬɪɿɛɧɟ ɜɢɤɪɟɫɥɢɬɢ)

ɜɿɞ “___” 20_____ ɪɨɤɭ ə, __________________________________________________________,

(ɩɨɫɚɞɚ, ɩɪɿɡɜɢɳɟ, ɿɧɿɰɿɚɥɢ)

ɪɨɡɝɥɹɧɭɜɲɢ ɡɚɹɜɭ ____________________________________________

_____________________________________________________________

(ɿɞɟɧɬɢɮɿɤɚɰɿɣɧɢɣ ɤɨɞ (ɧɚɡɜɚ ɩɿɞɩɪɢɽɦɫɬɜɚ ɱɢ (ɧɨɦɟɪ), ɩɪɿɡɜɢɳɟ, ɿɧɿɰɿɚɥɢ ɩɥɚɬɧɢɤɚ)

ɧɚ ɩɿɞɫɬɚɜɿ: Ɂɚɤɨɧɭ ɍɤɪɚʀɧɢ “ɉɪɨ ɞɟɪɠɚɜɧɭ ɩɨɞɚɬɤɨɜɭ ɫɥɭɠɛɭ ɜ ɍɤɪɚʀɧɿ”, ɫɬɚɬɬɿ 14 Ɂɚɤɨɧɭ ɍɤɪɚʀɧɢ “ɉɪɨ ɩɨɪɹɞɨɤ ɩɨɝɚɲɟɧɧɹ ɡɨɛɨɜ’ɹɡɚɧɶ ɩɥɚɬɧɢɤɿɜ ɩɨɞɚɬɤɿɜ ɩɟɪɟɞ ɛɸɞɠɟɬɚɦɢ ɬɚ ɞɟɪɠɚɜɧɢɦɢ ɰɿɥɶɨɜɢɦɢ ɮɨɧɞɚɦɢ” ɜɢɪɿɲɢɜ ɧɚɞɚɬɢ ɪɨɡɫɬɪɨɱɟɧɧɹ (ɜɿɞɫɬɪɨɱɟɧɧɹ) ɫɩɥɚɬɢ ɩɨɞɚɬɤɨɜɢɯ

(ɧɟɩɨɬɪɿɛɧɟ ɜɢɤɪɟɫɥɢɬɢ) ɡɨɛɨɜ’ɹɡɚɧɶ (ɛɨɪɝɭ) ɩɿɞ ɩɪɨɰɟɧɬɢ ɡɚ ɬɚɤɢɦɢ ɩɥɚɬɟɠɚɦɢ:

 

 

 

Ʉɨɞ

Ɋɚɡɨɦ

ɭ ɬɨɦɭ ɱɢɫɥɿ

 

 

 

 

ɇɚɡɜɚ

Ɉɫɧɨɜɧɢɣ

 

 

 

 

ʋ ɩ/ɩ

ɛɸɞɠɟɬɧɨʀ

Ɉɫɧɨɜɧɢɣ

ɩɥɚɬɿɠ ɡɚ ɚɤɬɨɦ

ɒɬɪɚɮɧɚ

 

 

 

ɩɥɚɬɟɠɭ

ɉɟɧɹ

 

 

 

 

ɤɥɚɫɢɮɿɤɚɰɿʀ

ɩɥɚɬɿɠ

ɞɨɤɭɦɟɧɬɚɥɶɧɨʀ

ɫɚɧɤɰɿɹ

 

 

 

 

 

 

 

ɩɟɪɟɜɿɪɤɢ

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

 

Ɋɚɡɨɦ

 

 

 

 

 

 

 

Ɋɨɡɫɬɪɨɱɟɧɧɹ (ɜɿɞɫɬɪɨɱɟɧɧɹ) ɧɚɞɚɽɬɶɫɹ ɡ ___________ ɞɨ ___________

(ɧɟɩɨɬɪɿɛɧɟ ɜɢɤɪɟɫɥɢɬɢ) ɞɚɬɚ ɞɚɬɚ

ɋɬɪɨɤɢ ɿ ɫɭɦɢ ɫɩɥɚɬɢ ɪɨɡɫɬɪɨɱɟɧɨɝɨ (ɜɿɞɫɬɪɨɱɟɧɨɝɨ) ɩɨɞɚɬɤɨɜɨɝɨ ɡɨɛɨɜ’ɹɡɚɧɧɹ (ɛɨɪɝɭ) _________________.

ɉɟɧɹ, ɧɚɪɚɯɨɜɚɧɚ ɧɚ ɪɨɡɫɬɪɨɱɟɧɿ (ɜɿɞɫɬɪɨɱɟɧɿ) ɫɭɦɢ, ɩɿɞɥɹɝɚɽ ɫɤɚɫɭɜɚɧɧɸ ɡɚ ɩɟɪɿɨɞ ɡ ɞɚɬɢ ɩɨɱɚɬɤɭ ɞɿʀ ɪɨɡɫɬɪɨɱɟɧɧɹ (ɜɿɞɫɬɪɨɱɟɧɧɹ) ɞɨ ɞɚɬɢ ɭɤɥɚɞɟɧɧɹ ɞɨɝɨɜɨɪɭ.

ɋɤɚɫɭɜɚɧɧɹ ɲɬɪɚɮɧɢɯ ɫɚɧɤɰɿɣ ɡɞɿɣɫɧɸɽɬɶɫɹ ɜ ɭɫɬɚɧɨɜɥɟɧɨɦɭ ɩɨɪɹɞɤɭ.

____________________________ __________ ___________________

(ɩɨɫɚɞɚ ɨɫɨɛɢ, ɹɤɚ ɩɪɢɣɧɹɥɚ ɪɿɲɟɧɧɹ) (ɩɿɞɩɢɫ) (ɩɪɿɡɜɢɳɟ, ɿɧɿɰɿɚɥɢ)

Ⱦɨɞɚɬɤɨɜɿ ɭɦɨɜɢ: ɚɤɬɢɜɢ ɩɥɚɬɧɢɤɚ ɡɜɿɥɶɧɹɸɬɶɫɹ ɡ ɩɨɞɚɬɤɨɜɨʀ ɡɚɫɬɚɜɢ ɧɚ ɬɟɪɦɿɧ ɞɿʀ ɪɨɡɫɬɪɨɱɟɧɧɹ (ɜɿɞɫɬɪɨɱɟɧɧɹ).

277

ȾɈȾȺɌɄɂ

Ⱦɨɞɚɬɨɤ Ɇ

ɉɪɢɦɿɪɧɢɣ

Ⱦɨɝɨɜɿɪ ɩɪɨ ɪɨɡɫɬɪɨɱɟɧɧɹ (ɜɿɞɫɬɪɨɱɟɧɧɹ) ɩɨɞɚɬɤɨɜɢɯ ɡɨɛɨɜ’ɹɡɚɧɶ

ɜɿɞ “___” 20____ ɪɨɤɭ Ⱦɟɪɠɚɜɧɚ ɩɨɞɚɬɤɨɜɚ ɿɧɫɩɟɤɰɿɹ (ɞɚɥɿ – Ⱦɉȱ) ɜ ɨɫɨɛɿ _______________

_______________________________________________________________

__________________________________________________________,

ɳɨ ɞɿɽ ɧɚ ɩɿɞɫɬɚɜɿ Ɂɚɤɨɧɭ ɍɤɪɚʀɧɢ “ɉɪɨ ɞɟɪɠɚɜɧɭ ɩɨɞɚɬɤɨɜɭ ɫɥɭɠɛɭ ɜ ɍɤɪɚʀɧɿ” ɬɚ ɫɬɚɬɬɿ 14 Ɂɚɤɨɧɭ ɍɤɪɚʀɧɢ “ɉɪɨ ɩɨɪɹɞɨɤ ɩɨɝɚɲɟɧɧɹ ɡɨɛɨɜ’ɹɡɚɧɶ ɩɥɚɬɧɢɤɿɜ ɩɨɞɚɬɤɿɜ ɩɟɪɟɞ ɛɸɞɠɟɬɚɦɢ ɬɚ ɞɟɪɠɚɜɧɢɦɢ ɰɿɥɶɨɜɢɦɢ ɮɨɧɞɚɦɢ”, ɡ ɨɞɧɨɝɨ ɛɨɤɭ, ɬɚ

(ɧɚɡɜɚ ɩɿɞɩɪɢɽɦɫɬɜɚ ɱɢ ɩɪɿɡɜɢɳɟ, ɿɧɿɰɿɚɥɢ ɩɥɚɬɧɢɤɚ)

(ɞɚɥɿ – ɉɥɚɬɧɢɤ) ɜ ɨɫɨɛɿ _______________________________________,

_______________________________________________________________

__________________________________________________________, ɳɨ ɞɿɽ ɧɚ ɩɿɞɫɬɚɜɿ _____________________________________________,

ɡ ɞɪɭɝɨɝɨ ɛɨɤɭ, ɭɤɥɚɥɢ ɰɟɣ ɞɨɝɨɜɿɪ ɜɿɞɩɨɜɿɞɧɨ ɞɨ ɪɿɲɟɧɧɹ ɜɿɞ

“__” 20 __ɪ. ʋ___ ____________________________________________.

1. ɉɪɟɞɦɟɬ ɬɚ ɭɦɨɜɢ ɞɨɝɨɜɨɪɭ Ⱦɉȱ ɧɚɞɚɽ ɉɥɚɬɧɢɤɭ ɪɨɡɫɬɪɨɱɟɧɧɹ (ɜɿɞɫɬɪɨɱɟɧɧɹ) ɫɩɥɚɬɢ ɩɨɞɚɬɤɨɜɢɯ

ɡɨɛɨɜ’ɹɡɚɧɶ ɧɚ ɡɚɝɚɥɶɧɭ ɫɭɦɭ ___________________________________

(ɫɭɦɚ ɰɢɮɪɚɦɢ ɿ ɥɿɬɟɪɚɦɢ)

ɩɿɞ ɩɪɨɰɟɧɬɢ ɬɟɪɦɿɧɨɦ ɡ _____________ ɞɨ___________.

Ɋɨɡɦɿɪ ɩɪɨɰɟɧɬɿɜ ɧɟ ɦɨɠɟ ɛɭɬɢ ɦɟɧɲɢɦ, ɧɿɠ ɫɬɚɜɤɚ ɇɚɰɿɨɧɚɥɶɧɨɝɨ ɛɚɧɤɭ ɍɤɪɚʀɧɢ, ɹɤɚ ɞɿɽ ɧɚ ɩɟɪɲɢɣ ɞɟɧɶ ɧɚɞɚɧɧɹ ɪɨɡɫɬɪɨɱɟɧɧɹ (ɜɿɞɫɬɪɨɱɟɧɧɹ) ɫɩɥɚɬɢ ɩɨɞɚɬɤɨɜɨɝɨ ɡɨɛɨɜ’ɹɡɚɧɧɹ (ɞɟɧɶ ɫɩɥɚɬɢ ɩɨɩɟɪɟɞɧɶɨʀ ɱɚɫɬɤɢ ɪɨɡɫɬɪɨɱɟɧɨɝɨ (ɜɿɞɫɬɪɨɱɟɧɨɝɨ) ɩɨɞɚɬɤɨɜɨɝɨ ɡɨɛɨɜ’ɹɡɚɧɧɹ) ɚɛɨ ɧɚ ɞɟɧɶ ɣɨɝɨ (ɣɨɝɨ ɱɚɫɬɢɧɢ) ɩɨɝɚɲɟɧɧɹ (ɞɟɧɶ ɩɪɢɣɧɹɬɬɹ ɪɿɲɟɧɧɹ ɩɪɨ ɫɤɚɫɭɜɚɧɧɹ ɪɨɡɫɬɪɨɱɟɧɧɹ (ɜɿɞɫɬɪɨɱɟɧɧɹ), ɡɚɥɟɠɧɨ ɜɿɞ ɬɨɝɨ, ɹɤɚ ɡ ɜɟɥɢɱɢɧ ɬɚɤɢɯ ɫɬɚɜɨɤ ɽ ɛɿɥɶɲɨɸ.

Ɋɨɡɫɬɪɨɱɟɧɿ (ɜɿɞɫɬɪɨɱɟɧɿ) ɫɭɦɢ ɩɨɞɚɬɤɨɜɢɯ ɡɨɛɨɜ’ɹɡɚɧɶ ɫɩɥɚɱɭɸɬɶɫɹ:

2.Ⱦɉȱ ɡɨɛɨɜ’ɹɡɭɽɬɶɫɹ:

2.1.Ɂɪɨɛɢɬɢ ɜɿɞɩɨɜɿɞɧɿ ɡɚɩɢɫɢ ɜ ɤɚɪɬɤɚɯ ɨɫɨɛɨɜɢɯ ɪɚɯɭɧɤɿɜ ɩɥɚɬɧɢɤɚ, ɳɨ ɜɟɞɭɬɶɫɹ ɜ ɨɪɝɚɧɚɯ ɞɟɪɠɚɜɧɨʀ ɩɨɞɚɬɤɨɜɨʀ ɫɥɭɠɛɢ ɫɬɨɫɨɜɧɨ ɪɨɡɫɬɪɨɱɟɧɢɯ (ɜɿɞɫɬɪɨɱɟɧɢɯ) ɫɭɦ ɬɚ ɩɪɨɰɟɧɬɿɜ ɡɚ ɤɨɪɢɫɬɭɜɚɧɧɹ ɪɨɡɫɬɪɨɱɟɧɧɹɦ (ɜɿɞɫɬɪɨɱɟɧɧɹɦ).

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ȺȾɆȱɇȱɋɌɊɍȼȺɇɇə ɉɈȾȺɌɄȱȼ

2.2.Ⱦɨɫɬɪɨɤɨɜɨ ɪɨɡɿɪɜɚɬɢ ɞɨɝɨɜɿɪ, ɧɚ ɩɿɞɫɬɚɜɿ ɪɿɲɟɧɧɹ ɩɪɨ ɫɤɚɫɭɜɚɧɧɹ ɪɨɡɫɬɪɨɱɟɧɧɹ (ɜɿɞɫɬɪɨɱɟɧɧɹ) ɬɚ ɩɪɟɞ’ɹɜɢɬɢ ɞɨ ɫɩɥɚɬɢ ɧɟɜɧɟɫɟɧɭ ɫɭɦɭ ɩɨɞɚɬɤɨɜɨɝɨ ɡɨɛɨɜ’ɹɡɚɧɧɹ, ɚ ɬɚɤɨɠ ɩɪɨɰɟɧɬɿɜ, ɧɚɪɚɯɨɜɚɧɢɯ ɡɚ ɮɚɤɬɢɱɧɢɣ ɬɟɪɦɿɧ ɤɨɪɢɫɬɭɜɚɧɧɹ ɪɨɡɫɬɪɨɱɟɧɧɹɦ (ɜɿɞɫɬɪɨɱɟɧɧɹɦ), ɹɤɳɨ:

ɡ’ɹɫɨɜɚɧɨ, ɳɨ ɿɧɮɨɪɦɚɰɿɹ, ɧɚɞɚɧɚ ɩɥɚɬɧɢɤɨɦ ɩɨɞɚɬɤɿɜ ɩɪɢ ɭɤɥɚɞɟɧɧɿ ɞɨɝɨɜɨɪɭ ɩɪɨ ɪɨɡɫɬɪɨɱɟɧɧɹ (ɜɿɞɫɬɪɨɱɟɧɧɹ), ɜɢɹɜɢɥɚɫɹ ɧɟɞɨɫɬɨɜɿɪɧɨɸ, ɧɟɩɨɜɧɨɸ ɚɛɨ ɩɟɪɟɤɪɭɱɟɧɨɸ; ɩɥɚɬɧɢɤ ɩɨɞɚɬɤɿɜ ɧɚɤɨɩɢɱɭɽ ɧɨɜɢɣ ɩɨɞɚɬɤɨɜɢɣ ɛɨɪɝ, ɬɨɛɬɨ ɧɟ ɫɩɥɚɱɭɽ

ɩɨɬɨɱɧɢɯ ɩɥɚɬɟɠɿɜ ɞɨ ɛɸɞɠɟɬɭ ɩɿɫɥɹ ɭɤɥɚɞɟɧɧɹ ɞɨɝɨɜɨɪɭ ɩɪɨ ɪɨɡɫɬɪɨɱɟɧɧɹ (ɜɿɞɫɬɪɨɱɟɧɧɹ); ɩɥɚɬɧɢɤ ɩɨɞɚɬɤɿɜ ɫɜɨɽɱɚɫɧɨ ɧɟ ɫɩɥɚɱɭɽ ɱɟɪɝɨɜɨʀ ɱɚɫɬɤɢ ɪɨɡɫɬɪɨɱɟɧɨʀ

(ɜɿɞɫɬɪɨɱɟɧɨʀ) ɫɭɦɢ ɬɚ ɧɚɪɚɯɨɜɚɧɿ ɧɚ ɧɟʀ ɩɪɨɰɟɧɬɿɜ.

2.3.ȼɿɞ ɞɧɹ, ɧɚɫɬɭɩɧɨɝɨ ɡɚ ɞɧɟɦ ɪɨɡɿɪɜɚɧɧɹ ɞɨɝɨɜɨɪɭ, ɧɚ ɪɨɡɫɬɪɨɱɟɧɿ (ɜɿɞɫɬɪɨɱɟɧɿ) ɫɭɦɢ, ɳɨ ɡɚɥɢɲɢɥɢɫɶ ɧɟ ɫɩɥɚɱɟɧɢɦɢ, ɧɚɪɚɯɨɜɭɜɚɬɢ ɩɟɧɸ ɬɚ ɲɬɪɚɮɧɿ ɫɚɧɤɰɿʀ ɭ ɪɨɡɦɿɪɚɯ, ɩɟɪɟɞɛɚɱɟɧɢɯ ɱɢɧɧɢɦ ɡɚɤɨɧɨɞɚɜɫɬɜɨɦ.

3.ɉɥɚɬɧɢɤ ɡɨɛɨɜ’ɹɡɭɽɬɶɫɹ:

3.1.Ɂɚɛɟɡɩɟɱɢɬɢ ɫɜɨɽɱɚɫɧɭ ɫɩɥɚɬɭ ɪɨɡɫɬɪɨɱɟɧɨʀ (ɜɿɞɫɬɪɨɱɟɧɨʀ) ɫɭɦɢ ɩɨɞɚɬɤɨɜɨɝɨ ɡɨɛɨɜ’ɹɡɚɧɧɹ.

3.2.Ɋɨɡɪɚɯɨɜɭɜɚɬɢ ɫɭɦɭ ɩɪɨɰɟɧɬɿɜ ɧɚ ɫɩɥɚɱɟɧɟ ɪɨɡɫɬɪɨɱɟɧɟ (ɜɿɞɫɬɪɨɱɟɧɟ) ɩɨɞɚɬɤɨɜɟ ɡɨɛɨɜ’ɹɡɚɧɧɹ (ɣɨɝɨ ɱɚɫɬɤɭ) ɬɚ ɫɩɥɚɱɭɜɚɬɢ ʀʀ ɨɞɧɨɱɚɫɧɨ ɡɿ ɫɩɥɚɬɨɸ ɜɿɞɫɬɪɨɱɟɧɨʀ ɚɛɨ ɱɟɪɝɨɜɨʀ ɱɚɫɬɢɧɢ ɪɨɡɫɬɪɨɱɟɧɨʀ (ɜɿɞɫɬɪɨɱɟɧɨʀ) ɫɭɦɢ.

3.3.ȼɿɞ ɞɧɹ ɞɨɫɬɪɨɤɨɜɨɝɨ ɪɨɡɿɪɜɚɧɧɹ ɞɨɝɨɜɨɪɭ ɩɥɚɬɧɢɤ ɩɨɞɚɬɤɿɜ ɡɨɛɨɜ’ɹɡɚɧɢɣ ɫɩɥɚɬɢɬɢ ɧɟɜɧɟɫɟɧɭ ɫɭɦɭ ɪɨɡɫɬɪɨɱɟɧɨɝɨ (ɜɿɞɫɬɪɨɱɟɧɨɝɨ) ɩɨɞɚɬɤɨɜɨɝɨ ɡɨɛɨɜ’ɹɡɚɧɧɹ ɬɚ ɫɭɦɭ ɩɪɨɰɟɧɬɿɜ, ɧɚɪɚɯɨɜɚɧɢɯ ɡɚ ɮɚɤɬɢɱɧɢɣ ɬɟɪɦɿɧ ɞɿʀ ɪɨɡɫɬɪɨɱɟɧɧɹ (ɜɿɞɫɬɪɨɱɟɧɧɹ).

4. Ⱦɉȱ ɦɚɽ ɩɪɚɜɨ:

4.1.Ɋɨɡɫɬɪɨɱɟɧɿ (ɜɿɞɫɬɪɨɱɟɧɿ) ɫɭɦɢ ɩɨɞɚɬɤɨɜɢɯ ɡɨɛɨɜ’ɹɡɚɧɶ ɬɚ ɫɭɦɢ ɧɚɪɚɯɨɜɚɧɢɯ ɩɪɨɰɟɧɬɿɜ, ɳɨ ɡɚɥɢɲɢɥɢɫɹ ɧɟ ɫɩɥɚɱɟɧɢɦɢ ɧɚ ɞɟɧɶ ɩɪɢɣɧɹɬɬɹ ɪɿɲɟɧɧɹ ɩɪɨ ɫɤɚɫɭɜɚɧɧɹ ɪɨɡɫɬɪɨɱɟɧɧɹ (ɜɿɞɫɬɪɨɱɟɧɧɹ), ɫɬɹɝɭɜɚɬɢ ɬɚ ɩɨɝɚɲɚɬɢ ɭ ɩɨɪɹɞɤɭ, ɭɫɬɚɧɨɜɥɟɧɨɦɭ ɡɚɤɨɧɨɞɚɜɫɬɜɨɦ ɞɥɹ ɫɬɹɝɧɟɧɧɹ ɬɚ ɩɨɝɚɲɟɧɧɹ ɩɨɞɚɬɤɨɜɨɝɨ ɛɨɪɝɭ.

5.ɉɥɚɬɧɢɤ ɦɚɽ ɩɪɚɜɨ:

5.1. Ⱦɨɫɬɪɨɤɨɜɨ ɫɩɥɚɬɢɬɢ ɪɨɡɫɬɪɨɱɟɧɭ (ɜɿɞɫɬɪɨɱɟɧɭ) ɫɭɦɭ ɩɨɞɚɬɤɨɜɨɝɨ ɡɨɛɨɜ’ɹɡɚɧɧɹ ɚɛɨ ʀʀ ɱɚɫɬɢɧɭ ɪɚɡɨɦ ɿɡ ɫɭɦɨɸ ɧɚɪɚɯɨɜɚɧɢɯ ɧɚ ɰɸ ɫɭɦɭ ɩɪɨɰɟɧɬɿɜ.

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ȾɈȾȺɌɄɂ

5.2. Ⱦɨɫɬɪɨɤɨɜɨ ɪɨɡɿɪɜɚɬɢ ɞɨɝɨɜɿɪ, ɩɨɜɧɿɫɬɸ ɫɩɥɚɬɢɜɲɢ ɪɨɡɫɬɪɨɱɟɧɿ (ɜɿɞɫɬɪɨɱɟɧɿ) ɩɨɞɚɬɤɨɜɿ ɡɨɛɨɜ’ɹɡɚɧɧɹ (ɛɨɪɝ) ɬɚ ɩɪɨɰɟɧɬɢ, ɧɚɪɚɯɨɜɚɧɿ ɡɚ ɮɚɤɬɢɱɧɢɣ ɬɟɪɦɿɧ ɤɨɪɢɫɬɭɜɚɧɧɹ ɪɨɡɫɬɪɨɱɟɧɧɹɦ (ɜɿɞɫɬɪɨɱɟɧɧɹɦ).

6.Ⱦɨɞɚɬɤɨɜɿ ɭɦɨɜɢ

6.1.ɋɩɿɪɧɿ ɩɢɬɚɧɧɹ ɡɚ ɰɢɦ ɞɨɝɨɜɨɪɨɦ ɪɨɡɝɥɹɞɚɸɬɶɫɹ ɡɝɿɞɧɨ ɡ ɱɢɧɧɢɦ ɡɚɤɨɧɨɞɚɜɫɬɜɨɦ.

6.2.ɉɥɚɬɧɢɤ ɡɨɛɨɜ’ɹɡɭɽɬɶɫɹ ɭ ɬɪɢɞɟɧɧɢɣ ɬɟɪɦɿɧ ɩɨɜɿɞɨɦɢɬɢ Ⱦɉȱ ɩɪɨ ɡɦɿɧɭ ɦɿɫɰɟɡɧɚɯɨɞɠɟɧɧɹ ɱɢ ɦɿɫɰɹ ɩɪɨɠɢɜɚɧɧɹ, ɧɨɦɟɪɚ ɬɟɥɟɮɨɧɭ.

6.3.Ɍɟɪɦɿɧ ɞɿʀ ɰɶɨɝɨ ɞɨɝɨɜɨɪɭ ɜɫɬɚɧɨɜɥɸɽɬɶɫɹ ɜɿɞ ɞɚɬɢ ɣɨɝɨ ɭɤɥɚɞɟɧɧɹ ɬɚ ɡɚɤɿɧɱɭɽɬɶɫɹ ɨɫɬɚɧɧɶɨɸ ɞɚɬɨɸ ɞɿʀ ɪɨɡɫɬɪɨɱɟɧɧɹ (ɜɿɞɫɬɪɨɱɟɧɧɹ) ɩɨɞɚɬɤɨɜɨɝɨ ɡɨɛɨɜ’ɹɡɚɧɧɹ, ɡɚ ɜɢɧɹɬɤɨɦ ɜɢɩɚɞɤɿɜ ɞɨɫɬɪɨɤɨɜɨɝɨ ɪɨɡɿɪɜɚɧɧɹ ɬɚɤɨɝɨ ɞɨɝɨɜɨɪɭ.

6.4.Ɉɫɨɛɥɢɜɿ ɭɦɨɜɢ:

6.5.ɐɟɣ ɞɨɝɨɜɿɪ ɫɤɥɚɞɟɧɢɣ ɭ ɞɜɨɯ ɩɪɢɦɿɪɧɢɤɚɯ, ɹɤɿ ɦɚɸɬɶ ɨɞɧɚɤɨɜɭ ɸɪɢɞɢɱɧɭ ɫɢɥɭ.

7.Ɇɿɫɰɟɡɧɚɯɨɞɠɟɧɧɹ (ɦɿɫɰɟ ɩɪɨɠɢɜɚɧɧɹ) ɬɚ ɪɟɤɜɿɡɢɬɢ

7.1.Ⱦɉȱ ____________________________________________________

_____________________________________________________________

7.2.ɉɥɚɬɧɢɤɚ _______________________________________________

_____________________________________________________________

ɉɿɞɩɢɫ ɤɟɪɿɜɧɢɤɚ

ɉɿɞɩɢɫ ɜɿɞɩɨɜɿɞɚɥɶɧɨʀ

(ɡɚɫɬɭɩɧɢɤɚ) Ⱦɉȱ

ɨɫɨɛɢ ɩɥɚɬɧɢɤɚ

_____________________________

_____________________________

(ɩɪɿɡɜɢɳɟ, ɿɦ’ɹ, ɩɨ ɛɚɬɶɤɨɜɿ)

(ɩɪɿɡɜɢɳɟ, ɿɦ’ɹ, ɩɨ ɛɚɬɶɤɨɜɿ)

Ɇ.ɉ. “___” ______________ ɪ.

Ɇ.ɉ. “___” ______________ ɪ.

ɉɚɫɩɨɪɬɧɿ ɞɚɧɿ:

ɤɟɪɿɜɧɢɤɚ:____________________________________________________

_____________________________________________________________

ɝɨɥɨɜɧɨɝɨ ɛɭɯɝɚɥɬɟɪɚ: _________________________________________

_____________________________________________________________

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