Page 1

‫ﻣﺤﻞ‬

‫ﺳﻔﺎﺭﺕ ﺟﻤﻬﻮﺭﻱ ﺍﺳﻼﻣﻲ ﺍﻳﺮﺍﻥ – ﻛﻮﺍﻻﻻﻣﭙﻮﺭ‬

‫ﺷﻤﺎﺭﻩ ‪:‬‬

‫ﺍﻟﺼﺎﻕ‬

‫ﭘﺮﺳﺸﻨﺎﻣﻪ ﺻﺪﻭﺭ ﻣﻬﺮ ﺧﺮﻭﺝ ﻣﻜﺮﺭ‬

‫ﺗﺎﺭﻳﺦ ‪:‬‬

‫ﻋﻜﺲ‬

‫ﻣﺨﺼﻮﺹ ﻣﻘﻴﻤﻴﻦ ﺧﺎﺭﺝ ﺍﺯ ﻛﺸﻮﺭ‬

‫ﻧﺎﻡ ﺧﺎﻧﻮﺍﺩﮔﻲ‪:‬‬

‫ﻧﺎﻡ ‪:‬‬ ‫ﺷﻤﺎﺭﻩ ﻭ ﻣﺤﻞ ﺻﺪﻭﺭ ﺷﻨﺎﺳﻨﺎﻣﻪ‪:‬‬ ‫ﻣﺮﺯ ﻭ ﺗﺎﺭﻳﺦ ﺁﺧﺮﻳﻦ ﺧﺮﻭﺝ ‪:‬‬

‫ﻧﺎﻡ ﺧﺎﻧﻮﺍﺩﮔﻲ ﻗﺒﻠﻲ‪:‬‬

‫ﺗﺎﺭﻳﺦ ﻭ ﻣﺤﻞ ﺗﻮﻟﺪ ‪:‬‬ ‫ﻭﺿﻌﻴﺖ ﻧﻈﺎﻡ ﻭﻇﻴﻔﻪ‪:‬‬

‫ﻧﺎﻡ ﭘﺪﺭ‪:‬‬

‫ﻋﻼﻳﻢ ﻇﺎﻫﺮﻱ)ﺭﻧﮓ ﻣﻮ ﻭ ﭼﺸﻢ(‬

‫ﺷﻐﻞ ﻗﺒﻠﻲ ﺩﺭ ﺍﻳﺮﺍﻥ‪:‬‬

‫ﻣﻴﺰﺍﻥ ﺗﺤﺼﻴﻼﺕ‪:‬‬

‫ﺷﻔﻞ ﻓﻌﻠﻲ ﻭ ﻧﺎﻡ ﺻﺎﺣﺐ ﻛﺎﺭ ‪:‬‬

‫ﻣﻴﺰﺍﻥ ﺩﺭﺁﻣﺪ ‪:‬‬

‫ﻣﺸﺨﺼﺎﺕ ﮔﺬﺭﻧﺎﻣﻪ ﻭ ﻛﺎﺭﺕ ﺍﻗﺎﻣﺖ ﺭﺍ ﺩﺭ ﺟﺪﻭﻝ ﺯﻳﺮ ﺑﻨﻮﻳﺴﻴﺪ‪.‬‬ ‫ﺷﻤﺎﺭﻩ ﮔﺬﺭﻧﺎﻣﻪ ‪:‬‬

‫ﻧﻮﻉ ﮔﺬﺭﻧﺎﻣﻪ ‪:‬‬

‫ﺗﺎﺭﻳﺦ ﺻﺪﻭﺭ ‪:‬‬

‫ﻣﺤﻞ ﺻﺪﻭﺭ ‪:‬‬

‫ﻣﺪﺕ ﺍﻋﺘﺒﺎﺭ‬

‫ﺷﻤﺎﺭﻩ ﻭ ﻧﻮﻉ ﻛﺎﺭﺕ ﺍﻗﺎﻣﺖ‬

‫ﺩﺭﺻﻮﺭﺕ ﺍﺷﺘﻐﺎﻝ ﺑﻪ ﺗﺤﺼﻴﻞ ‪ ،‬ﻧﺎﻡ ﺩﺍﻧﺸﮕﺎﻩ ‪ ،‬ﺭﺷﺘﻪ ﺗﺤﺼﻴﻠﻲ ‪ ،‬ﻣﻘﻄﻊ ﺗﺤﺼﻴﻠﻲ ﺧﻮﺩ ﺭﺍ ﺑﻨﻮﻳﺴﻴﺪ ‪:‬‬ ‫ﻋﻠﺖ ﺧﺮﻭﺝ ﺍﺯ ﻛﺸﻮﺭ ﺭﺍ ﺑﻨﻮﻳﺴﻴﺪ‪:‬‬ ‫ﻧﺤﻮ ﺍﺧﺬ ﺍﻗﺎﻣﺖ ﺧﻮﺩ ﺭﺍ ﺑﻨﻮﻳﺴﻴﺪ ‪:‬‬ ‫ﻭﺿﻌﻴﺖ ﺗﺎﻫﻞ‪ :‬ﻣﺠﺮﺩ‬ ‫ﺭﺩﻳﻒ‬

‫ﻧﺎﻡ‬

‫ﻣﺘﺎﻫﻞ‬ ‫ﻧﺎﻡ ﺧﺎﻧﻮﺍﺩﮔﻲ‬

‫)ﺩﺭ ﺻﻮﺭﺕ ﺗﺎﻫﻞ ﻣﺸﺨﺼﺎﺕ ﻫﻤﺴﺮ ﻭ ﻓﺮﺯﻧﺪﺍﻥ ﺧﻮﺩ ﺭﺍ ﺑﻨﻮﻳﺴﻴﺪ(‬ ‫ﻧﺎﻡ ﭘﺪﺭ‬

‫ﺷﻤﺎﺭﻩ ﻭ ﻣﺤﻞ ﺷﻨﺎﺳﻨﺎﻣﻪ‬

‫ﺗﺎﺭﻳﺦ ﺗﻮﻟﺪ‬

‫ﻧﺸﺎﻧﻲ ﻭ ﺷﻤﺎﺭﻩ ﺗﻠﻔﻦ ﺩﻗﻴﻖ ﻣﻨﺰﻝ ﻭ ﻣﺤﻞ ﻛﺎﺭ ﺧﻮﺩ ﺭﺍ ﺩﺭ ﺧﺎﺭﺝ ﺍﺯ ﻛﺸﻮﺭ ﺑﻨﻮﻳﺴﻴﺪ‪:‬‬

‫ﻣﻨﺰﻝ‪:‬‬

‫ﻣﺤﻞ ﻛﺎﺭ‪:‬‬

‫ﻣﺤﻞ ﺍﻗﺎﻣﺖ‬

‫ﺗﻠﻔﻦ‪:‬‬ ‫ﺗﻠﻔﻦ‪:‬‬

‫ﻧﺸﺎﻧﻲ ﻭ ﺷﻤﺎﺭﻩ ﺗﻠﻔﻦ ﺩﻗﻴﻖ ﻣﻨﺰﻝ ﻭ ﻣﺤﻞ ﻛﺎﺭ ﺧﻮﺩ ﺭﺍ ﺩﺭ ﺍﻳﺮﺍﻥ ﺑﻨﻮﻳﺴﻴﺪ‪:‬‬ ‫ﻣﻨﺰﻝ ‪:‬‬

‫ﺗﻠﻔﻦ‪:‬‬

‫ﻣﺤﻞ ﻛﺎﺭ‪:‬‬

‫ﺗﻠﻔﻦ‪:‬‬ ‫ﺗﺎﺭﻳﺦ ﻭ ﺍﻣﻀﺎﺀ ﻣﺘﻘﺎﺿﻲ‬

‫ﻣﻬﺮ ﻭ ﺍﻣﻀﺎﺀ ﻧﻤﺎﻳﻨﺪﮔﻲ‬

‫ﺷﻐﻞ‬

/khorooj  

http://www.iran2malaysia.com/Portals/0/Images/Pages/Embassy%20Application%20Forms-25-03-2010/khorooje_mokarar.pdf

Read more
Read more
Similar to
Popular now
Just for you