تصريح بفقدان رخصة السياقة Word

تصـريــح بالضياع

أنا الموقع أسفله

السيد: ….. المزداد بتاريخ: …… الحامل لبطاقة التعريف الوطنية رقم: …… والساكن بـ: …………

أصرح تصريحا تاما وأنا في كامل قواي العقلية والجسدية وألتزم بأنه قد ضاعت مني رخصة السياقة الخاصة بي في ظروف غامضة من صنف: (B) والتي تحمل رقم: ……/.. المسلمة بتاريخ: ……..

وبهذا أصرح وألتزم وعليه أمضي.

تحميل Word

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