е豸ͬ
ֽܶάȨʶڲǿͬеĴԽԽ࣬ͬǶ˫ıһԼͬвͬͣȻҲвͬĿģСྫĻе豸ͬϣܹҡ
е豸ͬ ƪ1
ⷽ______________
ⷽ______________
˫ƽȻԭ˫Э̣ͳ豸ǩЭ顣
һ豸ſ_________________
豸ʹõص㼰Ŀ__________________________豸ڹ̡
豸ȨʹȨ
1ҷӵж豸Ȩ
2ڱͬ涨ķΧӵи豸ʹȨ
ġҷ豸䱸ˡ
塢ļ㣺
1豸ʱ____________________________________ֹɸݹ̽ǰֹͬǰ_____֪ͨҷ豸ýҷ˳ʹãӦڱͬǰ________ǩЭ顣ǰʹϣӦڹ깤ʽ֪ͨҷҷǩȷϣڰ涨˳
е豸Ѽ㷽ʽ
ʵʹ̨Ϊ_____________Ԫ/գʱ䰴չҹ涨Ϊ______Сʱ_____е
ƣ˫ÿ°_____________Ԫ/£ÿ°_____________Ԫ/£ÿ²Ӱá_______е
취ݻеԱеԱ·ҷʵʳÿµˣɼ˫ڵǩȷϣÿ´ҵ֧֧̿ҷһãս塣
ҷʱṩϼƶȣȫķƱ
ߡ豸ʹáάޡͷã
1豸ڼõĸάޱ͡ʵһзҷ
2豸ڼɼʹãҷӦճάޡʹ豸״̬
3ʩС豸ִĹϣҷӦάų豸Ӱʩģ۳ҷӦѡ
4»еѣе֤ҷʱ䲻_____£____µļеҷ˷ѣʱ______µ˷ҷе
ˡҷκ
1Ϊṩõ豸豸Ագ緢Դ˲κΡ
2豸ʩֳҷӦӼʩֳԱĵָӣؼʩֳĹƶȣȨˡ
3ҷӦ豸̲ȫʩ
4ҷӦÿϸдλɷ豸ֳʩǩϿɡ
5ҷԱֵƻģӦðƻĽ_____зϴصģ˾
6ҷʩûаԱ涨Υ»ʩɵľʧҷе
7ҷʹжԼԱƲģҷӦ⳥ɵ`һʧ
šκ
1ǿҷΥ»ҵ
2ҷΥͬԼӦ֧ΥԼ_____________ԪΥԼֲʧӦ⳥ʧͬΥԼ⳥Ȩֱӿ۳
ʮΥԼΣ
ס˫ϸбͬĸκһ;ͬҷǰֹͬǰ_______֪ͨҷΥԼÿе________ԪΥԼ
ʮһĽйرͬһ飬ס˫Ӧݡл䡷طɵйѺЭ̽Э̲ɣύ____________ٲίԱ⡣
ʮͬδˣ˫кͬڼЭ̽ͬһʽķݣ˫ִݣ˫ǩֲºЧ
ʮȨݹʱ豸ˡ
ʮġȫʩ
1ҷ밴йطɡļ涨аȫʩǼɵ¹κ˷ķҷе
2ҷȫռҪʩɴľҷȫе
ⷽ___________
ϵʽ___________
ⷽ___________
ϵʽ___________
ǩص㣺___________
ǩڣ______________
е豸ͬ ƪ2
ⷽ__¼Ƽ
ⷽ__¼ҷ
ݡͬйع涨ƽȻԭΪȷͬ˫ȨЭһ£ǩͬ
һе豸ſ
ڶе豸ʹõص㼰Ŀе豸ڣڹ̡
е豸ȨȨҷӦӵге豸ȨгȨе豸ȨȨɼʧģҷе⳥Ρ
е豸Լ
1е豸:ҷΪĻе豸䱸ԱһԱݼָӰɹԱĹҷ֧ùڼ֧ҷС
2е豸:豸ṩҷҷ豣֤е豸䡢ȫڼҪʹʱڣӦȷе豸ȫС
㷽ʽ
1____________________________________[رԼΪ깤]ֹֹͬ
2ڣе豸ҷ˳ʹãӦڱͬǰǩͬ
3ѵļ취豸Ľʩ֧ҷѣΪ__Ԫ/__
4ҷԱҷÿ˶ԵɵĽʩ˫ǩȷϡ
5ÿ½һΣǰ֧
е豸άޡͷã
1е豸ɼʹãҷӦճάޱ豸ųάʹе豸״̬еɴ˲ķá
2е豸Ľá˳ááʧķҷ
3еڼĸҷ
¹Ĵ
1е豸ɲԱƲʧģҷе⳥Σ
2е豸ԱʧƲʧɲĹָӷе⳥Σ
3е豸¹ʣеεġ
ڰ
1ԭɻе豸ʧģɼ⳥ηΧΪ
2ǿҷԱΥ»ҵ
3볡`ҷе豸ȷϡԻе豸볡ȷϲӰҷԳе豸ʹúͰȫı֤Ρ
4Ӧʱ֧ܰʱ֧ģԳ֧Ϊÿ֮ıҷ֧ΥԼ
ھҷ
1ΪṩõĻе豸ṩĻе豸ܴﵽʹҪģҷӦԸ
2豸ʩֳҷԱӦӼʩֳԱĵָӣؼʩֳĹƶȡ
3ҷԱӦе豸̲
4ڼ䣬ҷе豸Ȩתø˵ģӦʽ֪ͨе豸Ȩ˼ȻΪͬijⷽ
ʮΥԼΣ
1ס˫ϸбͬĸһɻͬԼʹȨ⣬δԷͬ⣬κһ;ͬ
2ڼ䣬δҷͬ⣬е豸ӺͲе豸תѺɴɵʧɼе⳥Ρ
ʮһɿ
1κһڲɿԭкͬʱӦʮСʱ֪ͨԷȡй֤ԺɲֻȫеΥԼΡ
ʮĽ
1йرͬһ飬ס˫ӦѺЭ̽Э̲ɣ豸ʹõԺߡ
ʮͬЧ
1ͬ˫ǩҸºЧͬһʽݣ˫ִݡδˣ˫Э̽
ⵥλ
ⵥλҷ
ڣ__________________
е豸ͬ ƪ3
ⷽ___¼Ƽ__________________
ⷽ__¼ҷ__________________
ݡͬйع涨ƽȻԭΪȷס˫Ȩ˫Эһ£ǩͬ
һе豸
1е豸ƣ__________________
2е豸ͺţ__________________
3е豸__________________
4е豸;__________________
ڶ豸ʹõص㼰Ŀ
ҷûе豸豸____________________________________̡
豸ȨʹȨ
1ӵ豸Ȩ
2ҷڱͬ涨.Χӵи豸ʹȨ
1ҷûе豸________________£________________________________Ʋҷʹã________________________ջء
2ҷ豸ý˳ҷʹãӦڱͬǰǩͬ
㷽ʽ
ݹҹ涨________Ʋͳһ涨ģ˫̶ҷÿӦ________ԪʱΪÿµĩһգ˫̶ʱһλν
ո֪ȷ֧ʽѺĽ֧ʽȷԼײϾס֧ѺʱӦںͬԼ֧ʽת˷ʽȷʱг֧ݡֽ֧ķʽӦעⱣܺЧտƾ֤ھʱЧԼĺϷȨ档
豸䡢ʹáάޡͷ
1豸Ľҷ˳ɼҷӦ豸˳ǰ֪ͨ豸ʵһ½˳ȫҷе
2豸ڼĸҷ
3豸ڼҷʹãҷӦЭ豸ճάޡʹ豸״̬ά______Ԫµҷά______ԪϵɼԼǩΪɼIJִӼȡ豸п۳ҶƬȷҷе
4ڹУҷܶ豸ϽųӦʱ֪ͨάޣ豸ÿͣϵIJҷӦ۳Ӧ8Сʱѡ
5еİװܡʹһзã˰ҷе
ҷ
ڣ
ڣ
е豸ͬ ƪ4
_____(ⷽ)
ҷ______(ⷽ)
ס˫ݡлͬйع涨ƽȻԭ˫Э̣ͼҷе豸ǩͬ
һ̸ſ
1ĿƣӪˮ˫ٹ·ͬΡ
2̵ص㣺ʡ±硣
3аʽԹ̶۰
豸
Э鵥Ϊ̶ۣκԭԺõаҷĻеѡ˰Эʾʾһзռá
20_227̲ҪΪֹҷܰЭʱʵʽѡ
ġ˫
(һ)
1䱸ר˶Ļейȡ
2ṩҷʻԱʳޡ
3ƶйصģҷִС
4šЭҷеҵ
5֧ҷ豸õ
6еɼ
()ҷ
1ӼĹϸִмĹƶȡ
2е豸ճеѡͼϷѡ
3˾ճʻԱĹʡ𡢼õ'֧
4ҷʻԱҽƣ˱շѡ
5Ϊ֤ʹûеҷе䱸˫˾֤浽ʩҪ
6Ϊ֤ʩеҵȫҷʻԱ֤ϸڣ̽леҵΥ²ҷеҵзȫ¹ʣҷеȫȫ¹κͷãеκκͷá
7еĽDzҷԸ
8ΪάطȶͰȫҷļʻԱȾƣIJܶŹҷԱؼΥҼ͵¹ʱҷȫееκΡ
9Ϊά棬ҷʻԱڼʻе˽ϣԱһΣȨͬǰѲ֧
塢㼰֧ʽ
㷽ʽÿ20սе½㣬ÿ»е3άʱ䣬άʱ䳬3죬ݱЭ鵥۰ʵʹ㡣֧ʽÿ½֧ҷѵ70%ʣ30%֧ҷ֧ʱҷ밴չ˰ƲṩĹʽƱɼ۴˰ѡ
ΥԼ
ЭΪ˫ͬЭǩ˫빲ͬأκһĻδüͬ£ҷкͬͬҷΪΥԼȨ㣬Ҫ⳥ɵľʧ
ߡ
1ҷĻеҷ֪˫ͬЭ̽
2ҷԸӮҷƳֿʱŲ
3֧ʱЭǩ˻ȨίдˣԱһɲð
ˡЭЧ
Э鹲һʽݣݡҷһݣЭǩ֮ЧѺʧЧ
()_________
ҷ()_________
(ǩ)________
_(ǩ)_________
_________________
_________________
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