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ⷿͬס֤ʵ
ŷɹģͬеĴԽԽ࣬Ա·ɹϵĺͬʲôأСⷿͬס֤ʵãӭҷ
ⷿͬס֤ʵ1
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ݡлͬйطɡĹ涨˫ƽȡԸĻϣͷй˴Э£
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ͬȨջطݣҷӦԭ״ݼ丽Ʒ豸ʩ˫ӦԷݺƷ豸ʩˮʹõգӦе.á
ҷģӦǰҪЭһº˫ǩͬ
Ѻ
һ֧ʽÿ£________Ԫ/£Ѻ__________________Ԫͬµĺͬҷ
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άά
һӦ֤ݵĽṹ豸ʩϽΰȷİȫΣȫ˱֤عҡķɷ涨ԼСҵԼ
ڣ˫ӦͬϷݼ丽Ʒ豸ʩúͰȫ״̬
1ڷݼ丽Ʒ豸ʩȻԻʹöµģҷӦʱ֪ͨӦڽӵҷ֪ͨάޡ
2ҷܲʹãʹݼ丽Ʒ豸ʩϵģҷӦάе⳥Ρ
ת
һ˫Լ⣬ҷüͬ⣬תˣת˵ΪеΡ
ͬ
˫Эһ£Խͬ
ɿ±ͬеģͬн
Լ
ͬ˫ǩֺЧͬһʽ_________ݣмִ_________ݣҷִ_________ݡ
ͬЧ˫ԺͬݵıӦȡʽΪͬĸ뱾ͬͬȵķЧ
£_________ҷ£_________
ˣǩ֣_________ˣǩ֣_________
__________________________________
ⷿͬס֤ʵ2
ⷽ_________________
֤룺_________________
ҷⷽ_________________
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־˫˽⡢Э̣һ´¸ⷿЭ飺_________________
һݵ䡢װʩ豸_________________
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ʱ䣺_________________ÿԪҷӦÿ¸һΣȸסһҷӦڼݽͬʱ⸶ڶμԺҷӦǰһ¸塣
ġⷿѺ_________________ҷӦǩԼͬʱѺԪڽ㣬黹
塢ڼԼ_________________
1˫ӦṩʵЧķ֤֤֤
2ṩõķݡʩ豸ҷӦעⰮƻװޡṹʩ豸Ӧ⳥ʹзΪӦɼ
3ˮ硢ú绰硢ߵӵȵʹ÷Ѽҵݡѵзöҷ֧סճ_________________ˮȣȣúȡзҷӦʱ塣
4ֻҷʹãҷ˽ת⡢ıʹʻǷ;±ҷӦǼǡס˿ڵǼǵǷ¼ҷԸڣȷǰջطʱӦ̵ҷͬ⣬ҷʧ.Ӧ⳥
5ͬһǩ˫ǰڣɿصбͬģͬȻֹ˫еΥԼΡ
6˫Լҷ迪߷ⷢƱ˲˰ҷ֧
7˺ͬδˣ˫Э̽뱾ͬͬЧ˫־ףѺЭ̣Э̲ɵģԺö
8ⷿЭ龭ǩ֣£Ч
9Լ_________________
ΥԼΣ_________________
˫һΥԼģΥԼӦԼ֧ΥԼΥԼΪԪʧΥԼʱ⳥
ߡͬһʽݣִһݣͬȷЧ
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ϵ绰_________________ϵ绰_________________
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ⷿͬס֤ʵ3
ⷽ________________¼Ƽ
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ס˫ͷˣЭ飺
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ҷڼ䣬ˮѡѡȡůѡȼѡ绰ѡҵԼҷסķҷʱҷ뽻Ƿѡ
ġҷͬԤ____________ԪΪ֤𣬺ֹͬʱ֡
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ø÷ijطѡãҷе
ߡڳڼ䣬δͬ⣬ҷȨתת÷ݣøı䷿ݽṹ;ҷΪԭɸ÷ݼʩģҷе⳥Ρ
ˡ֤÷ȨףҷӪҪҪṩݲȨ֤й֤ϵģӦЭ
šͱͬף˫Э̽Э̲ɣκһȨԺϣ˾
ʮͬһʽݣס˫ִһݣ˫ǩ֮Ч
£_________ҷ£_________
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__________________________________
ⷿͬס֤ʵ4
ⷽ________________¼Ƽ
ⷽ________________¼ҷ
ס˫ͷˣЭ飺
һλ__________________________ֵ___________С_______¥_______ŵķݳҷסʹã________________________________________ա
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ҷڼ䣬ˮѡѡȡůѡȼѡ绰ѡҵԼҷסķҷʱҷ뽻Ƿѡ
ġҷͬԤ____________ԪΪ֤𣬺ֹͬʱ֡
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ø÷ijطѡãҷе
ߡڳڼ䣬δͬ⣬ҷȨתת÷ݣøı䷿ݽṹ;ҷΪԭɸ÷ݼʩģҷе⳥Ρ
ˡ֤÷ȨףҷӪҪҪṩݲȨ֤й֤ϵģӦЭ
šͱͬף˫Э̽Э̲ɣκһȨԺϣ˾
ʮͬһʽݣס˫ִһݣ˫ǩ֮Ч
£_________ҷ£_________
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ⷿͬס֤ʵ5
ⷽ__________________
ⷽҷ__________________
ݡлͬ______зĹ涨ס˫ƽȡԸƽͳʵõĻϣЭһ£ҷķزˣͬ
1ڱͬͬҷת⣬ҷڣüͬ⣬ɽ÷ݲֻȫתˡͬһסݣ÷ָת⡣
2ҷת÷ݣӦ涨ⷽתͬ涨÷طزĻũϵͳǼDZ
3ڣҷ÷תø˳˳ķݽнüͬ⡣תû÷ݳȨ˻Ӧǩͬбͬ
4ڣ۸÷ݣӦǰ֪ͨҷҷͬȹȨ
5ͬ
ס˫ͬڣ֮һģֹͬ˫еΣ
һ÷ռ÷ΧڵʹȨǰջصġ
÷ṫ汻õģ
÷нҪ뷿ݲǨɷΧģ
ģ÷ݻʧ߱ΪΣշݵģ
壩Ѹ֪ҷ÷ݳǰ趨Ѻֱֵġ
6ס˫ͬ⣬֮һģһ֪ͨ
һͬΥͬһӦһ________֧ΥԼ𣻸˫ʧģ֧ΥԼָһʧ`Ӧ⳥ɵʧΥԼIJ֣
һδʱ÷ݣҷ߸δģ
ĸ÷ݲϱͬԼʹʵĿĵģķݴȱݡΣҷȫġ
ҷδüͬı䷿;ʹģ
ģҷԭɷṹģ
壩ҷת÷ݡתø÷ݳȨ˽Գķݵģ
ҷڲ֧ۼƳµģ
ߣ________________________________________________
7ΥԼ
һ÷ݽʱȱݵģӦԽ֮______ڽڲģͬй
δڸúͬи֪ҷ÷ݳǰѵѺȨתܵƣҷʧģӦ⳥
ڼ䣬ʱбͬԼάޡΣʹҷƲʧ˺ģӦе⳥Ρ
ģڼ䣬DZͬ涨Խⷿͬǰջظ÷ݵģӦǰջ________ҷ֧ΥԼ֧ΥԼָҷʧģӦ⳥
壩ҷδüͬ߳ͬķΧҪװݻ踽ʩģҪҷ_________ָԭ״/⳥ʧ
ڼ䣬DZͬ涨ҷ;ģҷӦǰ________֧ΥԼΥԼָʧģҷӦ⳥ɴޱ֤еֿֿ֤ۡ۵ģ㲿ҷ֧
8
һڼ䣬Ѻ÷ݣӦ֪ҷҷŵ÷ݵѺЭۼۡʽָ÷ǰ________ѯҷ÷ݵ
ͬ˫ǩ/ǩֺ________ЧЧ15ڣɼ𰴹涨ڵطزĻũϵͳǼDZȡǼDZ֤ͬǼDZֹͬģ________/ҷڱֹ֮ͬ______ڣԭǼǻֹǼDZδǼDZֹǼDZģķɾףɼеһΡ
ͬδˣס˫Эһ£ɶͬΪͬɷָһ֣ͬ䲹ڿոдǦӡ־ͬ
ģס˫ǩ𱾺ͬʱԸԵȨףԸͬ涨ϸִСһΥͬһȨⷿͬ涨⡣
壩ס˫бͬз飬ӦͨЭ̽Э̽ɵģ˫ͬѡе________ַʽ
ύ________ٲίԱٲã
ߣԺߡ
9ͬͬһʽ______ݡУס˫һݣ______/______/أزһݣԼ______һݣͬЧ
________________֤ţ________________ڣ_____________
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