‫اﻟﺠﻤﮭﻮرﯾﺔ اﻟﺠﺰاﺋﺮﯾﺔ اﻟﺪﯾﻤﻘﺮاطﯿﺔ اﻟﺸﻌﺒﯿﺔ‬

‫ا وﻻد ﺑﺮاھﯿﻢ ﻓﻲ ‪:‬‬

‫وﻻﯾﺔ ﺳﻌﯿﺪة‬

‫داﺋﺮة اوﻻد ﺑﺮاھﯿﻢ‬

‫ﺑﻠﺪﯾﺔ اوﻻد ﺑﺮاھﯿﻢ‬

‫ﺷﮭﺎدة ﻋﺎﻣﻞ ﯾﻮﻣﻲ‬

‫اﻧﺎ اﻟﻤﻤﻀﻲ اﺳﻔﻠﮫ اﻟﺴﯿﺪ اﻟﺸﺎھﺪ اﻻول‪..............................................:‬‬

‫اﻟﻤﻮﻟﻮد ﺑﺘﺎرﯾﺦ ‪.......................................... :‬ب‪.........................................:‬‬

‫اﻟﺤﺎﻣﻞ)ب ت و(رﻗﻢ‪........................................:‬‬

‫اﻟﺼﺎدرة ﺑﺘﺎرﯾﺦ‪ .................................. :‬ﻋﻦ داﺋﺮة‪.................................:‬وﻻﯾﺔ‪....................:‬‬

‫اﻧﺎ اﻟﻤﻤﻀﻲ اﺳﻔﻠﮫ اﻟﺴﯿﺪ اﻟﺸﺎھﺪ اﻟﺜﺎﻧﻲ‪..............................................:‬‬

‫اﻟﻤﻮﻟﻮد ﺑﺘﺎرﯾﺦ ‪........................... :‬ب‪............................:‬‬

‫اﻟﺤﺎﻣﻞ)ب ت و(رﻗﻢ‪.................................:‬‬

‫اﻟﺼﺎدرة ﺑﺘﺎرﯾﺦ‪ ................................. :‬ﻋﻦ داﺋﺮة‪..............................:‬وﻻﯾﺔ‪.................:‬‬

‫ﻧﺸﮭﺪ ان ‪:‬‬

‫اﻟﺴﯿﺪ‪ :‬ﻣﺤﻤﺪ وﯾﺲ‬

‫ب‪ :‬اوﻻد ﺑﺮاھﯿﻢ‪ -‬وﻻﯾﺔ ﺳﻌﯿﺪة‪24/07/1992‬اﻟﻤﻮﻟﻮد ﺑﺘﺎرﯾﺦ‪:‬‬

‫اﺑﻦ ‪ :‬ﺑﻮﻣﺪﯾﻦ وﯾﺲ و ﺣﻠﯿﻤﺔ وﯾﺲ‬

‫ﺑﺒﻠﺪﯾﺔ اوﻻد ﺑﺮاھﯿﻢ‪ 12/09/2017.‬اﻟﺼﺎدرة ﺑﺘﺎرﯾﺦ ‪201810674‬اﻟﺤﺎﻣﻞ ﻟﺒﻄﺎﻗﺔ اﻟﺘﻌﺮﯾﻒ اﻟﻮطﻨﯿﺔ رﻗﻢ‬

‫ﯾﺸﻐﻞ ﻛﻌﺎﻣﻞ ﯾﻮﻣﻲ وﻟﯿﺲ ﻟﮫ اي ﺳﺠﻞ ﺗﺠﺎري ﺑﺎﺳﻤﮫ وﻻ وظﯿﻔﺔ‪.‬‬

‫ﻣﺼﺎدﻗﺔ اﻟﺒﻠﺪﯾﺔ‬ ‫اﻟﻤﻌﻨﻲ ﺑﺎﻻﻣﺮ‬