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øåøéá úëéøòì äù÷á
íéî úëéøö ãòá áåéç ìù
äìîø íéî ãéâàú
äðåôä éèøô
øçà
úéáä ãòå
ñëðá ÷éæçîä
:ñëðì ä÷éæ
ñëðä ìòá
____________________________ úåäæ øôñî ______________________________ äçôùî íù ______________________________ éèøô íù
_________________________ ãå÷éî __________________________________ øôñî_________________________________________ áåçø :úáåúë
_______________________ éðåøè÷ìà øàåã _______________________ ñ÷ô _______________________ ãééð _______________________ ïåôìè
:ñëðä éèøô
______________________________________ äøéã __________________________ øôñî ________________________________________________ áåçø
______________________ çå÷ì ïåáùç øôñî _______________________ ñëðá ÷éæçîä íù _______________________ íéî ãî øôñî
äðåðøàä / íéîä ïåáùçá íéòéôåîù éôë íéðåúðä úà ïééöì ùé *
:äù÷áä éèøô
úëéøö ãòá áåéç ìù øåøéá êåøòì ù÷áî __________________ úåäæ øôñî ______________________, äèî íåúçä éðà
äéáâìù äôå÷úä úà ïééöì ùé) ___________________ íéùãåçá (øúåéîä úà ÷çî) úôúåùîä íéîä úëéøö / éúøéãá íéîä
.(øåøéáä ù÷åáî
:úåôñåð úåáéñð
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ììåë úéèøô úùøá ïéòì úéàøð äìéæð úîéé÷ àì éë úéèøôä úùøá äìéæð úîéé÷ íà éú÷ãáù øçàì ,äæá øéäöî éðà
,íéæøáä ìë úà éúøâñù øçàì) úéèøôä íéîä úëøòîá íéîä úëéøö ìë ä÷ñôåäù øçàì éëå ,úåìñàáå íéæøáá
.ááåúñî àì íéîä ãî åðééäã ,ñëðá äëéøö ïéàù äàøî íéîä ãî ,(äîåãëå äñéáëä úðåëî
__________________ êéøàú __________________
ù÷áîä úîéúç
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