Demande Adhesion

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‫ﻧﻤﻮذج رﻗﻢ ‪1‬‬

‫اﻟﻤﻤﻠﻜﺔ اﻟﻤﻐﺮﺑﻴﺔ‬

‫ﻃﻠﺐ اﻻﻧﺨﺮاط ﻓﻲ اﻟﻤﺆﺳﺴﺔ‬ ‫أﻧﺎ اﻟﻤﻮﻗﻊ أﺳﻔﻠﻪ‬ ‫اﻟﺴﻴﺪ)ة(‬ ‫رﻗﻢ اﻟﺘﺄﺟﻴﺮ‪:‬‬

‫‪C.I.N :‬‬

‫ب‪.‬ت‪.‬و‪:‬‬

‫اﻟﻌﻨﻮان‪:‬‬ ‫اﻟﻬﺎﺗﻒ اﻟﻨﻘﺎل ‪:‬‬

‫اﻟﻬﺎﺗﻒ اﻟﺜﺎﺑﺖ ‪:‬‬

‫ﻣﻌﻠﻮﻣﺎت إﺿﺎﻓﻴﺔ ﺧﺎﺻﺔ ﺑﺎﻟﻤﺘﻘﺎﻋﺪﻳﻦ‬ ‫رﻗﻢ اﻟﻤﻌﺎش‪:‬‬ ‫ﻧﻮع اﻟﻤﻌﺎش‪:‬‬

‫ﺗﺎرﻳﺦ اﻹﺣﺎﻟﺔ ﻋﻠﻰ اﻟﻤﻌﺎش‪:‬‬ ‫ﺑﺮﺳﻢ ﺣﺪ اﻟﺴﻦ‬

‫ﺑﻄﻠﺐ ﻣﻨﻪ‬

‫ﺗﻘﺎﻋﺪ ﺣﺘﻤﻲ‬

‫ﻣﻐﺎدرة ﻃﻮﻋﻴﺔ‬

‫ﻣﻌﻠﻮﻣﺎت إﺿﺎﻓﻴﺔ ﺧﺎﺻﺔ ﺑﺎﻟﻤﻠﺤﻘﻴﻦ‬ ‫اﻹدارة اﻟﻤﻠﺤﻖ ﺑﻬﺎ‪:‬‬ ‫ﻣﺼﺪر اﻟﺘﺄﺟﻴﺮ‬

‫اﻟﻤﻜﺘﺐ اﻟﺮﺋﻴﺴﻲ ﻷداء اﻷﺟﻮر‪:‬‬

‫ﻣﻴﺰاﻧﻴﺔ ﺧﺎﺻﺔ‪:‬‬

‫‪PPR‬‬

‫ﻣﻌﻠﻮﻣﺎت إﺿﺎﻓﻴﺔ ﺧﺎﺻﺔ ﺑﺬوي ﺣﻘﻮق اﻟﻤﻨﺨﺮط اﻟﻤﺘﻮﻓﻲ‬ ‫ﻣﻜﺎن اﻟﻮﻓﺎة ‪:‬‬

‫ﺗﺎرﻳﺦ وﻓﺎة اﻟﻤﻨﺨﺮط‪:‬‬ ‫اﻹﺳﻢ‪:‬‬

‫رﻗﻢ اﻟﻤﻌﺎش‪:‬‬

‫اﻷﻳﻢ أو اﻷراﻣﻞ‪:‬‬

‫اﻷﻃﻔﺎل ﺗﺤﺖ اﻟﻜﻔﺎﻟﺔ‪:‬‬

‫اﻟﺸﺨﺺ اﻟﻤﻘﺪم ﻋﻠﻰ اﻷﻃﻔﺎل‪:‬‬

‫اﻹﺳﻢ‪:‬‬

‫رﻗﻢ اﻟﻤﻌﺎش‪:‬‬

‫اﻹﺳﻢ‪:‬‬

‫رﻗﻢ اﻟﻤﻌﺎش‪:‬‬

‫اﻹﺳﻢ‪:‬‬

‫رﻗﻢ اﻟﻤﻌﺎش‪:‬‬

‫اﻹﺳﻢ‪:‬‬

‫رﻗﻢ اﻟﻤﻌﺎش‪:‬‬

‫اﻹﺳﻢ‬

‫ب‪.‬ت‪.‬و‬

‫أرﻏﺐ ﻓﻲ اﻻﻧﺨﺮاط أو اﻻﺳﺘﻤﺮار ﻓﻲ اﻻﻧﺨﺮاط )‪ (1‬ﻓﻲ ﻣﺆﺳﺴﺔ ﻣﺤﻤﺪ اﻟﺴﺎدس ﻟﻠﻨﻬﻮض ﺑﺎﻷﻋﻤﺎل اﻻﺟﺘﻤﺎﻋﻴﺔ‬ ‫ﻟﻠﺘﺮﺑﻴﺔ واﻟﺘﻜﻮﻳﻦ‪ ،‬ﻃﺒﻘﺎ ﻷﺣﻜﺎم اﻟﻘﺎﻧﻮن رﻗﻢ ‪ 73.00‬اﻟﻤﺤﺪث واﻟﻤﻨﻈﻢ ﻟﻬﺎ‪ ،‬اﻟﺼﺎدر ﺑﺘﻨﻔﻴﺬﻩ اﻟﻈﻬﻴﺮ اﻟﺸﺮﻳﻒ رﻗﻢ‬ ‫‪ 1.01.197‬اﻟﻤﺆرخ ﻓﻲ ‪ 11‬ﻣﻦ ﺟﻤﺎدى اﻷوﻟﻰ ‪ ) 1422‬ﻓﺎﺗﺢ أﻏﺴﻄﺲ ‪ ،(2001‬آﻤﺎ ﺗﻢ ﺗﻐﻴﻴﺮﻩ وﺗﺘﻤﻴﻤﻪ ﺑﺎﻟﻘﺎﻧﻮن رﻗﻢ‬ ‫‪ ،09.05‬اﻟﺼﺎدر ﺑﺘﻨﻔﻴﺬﻩ اﻟﻈﻬﻴﺮ اﻟﺸﺮﻳﻒ رﻗﻢ ‪ 1.06.52‬اﻟﻤﺆرخ ﻓﻲ ‪ 15‬ﻣﺤﺮم ‪ 14) 1427‬ﻓﺒﺮاﻳﺮ‪.(2006‬‬ ‫ﺑﺘﺎرﻳﺦ‪:‬‬

‫ﺣﺮر ﻓﻲ‪،‬‬ ‫اﻹﻣﻀﺎء‪:‬‬

‫* ﺗﻮﺿﻊ ﻋﻼﻣﺔ × ﻋﻠﻰ اﻟﻤﻌﻠﻮﻣﺎت اﻟﺼﺤﻴﺤﺔ‬ ‫)‪ (1‬ﻳﺸﻄﺐ ﻋﻠﻰ اﻟﻌﺒﺎرة اﻟﺰاﺋﺪة‬

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