绉熸埧鍗忚涔﹀悎鍚岃寖鏈畝鍗曠殑

銆€銆€鎴戜滑骞虫椂閮芥湁鍦ㄥ闈㈢鎴跨殑缁忓巻锛岄偅涔堜綘鐭ラ亾绉熸埧鍚堝悓搴旇瑕佹湁浠€涔堝唴瀹瑰悧?浠ヤ笅鏄敱鍑哄浗鐣欏缃戝皬缂栦负澶у鏁寸悊鐨勨€滅鎴垮崗璁功鍚堝悓鑼冩湰绠€鍗曠殑鈥濓紝浠呬緵鍙傝€冿紝娆㈣繋澶у闃呰銆�

銆€銆€鍑虹浜�(鐢叉柟)锛歘___________ 韬唤璇侊細__________________________________

銆€銆€鎵跨浜�(涔欐柟)锛歘___________ 韬唤璇侊細__________________________________

銆€銆€鐢层€佷箼鍙屾柟閫氳繃鍙嬪ソ鍗忓晢锛屽氨鎴垮眿绉熻祦浜嬪疁杈炬垚鍗忚濡備笅锛�

銆€銆€绗竴鏉� 鎴垮眿鍩烘湰鎯呭喌

銆€銆€鐢叉柟鎴垮眿(浠ヤ笅绠€绉拌鎴垮眿)鍧愯惤浜巁_________甯俖__________鍖篲_______灏忓尯________鍙锋ゼ______闂╛_____瀹わ紝寤虹瓚闈㈢Н__________骞虫柟绫炽€�

銆€銆€绗簩鏉� 鎴垮眿鐢ㄩ€�

銆€銆€璇ユ埧灞嬬敤閫斾负绉熻祦灞呬綇銆�

銆€銆€闄ゅ弻鏂瑰彟鏈夌害瀹氬锛屼箼鏂逛笉寰椾换鎰忔敼鍙樻埧灞嬬敤閫斻€�

銆€銆€绗笁鏉� 绉熻祦鏈熼檺

銆€銆€鎴垮眿绉熻祦鏈熻嚜__________骞確_______鏈坃___鏃ヨ嚦_________骞確_______鏈坃___鏃ユ锛屽叡璁_____骞淬€備箼鏂规壙璇烘寜骞寸鐢ㄨ鎴垮眿銆�

銆€銆€绗洓鏉� 绉熼噾

銆€銆€(涓€)鏈浼樻儬绉熼噾锛歘___________ 鍏�/鏈堛€�

銆€銆€(浜�)鎶奸噾锛歘___________浜烘皯甯乢_______鍏冩暣 (锟ワ細____________ ) 绉熻祦鏈熸弧鎴栧悎鍚岃В闄ゅ悗锛屾埧灞嬬璧佹娂閲戦櫎鎶垫墸搴旂敱涔欐柟鎵挎媴鐨勮垂鐢ㄣ€佺閲戯紝浠ュ強涔欐柟搴斿綋鎵挎媴鐨勮繚绾﹁禂鍋胯矗浠诲锛屽墿浣欓儴鍒嗗簲濡傛暟杩旇繕缁欎箼鏂广€�

銆€銆€绗簲鏉� 浠樻

銆€銆€(涓€)浠樻鏂瑰紡锛歘___________鍗婂勾浠樸€傛敮浠樻柟寮忥細____________閾惰姹囨/鐜伴噾銆�

銆€銆€(浜�)鍏蜂綋鏀粯锛歘______________骞確___鏈堢璁㈠悎鍚屾椂锛屼箼鏂瑰皢棣栨鏀粯绉熼噾 鍏�(鍚玙___涓湀鎴跨 鍏冨拰鎶奸噾 鍏�);_______骞確___鏈坃___鏃ュ墠锛屼箼鏂规敮浠樼敳鏂筥_______鍏�(______涓湀鎴跨)銆�

銆€銆€绗叚鏉� 浜や粯鎴垮眿鏈熼檺

銆€銆€鏈悎鍚岀瀛楃敓鏁堜箣鏃ヨ捣鐢叉柟灏嗘埧灞嬫寜绾﹀畾鏉′欢浜や粯缁欎箼鏂逛娇鐢ㄣ€傘€婃埧灞嬩氦鍓叉竻鍗曘€�(瑙侀檮浠朵竴)缁忕敳涔欏弻鏂逛氦楠岀瀛楃洊绔犲苟绉讳氦鎴块棬閽ュ寵鍚庤涓轰氦浠樺畬鎴愩€�

銆€銆€绗竷鏉� 鐢叉柟瀵规埧灞嬩骇鏉冪殑鎵胯

銆€銆€鐢叉柟淇濊瘉鍦ㄦ埧灞嬬璧佹椂璇ユ埧灞嬫病鏈変骇鏉冪籂绾�;闄よˉ鍏呭崗璁彟鏈夌害瀹氬锛屾湁鍏虫寜鎻€佹姷鎶煎€哄姟銆佺◣椤瑰強绉熼噾绛夛紝鐢叉柟鍧囧湪浜や粯鎴垮眿鍓嶅姙濡ャ€備氦鏄撳悗濡傛湁涓婅堪鏈竻浜嬮」锛岀敱鐢叉柟鎵挎媴鍏ㄩ儴璐ｄ换锛岀敱姝ょ粰涔欐柟閫犳垚缁忔祹鎹熷け鐨勶紝鐢辩敳鏂硅礋璐ｈ禂鍋裤€�

銆€銆€绗叓鏉� 缁翠慨鍏绘姢璐ｄ换

銆€銆€绉熻祦鏈熼棿锛岀敳鏂瑰瀵规埧灞嬪強鍏堕檮鐫€璁炬柦杩涜妫€鏌ャ€佷慨缂紝涔欐柟搴斾簣绉瀬鍗忓姪锛屼笉寰楅樆鎸犳柦宸ャ€�

銆€銆€姝ｅ父鐨勬埧灞嬪ぇ淇悊璐圭敤鐢辩敳鏂规壙鎷�;鏃ュ父鐨勬埧灞嬬淮淇垂鐢ㄧ敱涔欐壙鎷呫€�

銆€銆€鍥犱箼鏂圭鐞嗕娇鐢ㄤ笉鍠勯€犳垚鎴垮眿鍙婂叾鐩歌繛璁惧鐨勬崯澶卞拰缁翠慨璐圭敤锛岀敱涔欐柟鎵挎媴骞惰矗浠昏禂鍋挎崯澶便€�

銆€銆€绉熻祦鏈熼棿锛岄槻鐏畨鍏紝闂ㄥ墠涓夊寘锛岀患鍚堟不鐞嗗強瀹夊叏銆佷繚鍗瓑宸ヤ綔锛屼箼鏂瑰簲鎵ц褰撳湴鏈夊叧閮ㄩ棬瑙勫畾骞舵壙鎷呭叏閮ㄨ矗浠诲拰鏈嶄粠鐢叉柟鐩戠潱妫€鏌ャ€�

銆€銆€绗節鏉� 鍏充簬瑁呬慨鍜屾敼鍙樻埧灞嬬粨鏋勭殑绾﹀畾

銆€銆€涔欐柟涓嶅緱闅忔剰鎹熷潖鎴垮眿璁炬柦锛屽闇€鏀瑰彉鎴垮眿鐨勫唴閮ㄧ粨鏋勫拰瑁呬慨鎴栬缃鎴垮眿缁撴瀯褰卞搷鐨勮澶囷紝闇€鍏堝緛寰楃敳鏂逛功闈㈠悓鎰忥紝骞舵壙鎷呰淇敼閫犺垂鐢ㄣ€傜璧佺粨鏉熸椂锛岄櫎鍙︽湁绾﹀畾澶栵紝鐢叉柟鏈夋潈瑕佹眰涔欐柟鎸夊師鐘舵仮澶嶆垨鍚戠敳鏂逛氦绾虫仮澶嶅伐绋嬫墍闇€璐圭敤銆�

銆€銆€绗崄鏉� 鍏充簬鎴垮眿绉熻祦鏈熼棿鐨勬湁鍏宠垂鐢�

銆€銆€鍦ㄦ埧灞嬬璧佹湡闂达紝浠ヤ笅璐圭敤鐢变箼鏂规敮浠橈紝骞剁敱涔欐柟鎵挎媴寤舵湡浠樻鐨勮繚绾﹁矗浠伙細__________________

銆€銆€1銆佹按銆佺數璐�

銆€銆€2銆佺噧姘旇垂

銆€銆€3銆佹湁绾跨數瑙嗚垂

銆€銆€4銆佺墿涓氱鐞嗚垂鍙婂崼鐢熻垂

銆€銆€5銆佺數璇濊垂鍙婁笂缃戜娇鐢ㄨ垂

銆€銆€鍦ㄧ璧佹湡闂达紝濡傛灉鍙戠敓鏀垮簻鏈夊叧閮ㄩ棬寰佹敹鏈悎鍚屾湭鍒楀嚭椤圭洰浣嗕笌绉熻祦鍜屼娇鐢ㄨ鎴垮眿鏈夊叧鐨勮垂鐢紝鍧囩敱涔欐柟鏀粯銆�

銆€銆€绗崄涓€鏉� 绉熻祦鏈熸弧

銆€銆€绉熻祦鏈熸弧鎴栧悎鍚岃В闄ゅ悗锛岀敳鏂规湁鏉冩敹鍥炴埧灞嬶紝涔欐柟搴旀寜鐓у師鐘惰繑杩樻埧灞嬪強鍏堕檮灞炵墿鍝併€佽澶囪鏂姐€傜敳涔欏弻鏂瑰簲瀵规埧灞嬪拰闄勫睘鐗╁搧銆佽澶囪鏂藉強姘寸數浣跨敤绛夋儏鍐佃繘琛岄獙鏀讹紝缁撴竻鍚勮嚜搴斿綋鎵挎媴鐨勮垂鐢ㄣ€�

銆€銆€涔欐柟缁х画鎵跨鐨勶紝搴旀彁鍓峗_______鏃ュ悜鐢叉柟鎻愬嚭缁瑕佹眰,鍗忓晢涓€鑷村悗鍙屾柟閲嶆柊绛捐鎴垮眿绉熻祦鍚堝悓銆�

銆€銆€绗崄浜屾潯 杩濈害璐ｄ换

銆€銆€绉熺敤鏈熷唴锛屼箼鏂规湁涓嬪垪鎯呭舰涔嬩竴鐨勭敳鏂瑰彲浠ョ粓姝㈠悎鍚岋紝鏀跺洖鎴垮眿浣跨敤鏉冿紝涔欐柟闇€鎷呭叏閮ㄨ矗浠伙紝骞惰禂鍋跨敳鏂规崯澶便€�

銆€銆€1銆� 涔欐柟鎿呰嚜灏嗚鎴垮眿杞銆佽浆璁╂垨杞€熶粬浜虹殑;

銆€銆€2銆� 涔欐柟灏嗚鎴垮眿鎿呰嚜璋冩崲浣跨敤鐨�;

銆€銆€3銆� 涔欐柟鎿呰嚜鎷嗘敼璇ユ埧灞嬬粨鏋勬垨鏀瑰彉璇ユ埧灞嬬敤閫旂殑;

銆€銆€4銆� 涔欐柟鍒╃敤鎵跨鎴垮眿杩涜闈炴硶娲诲姩鎹熷鍏叡鍒╃泭鐨�;

銆€銆€5銆� 涔欐柟鏃犳晠鎷栨瑺鎴垮眿绉熼噾杈綺_____涓湀;

銆€銆€6銆� 鏈夋崯瀹崇敳鏂瑰０瑾夌殑琛屼负銆�

銆€銆€涔欐柟鎵胯鎸夊勾绉熺敤璇ユ埧灞嬶紝濡傜鏈熸湭婊�12涓湀涔欐柟鎻愬嚭閫€绉燂紝鍒欎箼鏂瑰湪宸插彂鐢熺殑绉熺敤绉熼噾涔嬪锛岄』鍚戠敳鏂瑰缂寸撼1涓湀鐨勭閲戜綔涓鸿ˉ鍋裤€�

銆€銆€绗崄涓夋潯 鍥犱笉鍙姉鍔涘師鍥犲鑷磋鎴垮眿姣佹崯鍜岄€犳垚鎹熷け鐨勶紝鍙屾柟浜掍笉鎵挎媴璐ｄ换銆�

銆€銆€绗崄鍥涙潯 鏈悎鍚屾湭灏戒簨椤癸紝鐢辩敳銆佷箼鍙屾柟鍙﹁璁畾锛屽苟绛捐琛ュ厖鍗忚銆傝ˉ鍏呭崗璁笌鏈悎鍚屼笉涓€鑷寸殑锛屼互琛ュ厖鍗忚涓哄噯銆�

銆€銆€绗崄浜旀潯 鏈悎鍚屼箣闄勪欢鍧囦负鏈悎鍚屼笉鍙垎鍓蹭箣涓€閮ㄥ垎銆傛湰鍚堝悓鍙婂叾闄勪欢鍐咃紝绌烘牸閮ㄥ垎濉啓鐨勬枃瀛椾笌鍗板埛鏂囧瓧鍏锋湁鍚岀瓑鏁堝姏銆�

銆€銆€鏈悎鍚屽強鍏堕檮浠跺拰琛ュ厖鍗忚涓湭瑙勫畾鐨勪簨椤癸紝鍧囬伒鐓т腑鍗庝汉姘戝叡鍜屽浗鏈夊叧娉曞緥銆佹硶瑙勫拰鏀跨瓥鎵ц銆�

銆€銆€绗崄鍏潯 鏈悎鍚屽湪灞ヨ涓彂鐢熶簤璁紝鐢辩敳銆佷箼鍙屾柟鍗忓晢瑙ｅ喅銆傚崗鍟嗕笉鎴愭椂锛岀敳銆佷箼鍙屾柟搴旀寜鐜拌娉曡鍔炵悊鎴栧彲鍚戜汉姘戞硶闄㈣捣璇夈€�

銆€銆€绗崄涓冩潯 鏈悎鍚岃嚜鐢层€佷箼鍙屾柟绛惧瓧涔嬫棩璧风敓鏁堬紝涓€寮忎袱浠斤紝鐢层€佷箼鍙屾柟鍚勬墽涓€浠斤紝鍏锋湁鍚岀瓑鏁堝姏銆�

銆€銆€鍑虹浜�(鐢叉柟)绛惧瓧锛歘__________________鎵跨浜�(涔欐柟)绛惧瓧锛歘____________________

銆€銆€_______________骞確_________鏈坃______鏃� _______________骞確_________鏈坃______鏃�

銆€銆€鐢叉柟(鍑虹鏂�)锛歘___________韬唤璇佸彿锛歘________________________________

銆€銆€涔欐柟(鎵跨鏂�)锛歘___________韬唤璇佸彿锛歘________________________________

銆€銆€缁忕敳銆佷箼鍙屾柟鍦ㄥ钩绛夈€佽嚜鎰裤€佷簰鍒╃殑鍩虹涓婏紝鍙嬪ソ鍗忓晢锛岃揪鎴愪互涓嬪崗璁細

銆€銆€涓€銆佺鎴垮湴鐐�

銆€銆€鐢叉柟鍚屾剰鎶� 鐨勬埧灞嬬缁欎箼鏂癸紝骞朵繚璇佽鎴跨殑鍚堟硶鍑虹鎬с€�

銆€銆€浜屻€佹埧灞嬬敤閫�

銆€銆€涔欐柟鎵€绉熸埧灞嬩粎涓哄眳浣忎娇鐢�;涓嶅緱杩涜浠讳綍杩濇硶娲诲姩锛屽惁鍒欏悗鏋滆嚜璐熴€�

銆€銆€涓夈€佺鏈�

銆€銆€鑷猒____________骞確________鏈坃_____鏃ヨ捣銆�

銆€銆€鍥涖€佺閲�

銆€銆€姣忔湀_____________鍏冧汉姘戝竵锛屼繚璇侀噾__________________鍏�

銆€銆€浜斻€佷粯娆炬柟寮�

銆€銆€1銆佷箼鏂规瘡______鏈堟敮浠樹竴娆★紝绗竴娆＄閲戝強淇濊瘉閲戝湪绛惧畾鏈悎鍚屾椂鏀粯锛屼互鍚庣閲戞寜瑙勫畾鐨勪粯娆炬湡闄愩€�

銆€銆€2銆佺敳鏂瑰湪鏀跺埌绗竴娆＄閲戝綋鏃ュ皢涔欐柟鑳芥甯稿眳浣忕殑閽ュ寵绛変氦缁欎箼鏂广€� 鍩烘湰璐圭敤锛氫箼鏂规壙鎷呬笅鍒楀湪绉熻祦鏃舵墍鍙戠敓璐圭敤锛氭按璐光枴鐢佃垂鈻℃湁绾跨數瑙嗘湀绉熻垂鈻�

銆€銆€鍏€佺敳鏂逛箟鍔�

銆€銆€1銆佺敳鏂瑰繀椤讳繚璇佽鎴垮眿鐨勭粨鏋勫拰璁炬柦鍧囪兘姝ｅ父浣跨敤;

銆€銆€2銆佸鍐呭姝ｅ父缁翠慨鐢辩敳鏂硅礋璐�;

銆€銆€3銆佺敳鏂瑰湪绉熻祦鏈熷唴涓嶅緱鍗曟柟闈㈡彁楂樼閲戯紝鍚﹀垯绠椾綔杩濈害澶勭悊銆�

銆€銆€涓冦€佷箼鏂逛箟鍔�

銆€銆€1銆佹寜鐓ф湰鍚堝悓瑙勫畾鐨勬椂闂村拰鏂瑰紡鏀粯绉熼噾銆佷繚璇侀噾鍙婂叾瀹冭垂鐢�;

銆€銆€2銆佹湭缁忕敳鏂瑰悓鎰忥紝涔欐柟涓嶅緱绉佽嚜鎶婅鎴跨殑閮ㄥ垎鎴栧叏閮ㄨ浆绉熶粬浜�;

銆€銆€3銆佹湰鍚堝悓缁堟鏃讹紝闇€瀵圭敳鏂规彁渚涚殑璁炬柦杩涜娓呯偣銆佹鏌ョЩ浜わ紝濡傛湁鎹熷潖銆佺煭缂哄簲鐓у€兼垨閰屾儏璧斿伩;

銆€銆€4銆佽嫢鍚堝悓鍙屾柟褰撲簨浜哄洜鎴垮眿鍏朵粬浠讳綍鎯呭喌锛岄€犳垚鎴垮眿鎹熷潖锛屽弻鏂逛笉鑳藉崗鍟嗕竴鑷达紝鍒欐壘寰嬪笀缃戜笂鍗忓晢澶勭悊锛屽崗鍟嗕笉鎴愬湪鎴垮眿鎵€鍦ㄥ湴鎻愯捣璇夎;

銆€銆€5銆佷箼鏂瑰鍥犱娇鐢ㄤ笉褰撴崯鍧忔埧灞嬪強璁炬柦鐨勶紝搴旇礋璐ｄ慨澶嶅師鐘舵垨浜堜互缁忔祹璧斿伩銆傝嫢姘淬€佺數銆佺瓑浣跨敤涓嶅綋鎴栦汉涓洪€犳垚鐨勪汉韬激浜″拰鎰忓浜嬫晠锛屼笌鎴夸笢鏃犲叧锛屽悗鏋滆嚜璐熴€�

銆€銆€鍏€佽繚绾﹀鐞�

銆€銆€1銆佸涔欐柟杩濆弽鏈悎鍚岀涓冩潯锛岀敳鏂规湁鏉冪粓姝㈠悎鍚岋紝鏀跺洖鎴垮眿锛屾病鏀跺墿浣欐埧娆撅紝濡備笉瓒充綆杩囩敳鏂规崯澶憋紝涔欐柟搴斾簣浠ヨ禂鍋�;

銆€銆€2銆佸鐢叉柟杩濆弽鏈悎鍚岀鍏潯锛屽簲鎸夌収_______鏈堢閲戝悜涔欐柟鏀粯杩濈害閲戯紝骞堕€€鍥炲墿浣欐埧娆惧強淇濊瘉閲�;

銆€銆€涔濄€佽ˉ鍏呮潯娆撅細(鏄庣粏娓呭崟)姘磋〃璇绘暟_____搴︼紝鐢佃〃鎬昏鏁癬____搴︼紝闂ㄩ挜鍖�1鎶婏紝

銆€銆€鍗併€佹湰鍚堝悓鏈敖浜嬪疁锛屼竴寰嬫寜銆婁腑鍗庝汉姘戝叡鍜屽浗姘戞硶鍏搞€嬬殑鏈夊叧瑙勫畾锛岀粡鍙屾柟鍗忓晢浣滀簡琛ュ厖瑙勫畾锛岃ˉ鍏呰瀹氫笌鏈悎鍚屽叿鏈夊悓绛夋硶寰嬫晥鍔涖€�

銆€銆€鍗佷竴銆佸鍥犳椽姘淬€佸湴闇囥€佺伀鐏俱€佹媶杩佸拰娉曞緥娉曡鏀垮簻鏀跨瓥鍙樺寲绛変笉鍙姉鍔涘師鍥狅紝瀵艰嚧鏈崗璁笉鑳藉叏闈㈠饱琛岋紝鐢层€佷箼浜掍笉鎵挎媴杩濈害璐ｄ换銆傜閲戞寜瀹為檯绉熻祦鏃堕棿璁＄畻锛屽閫€灏戣ˉ銆�

銆€銆€鍗佷簩銆佹湰鍚堝悓涓€寮忎袱浠斤紝鐢层€佷箼鍙屾柟鍚勬墽涓€浠斤紝姣忎唤鍧囧叿鏈夊悓绛夋硶寰嬫晥鍔涖€�

銆€銆€鐢叉柟绛惧悕锛歘_______________________ 涔欐柟绛惧悕锛歘_______________________

銆€銆€______________骞確______鏈坃_______鏃_____________骞確______鏈坃_______鏃�

銆€銆€鐢叉柟濮撳悕(鍑虹鏂�)锛歘_____________韬唤璇侊細______________________________

銆€銆€涔欐柟濮撳悕(鎵跨鏂�)锛歘_____________韬唤璇侊細______________________________

銆€銆€缁忓弻鏂瑰崗鍟嗙敳鏂瑰皢浣嶄簬______________________________鎴垮眿鍑虹缁欎箼鏂瑰眳浣忎娇鐢ㄣ€�

銆€銆€涓€銆佺鎴夸粠_____骞確__鏈坃__鏃ヨ捣鑷砡_____骞確__鏈坃__鏃ユ銆�

銆€銆€浜屻€佹湀绉熼噾涓篲___鍏冿紝缂寸涓篲___鏀粯涓€娆★紝浜烘皯甯�(澶у啓)_________鍏�(锟___鍏�),浠ュ悗搴旀彁鍓峗__澶╂敮浠樸€�

銆€銆€涓夈€佺害瀹氫簨椤�

銆€銆€1銆佷箼鏂瑰叆浣忔椂锛屽簲鍙婃椂鏇存崲闂ㄩ攣鑻ュ彂鐢熸剰澶栦笌鐢叉柟鏃犲叧銆傚洜涓嶆厧鎴栦娇鐢ㄤ笉褰撳紩璧风伀鐏俱€佺數銆佹皵鐏惧绛夐潪鑷劧鐏惧鎵€閫犳垚鎹熷け鐢变箼鏂硅礋璐ｃ€�

銆€銆€2銆佷箼鏂规棤鏉冭浆绉熴€佽浆鍊熴€佽浆鍗栬鎴垮眿锛屽強灞嬪唴瀹跺叿瀹剁數锛屼笉寰楁搮鑷敼鍔ㄦ埧灞嬬粨鏋勶紝鐖辨姢灞嬪唴璁炬柦锛屽鏈変汉涓哄師鍥犻€犳垚鐮存崯涓㈠け搴旂淮淇畬濂斤紝鍚﹀垯鐓т环璧斿伩銆傚苟鍋氬ソ闃茬伀锛岄槻鐩楋紝闃叉紡姘达紝鍜岄槼鍙版憜鏀俱€佽姳鐩嗙殑瀹夊叏宸ヤ綔锛岃嫢閫犳垚鎹熷け璐ｄ换鑷礋銆�

銆€銆€3銆佷箼鏂瑰繀椤绘寜鏃剁即绾虫埧绉燂紝鍚﹀垯瑙嗕负涔欐柟杩濈害銆傚崗璁粓姝€€�

銆€銆€4銆佷箼鏂瑰簲閬靛畧灞呬綇鍖哄唴鍚勯」瑙勭珷鍒跺害锛屾寜鏃剁即绾虫按銆佺數銆佹皵銆佸厜绾ゃ€佺數璇濄€佺墿涓氱鐞嗙瓑璐圭敤銆備箼鏂逛氦淇濊瘉閲慱_______鍏冪粰鐢叉柟锛屼箼鏂归€€鎴挎椂浜ゆ竻姘达紝鐢碉紝姘旓紝鍏夌氦鍜岀墿涓氱鐞嗙瓑璐圭敤鍙婂眿鍐呰鏂藉鍏枫€佸鐢垫棤鎹熷潖锛屼笅姘寸閬擄紝鍘曟墍鏃犲牭婕忋€傜敳鏂瑰鏁伴€€杩樹繚璇侀噾銆�

銆€銆€5銆佺敳鏂逛繚璇佽鎴垮眿鏃犱骇鏉冪籂绾枫€傚閬囨媶杩侊紝涔欐柟鏃犳潯浠舵惉鍑猴紝宸蹭氦绉熼噾鐢叉柟鎸夋湭婊″ぉ鏁伴€€杩樸€�

銆€銆€6銆佸娉細_______________________________________________________________

銆€銆€鍥涖€佹湰鍚堝悓涓€寮忎袱浠斤紝鐢蹭箼鍙屾柟鍚勫瓨涓€浠斤紝鑷弻鏂圭瀛椾箣鏃ヨ捣鐢熸晥銆�

銆€銆€鍙︽按锛歘____鍚紝姘旓細____绔嬫柟锛岀數锛歘__搴�

銆€銆€鐢叉柟绛惧悕锛歘_______________________ 涔欐柟绛惧悕锛歘_______________________

銆€銆€______________骞確______鏈坃_______鏃_____________骞確______鏈坃_______鏃�

銆€銆€鍑虹鏂癸細________浠ヤ笅绠€绉扮敳鏂癸紝韬唤璇侊細____________________________________

銆€銆€鎵跨鏂癸細________浠ヤ笅绠€绉颁箼鏂癸紝韬唤璇侊細____________________________________

銆€銆€鏍规嵁銆婁腑鍗庝汉姘戝叡鍜屽浗姘戞硶鍏搞€嬪強鏈夊叧瑙勫畾锛屼负鏄庣‘鐢层€佷箼鍙屾柟鐨勬潈鍒╀箟鍔″叧绯伙紝缁忓弻鏂瑰崗鍟嗕竴鑷达紝绛捐鏈悎鍚屻€�

銆€銆€绗竴鏉°€€鐢叉柟灏嗚嚜鏈夌殑鍧愯惤鍦╛______甯俖_____琛梍_____宸穇____鍙风殑鎴垮眿_____鏍媉____闂达紝寤虹瓚闈㈢Н______骞虫柟绫炽€佷娇鐢ㄩ潰绉痏_____骞虫柟绫筹紝绫诲瀷___锛岀粨鏋勭瓑绾_________锛屽畬鎹熺瓑绾________涓昏瑁呬慨璁惧__________锛屽嚭绉熺粰涔欐柟浣淿__浣跨敤銆�

銆€銆€绗簩鏉°€€绉熻祦鏈熼檺

銆€銆€绉熻祦鏈熷叡___涓湀锛岀敳鏂逛粠______________骞確________鏈坃_____鏃ヨ捣灏嗗嚭绉熸埧灞嬩氦浠樹箼鏂逛娇鐢紝鑷砡_____________骞確________鏈坃_____鏃ユ敹鍥炪€�

銆€銆€涔欐柟鏈変笅鍒楁儏褰箣涓€鐨勶紝鐢叉柟鍙互缁堟鍚堝悓锛屾敹鍥炴埧灞嬶細

銆€銆€1銆佹搮鑷皢鎴垮眿杞銆佸垎绉熴€佽浆璁┿€佽浆鍊熴€佽仈钀ャ€佸叆鑲℃垨涓庝粬浜鸿皟鍓備氦鎹㈢殑;

銆€銆€2銆佸埄鐢ㄦ壙绉熸埧灞嬭繘琛岄潪娉曟椿鍔紝鎹熷鍏叡鍒╃泭鐨�;

銆€銆€3銆佹嫋娆犵閲戜釜鏈堟垨绌哄叧涓湀鐨勩€�

銆€銆€鍚堝悓鏈熸弧鍚庯紝濡傜敳鏂逛粛缁х画鍑虹鎴垮眿鐨勶紝涔欐柟鎷ユ湁浼樺厛鎵跨鏉冦€� 绉熻祦鍚堝悓鍥犳湡婊¤€岀粓姝㈡椂锛屽涔欐柟纭疄鏃犳硶鎵惧埌鎴垮眿锛屽彲涓庣敳鏂瑰崗鍟嗛厡鎯呭欢闀跨璧佹湡闄愩€�

銆€銆€绗笁鏉°€€绉熼噾鍜岀閲戜氦绾虫湡闄愩€佺◣璐瑰拰绋庤垂浜ょ撼鏂瑰紡

銆€銆€鐢蹭箼鍙屾柟璁畾鏈堢閲慱______鍏冿紝鐢变箼鏂瑰湪___鏈坃__鏃ヤ氦绾崇粰鐢叉柟銆傚厛浠樺悗鐢ㄣ€傜敳鏂规敹鍙栫閲戞椂蹇呴』鍑哄叿鐢辩◣鍔℃満鍏虫垨鍘夸互涓婅储鏀块儴闂ㄧ洃鍒剁殑鏀剁鍑瘉銆傛棤鍚堟硶鏀剁鍑瘉鐨勪箼鏂瑰彲浠ユ嫆浠樸€�

銆€銆€鐢蹭箼鍙屾柟鎸夎瀹氱殑绋庣巼鍜屾爣鍑嗕氦绾虫埧浜х璧佺◣璐癸紝浜ょ撼鏂瑰紡鎸変笅鍒楃__娆炬墽琛岋細

銆€銆€1銆佹湁鍏崇◣娉曞拰__________________瑙勫畾姣斾緥鐢辩敳銆佷箼鏂瑰悇鑷礋鎷�;

銆€銆€2銆佺敳銆佷箼鍙屾柟璁畾銆�

銆€銆€绗洓鏉°€€绉熻祦鏈熼棿鐨勬埧灞嬩慨缂拰瑁呴グ

銆€銆€淇籍鎴垮眿鏄敳鏂圭殑涔夊姟銆傜敳鏂瑰鍑虹鎴垮眿鍙婂叾璁惧搴斿畾鏈熸鏌ワ紝鍙婃椂淇籍锛屽仛鍒颁笉婕忋€佷笉娣广€佷笁閫�(鎴峰唴涓婃按銆佷笅姘淬€佺収鏄庣數)鍜岄棬绐楀ソ锛屼互淇濋殰涔欐柟瀹夊叏姝ｅ父浣跨敤銆�

銆€銆€鐢叉柟淇籍鎴垮眿鏃讹紝涔欐柟搴旂Н鏋佸崗鍔╋紝涓嶅緱闃绘尃鏂藉伐銆�

銆€銆€鍑虹鎴垮眿鐨勪慨缂紝缁忕敳涔欏弻鏂瑰晢瀹氾紝閲囧彇涓嬭堪绗琠______娆惧姙娉曞鐞嗭細

銆€銆€1銆佹寜瑙勫畾鐨勭淮淇寖鍥达紝鐢辩敳鏂瑰嚭璧勫苟缁勭粐鏂藉伐;

銆€銆€2銆佺敱涔欐柟鍦ㄧ敳鏂瑰厑璇虹殑缁翠慨鑼冨洿鍜屽伐绋嬮」鐩唴锛屽厛琛屽灚鏀淮淇垂骞剁粍缁囨柦宸ワ紝绔ｅ伐鍚庯紝鍏剁淮淇垂鐢ㄥ嚟姝ｅ紡鍙戠エ鍦ㄤ箼鏂瑰簲浜ょ撼鐨勬埧绉熶腑鍒哶_____娆℃墸闄�;

銆€銆€3銆佺敱涔欐柟璐熻矗缁翠慨;

銆€銆€4銆佺敳涔欏弻鏂硅瀹氥€�

銆€銆€涔欐柟鍥犱娇鐢ㄩ渶瑕侊紝鍦ㄤ笉褰卞搷鎴垮眿缁撴瀯鐨勫墠鎻愪笅锛屽彲浠ュ鎵跨鎴垮眿杩涜瑁呴グ锛屼絾鍏惰妯°€佽寖鍥淬€佸伐鑹恒€佺敤鏂欑瓑鍧囧簲浜嬪厛寰楀埌鐢叉柟鍚屾剰鍚庢柟鍙柦宸ャ€傚瑁呴グ鐗╃殑宸ユ枡璐瑰拰绉熻祦鏈熸弧鍚庣殑鏉冨睘澶勭悊锛屽弻鏂硅瀹氾細

銆€銆€宸ユ枡璐圭敱_____鏂规壙鎷�(銆€);

銆€銆€鎵€鏈夋潈灞瀇____鏂�(銆€)銆�

銆€銆€绗簲鏉°€€绉熻祦鍙屾柟鐨勫彉鏇�

銆€銆€1銆佸鐢叉柟鎸夋硶瀹氭墜缁▼搴忓皢鎴夸骇鎵€鏈夋潈杞Щ缁欑涓夋柟鏃讹紝鍦ㄦ棤绾﹀畾鐨勬儏鍐典笅锛屾湰鍚堝悓瀵规柊鐨勬埧浜ф墍鏈夎€呯户缁湁鏁�;

銆€銆€2銆佺敳鏂瑰嚭鍞埧灞嬶紝椤诲湪涓変釜鏈堝墠涔﹂潰閫氱煡涔欐柟锛屽湪鍚岀瓑鏉′欢涓嬶紝涔欐柟鏈変紭鍏堣喘涔版潈;

銆€銆€3銆佷箼鏂归渶瑕佷笌绗笁浜轰簰鎹㈢敤鎴挎椂锛屽簲浜嬪厛寰佸緱鐢叉柟鍚屾剰锛岀敳鏂瑰簲褰撴敮鎸佷箼鏂圭殑鍚堢悊瑕佹眰銆�

銆€銆€绗叚鏉°€€杩濈害璐ｄ换

銆€銆€1銆佺敳鏂规湭鎸夋湰鍚堝悓绗竴銆佷簩鏉＄殑绾﹀畾鍚戜箼鏂逛氦浠樼鍚堣姹傜殑鎴垮眿锛岃礋璐ｈ禂鍋垮厓銆�

銆€銆€2銆佺璧佸弻鏂瑰鏈変竴鏂规湭灞ヨ绗洓鏉＄害瀹氱殑鏈夊叧鏉℃鐨勶紝杩濈害鏂硅礋璐ｈ禂鍋垮鏂瑰厓銆�

銆€銆€3銆佷箼鏂归€炬湡浜や粯绉熼噾锛岄櫎浠嶅簲琛ヤ氦娆犵澶栵紝骞舵寜绉熼噾鐨刜__%,浠ュぉ鏁拌绠楀悜鐢叉柟浜や粯杩濈害閲戙€�

銆€銆€4銆佺敳鏂瑰悜涔欐柟鏀跺彇绾﹀畾绉熼噾浠ュ鐨勮垂鐢紝涔欐柟鏈夋潈鎷掍粯銆�

銆€銆€5銆佷箼鏂规搮鑷皢鎵跨鎴垮眿杞粰浠栦汉浣跨敤锛岀敳鏂规湁鏉冭矗浠ゅ仠姝㈣浆璁╄涓猴紝缁堟绉熻祦鍚堝悓銆傚悓鏃舵寜绾﹀畾绉熼噾鐨刜__%锛屼互澶╂暟璁＄畻鐢变箼鏂瑰悜鐢叉柟鏀粯杩濈害閲戙€�

銆€銆€6銆佹湰鍚堝悓鏈熸弧鏃讹紝涔欐柟鏈粡鐢叉柟鍚屾剰锛岀户缁娇鐢ㄦ壙绉熸埧灞嬶紝鎸夌害瀹氱閲戠殑___%锛屼互澶╂暟璁＄畻鍚戠敳鏂规敮浠樿繚绾﹂噾鍚庯紝鐢叉柟浠嶆湁缁堟鍚堝悓鐨勭敵璇夋潈銆�

銆€銆€涓婅堪杩濈害琛屼负鐨勭粡娴庣储璧斾簨瀹滐紝鐢蹭箼鍙屾柟璁畾鍦ㄦ湰鍚堝悓绛捐瘉鏈哄叧鐨勭洃鐫ｄ笅杩涜銆�

銆€銆€绗竷鏉°€€鍏嶈矗鏉′欢

銆€銆€1銆佹埧灞嬪鍥犱笉鍙姉鎷掔殑鍘熷洜瀵艰嚧鎹熸瘉鎴栭€犳垚涔欐柟鎹熷け鐨勶紝鐢蹭箼鍙屾柟浜掍笉鎵挎媴璐ｄ换銆�

銆€銆€2銆佸洜甯傛斂寤鸿闇€瑕佹媶闄ゆ垨鏀归€犲凡绉熻祦鐨勬埧灞嬶紝浣跨敳涔欏弻鏂归€犳垚鎹熷け锛屼簰涓嶆壙鎷呰矗浠汇€�

銆€銆€鍥犱笂杩板師鍥犺€岀粓姝㈠悎鍚岀殑锛岀閲戞寜瀹為檯浣跨敤鏃堕棿璁＄畻锛屽閫€灏戣ˉ銆�

銆€銆€绗叓鏉°€€浜夎瑙ｅ喅鐨勬柟寮�

銆€銆€鏈悎鍚屽湪灞ヨ涓鍙戠敓浜夎锛屽弻鏂瑰簲鍗忓晢瑙ｅ喅;鍗忓晢涓嶆垚鏃讹紝浠讳綍涓€鏂瑰潎鍙悜鎴垮眿绉熻祦绠＄悊鏈哄叧鐢宠璋冭В锛岃皟瑙ｆ棤鏁堟椂锛屽彲鍚戝競宸ュ晢琛屾斂绠＄悊灞€缁忔祹鍚堝悓浠茶濮斿憳浼氱敵璇蜂徊瑁侊紝涔熷彲浠ュ悜浜烘皯娉曢櫌璧疯瘔銆�

銆€銆€绗節鏉°€€鍏朵粬绾﹀畾浜嬪疁

銆€銆€绗崄鏉°€€鏈悎鍚屾湭灏戒簨瀹滐紝鐢蹭箼鍙屾柟鍙叡鍚屽崗鍟嗭紝绛捐琛ュ厖鍗忚銆傝ˉ鍏呭崗璁姤閫佸競鎴垮眿绉熻祦绠＄悊鏈哄叧璁ゅ彲骞舵姤鏈夊叧閮ㄩ棬澶囨鍚庯紝涓庢湰鍚堝悓鍏锋湁鍚岀瓑鏁堝姏銆�

銆€銆€鏈悎鍚屼竴寮�4浠斤紝鍏朵腑姝ｆ湰2浠斤紝鐢蹭箼鏂瑰悇鎵�1浠�;鍓湰2浠斤紝閫佸競鎴跨灞€銆佸伐鍟嗗眬澶囨銆�

銆€銆€鐢叉柟绛惧悕锛歘_______________________ 涔欐柟绛惧悕锛歘_______________________

銆€銆€______________骞確______鏈坃_______鏃_____________骞確______鏈坃_______鏃�