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銆€銆€鎵跨鏂�(浠ヤ笅绠€绉颁箼鏂�)锛歘___________________韬唤璇侊細____________________________________

銆€銆€鏍规嵁銆婁腑鍗庝汉姘戝叡鍜屽浗鍚堝悓娉曘€嬨€併€婁腑鍗庝汉姘戝叡鍜屽浗鍩庡競鎴垮湴浜х鐞嗘硶銆嬪強鏈夊叧娉曞緥銆佹硶瑙勮瀹氾紝涓烘槑纭敳銆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€�

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銆€銆€绗簩鏉� 绉熻祦鏈熼檺

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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. 鎿呰嚜灏嗘埧灞嬭浆绉熴€佸垎绉熴€佽浆璁┿€佽浆鍊熴€佽仈钀ャ€佸叆鑲℃垨浠栦汉璋冨墏浜ゆ崲鐨�;

銆€銆€2. 鍒╃敤鎵跨鎴垮眿杩涜闈炴硶娲诲姩锛屾崯瀹冲叕鍏卞埄鐩婄殑;

銆€銆€3. 鎷栨瑺绉熼噾_______涓湀鎴栫┖缃甠______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€�

銆€銆€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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€鐢层€佷箼鍙屾柟璁畾鏈堢閲慱_____鍏冿紝鐢变箼鏂瑰湪______鏈坃_____鏃ヤ氦缁欑敳鏂广€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℃満鍏虫垨鏃ヤ氦缁欑敳鏂广€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璧佽瘉銆傛棤鍚堟硶鏀剁鍑瘉鐨勪箼鏂瑰彲浠ユ嫆浠樸€�

銆€銆€鐢层€佷箼鍙屾柟鎸夎瀹氱殑绋庣巼鍜屾爣鍑嗙即绾虫埧浜х璧佺◣璐癸紝缂寸撼鏂瑰紡鎸変笅鍒楃_______娆炬墽琛岋細

銆€銆€1.鏈夊叧绋庢硶鍜宊____________________鏂囦欢瑙勫畾姣斾緥鐢辩敳銆佷箼鏂瑰悇鑷礋鎷�;

銆€銆€2.鐢层€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� 锛岀粡鐢层€佷箼鍙屾柟鍟嗗畾锛岄噰鍙栦笅杩扮_______娆惧姙娉曞鐞嗭細

銆€銆€1. 鎸夎瀹氱殑缁翠慨鑼冨洿锛岀敱鐢叉柟鍑鸿祫骞剁粍缁囨柦宸�;

銆€銆€2. 鐢变箼鏂瑰湪鐢叉柟鍏佽鐨勭淮淇寖鍥村拰宸ョ▼椤圭洰鍐咃紝鍏堣鍨敮缁翠慨璐瑰苟缁勭粐鏂藉伐锛岀宸ュ悗锛岀宸ュ悗锛屽叾缁翠慨璐圭敤鍑寮忓彂绁ㄥ湪涔欐柟搴斾氦绾崇殑鎴跨涓垎_______娆℃墸闄�;

銆€銆€3. 涔欐柟璐熻矗缁翠慨;

銆€銆€4. 鐢层€佷箼鍙屾柟璁畾銆�

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銆€銆€绗簲鏉� 绉熻祦鍙屾柟鐨勫彉鏇�

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銆€銆€2. 鐢叉柟鍑哄敭鎴垮眿锛岄』鍦ㄤ笁涓湀鍓嶄功闈㈤€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. 涔欐柟闇€瑕佷笌绗笁浜哄拰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

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銆€銆€2. 绉熻祦鍙屾柟濡傛湁涓€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鏂筥_____鍏冦€�

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銆€銆€4. 鐢叉柟鍚戜箼鏂规敹鍙栫害瀹氱閲戜互澶栫殑璐圭敤锛屼箼鏂规湁鏉冩嫆浠樸€�

銆€銆€5. 涔欐柟鎿呰嚜灏嗘壙绉熸埧灞嬭浆缁欎粬浜轰娇鐢紝鐢叉柟鏈夋潈璐ｄ护鍋滄杞琛屼负锛岀粓姝㈢璧佸悎鍚屻€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. 鏈悎鍚屾湡婊℃椂锛屼箼鏂规湭缁忕敳鏂瑰悓鎰忥紝缁х画浣跨敤鎵跨鎴垮眿锛屾寜绾﹀畾绉熼噾鐨刜______ %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层€佷箼鍙屾柟璁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

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銆€銆€2. 鍥犲競鏀垮缓璁鹃渶瑕佹媶闄ゆ垨鏀归€犲凡绉熻祦鐨勬埧灞嬶紝浣跨敳銆佷箼鍙屾柟閫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棤鏁堟椂锛屽彲鍚慱______浠茶濮斿憳浼氱敵璇蜂徊瑁侊紝鎴栬€呭悜_________ 浜烘皯娉曢櫌璧疯瘔銆�

銆€銆€绗節鏉� 鍏朵粬绾﹀畾浜嬪疁

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銆€銆€2.______________________________________________________________ 銆�

銆€銆€3.______________________________________________________________ 銆�

銆€銆€绗崄鏉� 鏈悎鍚屾湭灏戒簨瀹滐紝鐢层€佷箼鍙屾柟鍏卞悓鍗忓晢锛岀璁㈣ˉ鍏呭崗璁€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�

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銆€銆€鐢叉柟(绛惧瓧)_____________________ 涔欐柟(绛惧瓧)_____________________

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銆€銆€鍑虹鏂�(浠ヤ笅绠€绉扮敳鏂�)锛歘___________________韬唤璇侊細____________________________________

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銆€銆€涔欐柟鎵跨鐢叉柟绠＄悊鐨勪笂鍒楁埧灞嬩綔涓篲________浣跨敤锛屽弻鏂硅瀹氶伒瀹堜簨椤瑰涓嬶細

銆€銆€鎴垮眿搴ц惤锛歘________鍖篲________妤糭________鍗曞厓_________鍙� 鎴垮眿浣跨敤闈㈢Н锛歘________骞虫柟绫炽€�

銆€銆€涓€銆佹湰绉熺害涓轰箼鏂瑰彇寰楁壙绉熸埧灞嬩娇鐢ㄦ潈鐨勫嚟璇併€傜敳銆佷箼鍙屾柟鍧囨湁閬靛畧鍥藉鏈夊叧浣忓畢娉曞緥鍜屾湰甯傛埧灞嬫斂绛栥€佹硶浠ょ殑涔夊姟銆�

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銆€銆€涓夈€佷箼鏂规湁涓嬪垪鎯呭喌涔嬩竴鏃讹紝鐢叉柟鍙互缁堟绉熺害锛屾敹鍥炴埧灞嬶細

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銆€銆€涓€銆佺敳鏂瑰皢浣嶄簬________________________________鐨勬埧灞嬪嚭绉熺粰涔欐柟灞呬綇浣跨敤锛岀璧佹湡闄愯嚜___________骞確________鏈坃___鏃ヨ嚦___________骞確_________鏈坃___鏃ワ紝璁___涓湀銆�

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銆€銆€鍥涖€佷箼鏂瑰悓鎰忛浜� ________鍏冧綔涓轰繚璇侀噾锛屽悎鍚岀粓姝㈡椂锛屽綋浣滄埧绉熷啿鎶点€�

銆€銆€浜斻€佹埧灞嬬璧佹湡涓� 锛屼粠 _____________骞確________鏈坃______ 鏃ヨ嚦__________骞確_____鏈坃_____鏃ャ€傚湪姝ゆ湡闂达紝浠讳綍涓€鏂硅姹傜粓姝㈠悎鍚岋紝椤绘彁鍓峗__涓湀閫氱煡瀵规柟锛屽苟鍋夸粯瀵规柟鎬荤閲� 鐨勮繚绾﹂噾;濡傛灉鐢叉柟杞璇ユ埧灞嬶紝涔欐柟鏈変紭鍏堣喘涔版潈銆�

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銆€銆€鐢叉柟(绛惧瓧)_____________________ 涔欐柟(绛惧瓧)_____________________

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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______________________________________________________________

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銆€銆€鐢叉柟(绛惧瓧)_____________________ 涔欐柟(绛惧瓧)_____________________

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�)韬唤璇侊細__________________________________

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銆€銆€涔欐柟鎵跨鐢叉柟绠＄悊鐨勪笂鍒楁埧灞嬩綔涓篲________浣跨敤锛屽弻鏂硅瀹氶伒瀹堜簨椤瑰涓嬶細

銆€銆€鎴垮眿搴ц惤锛歘________鍖篲________妤糭________鍗曞厓_________鍙� 鎴垮眿浣跨敤闈㈢Н锛歘________骞虫柟绫�

銆€銆€涓€銆佹湰绉熺害涓轰箼鏂瑰彇寰楁壙绉熸埧灞嬩娇鐢ㄦ潈鐨勫嚟璇併€傜敳銆佷箼鍙屾柟鍧囨湁閬靛畧鍥藉鏈夊叧浣忓畢娉曞緥鍜屾湰甯傛埧灞嬫斂绛栥€佹硶浠ょ殑涔夊姟銆�

銆€銆€浜屻€佹埧灞嬬閲戞暟棰濆洜鎴垮眿鏉′欢鎴栫閲戞爣鍑嗗彉鍔ㄦ椂锛屽叾绉熼寰椾簣璋冩暣锛屾瘡鏈堢閲戯紝涔欐柟搴斾簬_________鏃ュ墠浜ゆ竻銆�

銆€銆€涓夈€佷箼鏂规湁涓嬪垪鎯呭喌涔嬩竴鏃讹紝鐢叉柟鍙互缁堟绉熺害锛屾敹鍥炴埧灞嬶細

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