绠€鏄撶鎴垮悎鍚屾ā鏉夸釜浜虹簿閫�

銆€銆€绉熸埧鐨勬湅鍙嬪凡缁忚秺鏉ヨ秺澶氾紝鑰屼笖寰堝涓嶆効鎰忔壘涓粙锛岄偅涔堣嚜宸辩鎴夸篃瑕佹敞鎰忕濂藉悎鍚屻€備互涓嬫槸鐢卞嚭鍥界暀瀛︾綉灏忕紪涓哄ぇ瀹舵暣鐞嗙殑鈥滅畝鏄撶鎴垮悎鍚屾ā鏉夸釜浜虹簿閫夆€濓紝浠呬緵鍙傝€冿紝娆㈣繋澶у闃呰銆�

銆€銆€鐢叉柟锛歘____________韬唤璇佸彿鐮侊細________________________

銆€銆€涔欐柟锛歘____________韬唤璇佸彿鐮侊細________________________

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_________鍙锋埧灞嬩娇鐢ㄩ潰绉細_________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�

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

銆€銆€1銆佹妸鎵跨鐨勬埧灞嬭浆璁╋紝杞€熸垨绉佽嚜浜ゆ崲浣跨敤鐨勩€�

銆€銆€2銆佹湭缁忕敳鏂瑰悓鎰忕鑷敼鍙樻壙绉熺敤閫旂殑銆�

銆€銆€3銆佹棤鏁呮嫋娆犵閲慱_______涓湀浠ヤ笂鐨勩€�

銆€銆€鍥涖€佺敳鏂规牴鎹慨缂爣鍑嗘鏌ワ紝缁翠慨鎴垮眿鍜岃澶囷紝淇濋殰瀹夊叏銆佹甯镐娇鐢ㄣ€傜敳鏂圭淮淇埧灞嬫椂锛屼箼鏂瑰簲绉瀬鍗忓姪锛屼笉寰楅樆纰嶆柦宸ャ€傚湪姝ｅ父鎯呭喌涓嬶紝濡傚洜妫€鏌ヤ笉鍛紝缁翠慨涓嶅強鏃讹紝浠ヨ嚧鎴垮眿鍊掑锛屼娇涔欐柟閬彈缁忔祹鎹熷け鏃讹紝鐢辩敳鏂硅礋璐ｈ禂鍋裤€�

銆€銆€浜斻€佺敳鏂归壌瀹氭埧灞嬪嵄闄╋紝涓嶈兘缁х画浣跨敤锛屽繀椤昏吘鍑烘椂锛屼箼鏂瑰簲鎸夋湡杩佸嚭锛屽叾灞呬綇鎴跨敱鐢叉柟瑙ｅ喅銆傚涔欐柟绫嶆晠鎷栧欢涓嶈縼閫犳垚鐨勪竴鍒囨崯澶憋紝鐢变箼鏂硅礋璐ｃ€�

銆€銆€鍏€佺敳鏂瑰涔欐柟鎵跨鐨勬埧灞嬭繘琛岀炕寤哄ぇ淇悗锛屼箼鏂规湁浼樺厛鎵跨鏉冿紝浣嗕簨鍏堝簲绛捐鍗忚銆�

銆€銆€涓冦€佷箼鏂瑰鎵跨鐨勬埧灞嬪強瀹ゅ唴瑁呬慨璁惧锛屽簲璐熻矗淇濈锛岀埍鎶や娇鐢紝娉ㄦ剰闃茬伀銆侀槻鍐汇€傚鏈夋崯鍧忥紝涔欐柟搴旇礋璐ｄ慨澶嶆垨璧斿伩銆傛ゼ姊棿銆侀棬閬撱€佽蛋寤婄瓑鍏敤鎴垮眿鍜岃鏂斤紝涔欐柟搴旂埍鎶や娇鐢紝娉ㄦ剰鐓х锛岄槻姝㈡崯鍧忋€�

銆€銆€鍏€佷箼鏂逛笉寰楃鑷媶鏀广€佸娣绘埧灞嬫垨璁惧銆傚灞炲繀闇€鏃讹紝搴斾簨鍏堝彇寰楃敳鏂瑰悓鎰忔垨鍙﹁绛捐鍗忚鍚庢柟鍙姩宸ャ€傚惁鍒欙紝涔欐柟搴旇礋璐ｆ仮澶嶅師鐘躲€�

銆€銆€涔濄€佷箼鏂归€€绉熸埧灞嬫椂锛屽簲浜巁_______鏃ュ墠閫氱煡鐢叉柟锛屽苟鍔炴竻浠ヤ笅鎵嬬画锛�

銆€銆€1銆佷氦娓呯閲戝拰搴斾氦绾崇殑璧斿伩璐广€�

銆€銆€2銆佹寜鐓х绾﹁礋璐ｄ繚绠＄殑鎴垮眿鍙婅淇澶囥€�

銆€銆€3銆佹挙閿€绉熺害銆�

銆€銆€鍗併€佷箼鏂规壙绉熺敳鏂逛唬绠°€佹墭绠＄殑鎴垮眿鍦ㄥ彂杩樺師涓绘椂锛岀敳鏂瑰緱缁堟绉熺害銆�

銆€銆€鍗佷竴銆佷箼鏂规壙绉熺殑鎴垮眿鍥犲浗瀹跺缓璁撅紝鐗规畩闇€瑕佸繀椤昏吘璁╂椂锛岀敳鏂瑰緱缁堟绉熺害銆備箼鏂规墍闇€鎴垮眿鎸夋湁鍏宠瀹氬姙鐞嗐€�

銆€銆€鍗佷簩銆佹湰绉熺害鑷珛绾︽棩璧疯嚦_________骞確_______鏈坃______鏃ユ鏈夋晥銆備竴鎴朹______浠斤紝鐢蹭箼鍙屾柟鍚勬墽_______浠斤紝濡傛湁鏈敖浜嬪疁锛屽弻鏂瑰崗璁В鍐炽€�

銆€銆€鍗佷笁銆佸叾浠栵細_____________________________________________________________銆�

銆€銆€鐢叉柟绛惧瓧锛歘_______________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�)____________韬唤璇佸彿鐮侊細________________________

銆€銆€涔欐柟(鎵跨鏂�)____________韬唤璇佸彿鐮侊細________________________

銆€銆€鐜扮粡鐢蹭箼鍙屾柟鍏呭垎浜嗚В銆佸崗鍟嗭紝涓€鑷磋揪鎴愬涓嬩釜浜虹鎴垮崗璁功锛�

銆€銆€涓€銆佹埧灞嬬殑浣嶇疆锛歘_______________________;闈㈢Н____________________________________;瑁呬慨鍙婅鏂絖_______________________________;璁惧________________________________________銆�

銆€銆€浜屻€佺璧佹湡闄愶細___________锛屽嵆__________骞確_______鏈坃___鏃ヨ嚦________骞確______鏈坃__鏃ャ€�

銆€銆€涓夈€佺閲戝強浜ょ撼鏃堕棿锛氭瘡鏈坃______鍏冿紝涔欐柟搴旀瘡鏈堜粯涓€娆★紝鍏堜粯鍚庝綇銆傜涓€娆′箼鏂瑰簲浜庣敳鏂瑰皢鎴垮眿浜や粯鍚屾椂锛屽皢鎴跨浠樼粰鐢叉柟;绗簩娆″強浠ュ悗浠樼閲戯紝涔欐柟搴旀彁鍓嶄竴涓湀浠樻竻銆�

銆€銆€鍥涖€佺鎴挎娂閲戯細涔欐柟搴斾簬绛剧害鍚屾椂浠樼粰鐢叉柟鎶奸噾__________鍏冿紝鍒版湡缁撶畻锛屽浣欏綊杩樸€�

銆€銆€浜斻€佺璧佹湡闂寸殑鍏朵粬绾﹀畾浜嬮」

銆€銆€1銆佺敳涔欏弻鏂瑰簲鎻愪緵鐪熷疄鏈夋晥鐨勬埧浜ц瘉銆佽韩浠借瘉绛夎瘉浠躲€�

銆€銆€2銆佺敳鏂规彁渚涘畬濂界殑鎴垮眿銆佽鏂姐€佽澶囷紝涔欐柟搴旀敞鎰忕埍鎶わ紝涓嶅緱鐮村潖鎴垮眿瑁呬慨銆佺粨鏋勫強璁炬柦銆佽澶囷紝鍚﹀垯搴旀寜浠疯禂鍋裤€傚浣跨敤涓湁闈炰汉涓烘崯鍧忥紝搴旂敱鐢叉柟淇悊銆�

銆€銆€3銆佹按銆佺數銆佺叅姘斻€佺數璇濄€佺綉缁溿€佹湁绾跨數瑙嗙瓑鐨勪娇鐢ㄨ垂鍙婄墿涓氥€佺數姊€佸崼鐢熻垂绛夋墍鏈夎垂鐢ㄩ兘鐢变箼鏂规敮浠樸€傚叆浣忔棩鎶勮锛氭按_____搴︼紝鐢礯____搴︼紝鐓ゆ皵_____搴︺€傛墍鏈夎垂鐢ㄤ箼鏂瑰簲鎸夋椂浠樻竻銆�

銆€銆€4銆佹埧灞嬪彧闄愪箼鏂逛娇鐢紝涔欐柟涓嶅緱绉佽嚜杞銆佹敼鍙樹娇鐢ㄦ€ц川鎴栦緵闈炴硶鐢ㄩ€斻€傜涓嬫湰鎴垮悗锛屼箼鏂瑰簲绔嬪嵆鍔炲ソ绉熻祦鐧昏銆佹殏浣忎汉鍙ｇ櫥璁扮瓑鎵嬬画銆傝嫢鍙戠敓闈炴硶浜嬩欢锛屼箼鏂硅嚜璐熷悗鏋溿€傚湪绉熻祦鏈熼檺鍐咃紝鐢叉柟纭渶鎻愬墠鏀跺洖鎴垮眿鏃讹紝搴斿綋浜嬪厛鍟嗗緱涔欐柟鍚屾剰锛岀粰涔欐柟閫犳垚鎹熷け鐨勶紝搴斿綋浜堜互璧斿伩銆�

銆€銆€5銆佸悎鍚屼竴缁忕璁紝鍙屾柟閮戒笉寰楁彁鍓嶈В闄ゃ€傜璧佹湡鍐咃紝濡傞亣涓嶅彲鎶楀姏鍥犵礌瀵艰嚧鏃犳硶缁х画灞ヨ鏈悎鍚岀殑锛屾湰鍚堝悓鑷劧缁堟锛屽弻鏂逛簰涓嶆壙鎷呰繚绾﹁矗浠汇€�

銆€銆€6銆佺敳涔欏弻鏂圭害瀹氾紝涔欐柟濡傞渶寮€鍏锋埧绉熷彂绁紝鍥犳浜х敓鐨勭◣璐圭敱涔欐柟鏀粯銆�

銆€銆€7銆佹鍚堝悓鏈敖浜嬪疁锛屽弻鏂瑰彲鍗忓晢瑙ｅ喅锛屽苟浣滃嚭琛ュ厖鏉℃锛岃ˉ鍏呮潯娆句笌鏈悎鍚屾湁鍚岀瓑鏁堝姏銆傚弻鏂瑰鏋滃嚭鐜扮籂绾凤紝鍏堝弸濂藉崗鍟嗭紝鍗忓晢涓嶆垚鐨勶紝鐢变汉姘戞硶闄㈣瀹氥€�

銆€銆€8銆佹湰涓汉绉熸埧鍗忚涔︾粡绛惧瓧(鐩栫珷)鐢熸晥銆�

銆€銆€9銆佸叾浠栫害瀹氫簨椤癸細___________________________銆�

銆€銆€鍏€佽繚绾﹁矗浠�

銆€銆€鐢蹭箼鍙屾柟涓换涓€鏂规湁杩濈害鎯呭喌鍙戠敓鐨勶紝杩濈害鏂瑰簲鍚戝畧绾︽柟鏀粯杩濈害閲戯紝杩濈害閲戜负________鍏冿紝鎹熷け瓒呰繃杩濈害閲戞椂锛岄』鍙﹁杩藉姞璧斿伩銆�

銆€銆€涓冦€佹湰鍚堝悓涓€寮廮___浠斤紝鐢蹭箼涓ゆ柟鍚勬墽____浠斤紝鍏锋湁鍚岀瓑娉曞緥鏁堝姏銆�

銆€銆€鐢叉柟(绛惧瓧)锛歘_______________涔欐柟(绛惧瓧)锛歘________________

銆€銆€___________骞確______鏈坃____鏃__________骞確______鏈坃____鏃�

銆€銆€鍑虹鏂�(浠ヤ笅绉扮敳鏂�)锛歘____________韬唤璇佸彿锛歘______________________________

銆€銆€鎵跨鏂�(浠ヤ笅绉颁箼鏂�)锛歘____________韬唤璇佸彿锛歘______________________________

銆€銆€鐢叉柟鎰挎剰灏嗕骇鏉冨睘浜庤嚜宸辩殑鎴垮眿鍑虹缁欎箼鏂广€傚弻鏂规牴鎹浗瀹剁浉鍏虫硶寰嬨€佹硶瑙勶紝缁忓崗鍟嗕竴鑷达紝璁㈢珛鏈崗璁紝璇︾粏鎯呭喌濡備笅锛�

銆€銆€绗竴鏉℃埧灞嬪熀鏈儏鍐�

銆€銆€鐢叉柟鍚屾剰灏哶___________甯俖________璺痏______鐨勬埧灞嬪強鍏惰鏂界璧佺粰涔欐柟锛岃绉熷缓绛戦潰绉负__________骞虫柟绫炽€傜敳鏂广€婃埧灞嬩骇鏉冭瘉銆�(浜ф潈璇佺紪鍙凤細_______瀛楃______鍙�)

銆€銆€绗簩鏉＄璧佹湡闄�

銆€銆€绉熸湡________骞达紝鑷猒________骞確____鏈坃_鏃ヨ捣鑷砡_________骞確____鏈坃_鏃ユ銆傛壙绉熶汉鏈変笅鍒楁儏褰箣涓€鐨勶紝鍑虹浜哄彲浠ヤ腑姝㈠崗璁紝鏀跺洖鎴垮眿锛�

銆€銆€1銆佹壙绉熶汉鎿呰嚜灏嗘埧灞嬭浆绉熴€佽浆璁╂垨杞€熺殑;

銆€銆€2銆佹壙绉熶汉鍒╃敤鎵跨鎴胯繘琛岄潪娉曟椿鍔ㄧ殑锛屾崯瀹冲叕鍏卞埄鐩婄殑;

銆€銆€3銆佹壙绉熶汉鎷栨瑺绉熼噾绱杈綺_____澶╃殑锛屽苟璧斿伩杩濈害閲慱_________鍏冦€�

銆€銆€鍗忚鏈熸弧鍚庯紝濡傚嚭绉熸柟浠嶇户缁嚭绉熸埧灞嬶紝鎵跨鏂逛韩鏈変紭鍏堟潈銆備絾绉熼噾鎸夊綋鏃剁殑鐗╀环鍙婂懆鍥存埧灞嬬閲戞定骞呬綔閫傚綋璋冩暣銆�

銆€銆€绗笁鏉＄閲戝拰绉熼噾浜ょ撼鏈熼檺

銆€銆€1銆佹瘡骞寸閲戜负涓轰汉姘戝竵________涓嘷_______浠熷厓鏁�(锟_______鍏�)銆傛娂閲戯細_____________鍏冧汉姘戝竵銆�

銆€銆€2銆佷箼鏂规瘡鍗婂勾浠ョ幇閲戝舰寮忔敮浠樼閲戯細_____________銆備粯娆炬椂闂翠负姣忓勾鐨刜____鏈坃___鏃ャ€�

銆€銆€3銆佷箼鏂瑰繀椤绘寜鐓х害瀹氬悜鐢叉柟缂寸撼绉熼噾銆傚鏃犳晠鎷栨瑺绉熼噾锛岀敳鏂圭粰浜堜箼鏂�7澶╃殑瀹介檺鏈燂紝浠庣______澶╁紑濮嬬敳鏂规湁鏉冨悜涔欐柟姣忓ぉ鎸夊疄娆犵閲慱_____%鍔犳敹婊炵撼閲戙€�

銆€銆€绗洓鏉＄璧佹湡闂存埧灞嬩慨缂�

銆€銆€鍑虹鏂瑰皢鎴垮眿浜ょ粰鎵跨鏂瑰悗锛屾壙绉熸柟鐨勮淇強淇籍锛屽嚭绉熸柟姒備笉璐熻矗銆傚鎵跨鏂逛笉鍐嶄娇鐢ㄥ嚭绉熸柟鐨勯棬甯傚悗锛屾壙绉熸柟涓嶅緱鐮村潖宸茶淇儴鍒嗗強鎴垮眿鏋舵瀯銆�

銆€銆€绗簲鏉″悇椤硅垂鐢ㄧ殑缂寸撼

銆€銆€1銆佺墿涓氱鐞嗚垂锛氫箼鏂硅嚜琛屽悜鐗╀笟绠＄悊鍏徃浜ょ撼;

銆€銆€2銆佹按鐢佃垂锛氱敱涔欐柟鑷缂寸撼;(姘磋〃琛ㄥ簳鏁颁负______搴︼紝鐢佃〃搴曟暟涓篲_____搴︼紝姝ゅ害鏁颁互鍚庣殑璐圭敤鐢变箼鏂规壙鎷咃紝鐩磋嚦鍗忚鏈熸弧)銆�

銆€銆€3銆佺淮淇垂锛氱璧佹湡闂达紝鐢变簬涔欐柟瀵艰嚧绉熻祦鎴垮眿鐨勮川閲忔垨鎴垮眿鐨勫唴閮ㄨ鏂芥崯姣侊紝鍖呮嫭闂ㄧ獥銆佹按鐢电瓑锛岀淮淇垂鐢变箼鏂硅礋璐ｃ€�

銆€銆€4銆佷娇鐢ㄨ鎴垮眿杩涜鍟嗕笟娲诲姩浜х敓鐨勫叾瀹冨悇椤硅垂鐢ㄥ潎鐢变箼鏂圭即绾筹紝(鍏朵腑鍖呮嫭涔欐柟鑷凡鐢宠瀹夎鐢佃瘽銆佸甯︺€佹湁绾跨數瑙嗙瓑璁惧鐨勮垂鐢�)銆�

銆€銆€绗叚鏉″嚭绉熸柟涓庢壙绉熸柟鐨勫彉鏇�

銆€銆€1銆佸鏋滃嚭绉熸柟灏嗘埧浜ф墍鏈夋潈杞Щ缁欑涓夋柟鏃讹紝鍗忚瀵规柊鐨勬埧浜ф墍鏈夎€呯户缁湁鏁堛€傛壙绉熶汉鍑哄崠鎴垮眿锛岄』鍦╛____涓湀鍓嶉€氱煡鎵跨浜猴紝鍦ㄥ悓绛夋潯浠朵笅锛屾壙绉熶汉鏈変紭鍏堣喘涔版潈銆�

銆€銆€2銆佺璧佹湡闂达紝涔欐柟濡傛灏嗙璧佹埧灞嬭浆绉熺粰绗笁鏂逛娇鐢紝蹇呴』浜嬪厛涔﹂潰鍚戠敳鏂圭敵璇凤紝鐢辩涓夋柟涔﹂潰纭锛屽緛寰楃敳鏂圭殑涔﹂潰鍚屾剰銆傚彇寰椾娇鐢ㄦ潈鐨勭涓夋柟鍗虫垚涓烘湰鍗忚鐨勫綋鐒朵箼鏂癸紝浜湁鍘熶箼鏂圭殑鏉冨埄锛屾壙鎷呭師涔欐柟鐨勪箟鍔°€�

銆€銆€绗竷鏉¤繚绾﹂噾鍜岃繚绾﹁矗浠�

銆€銆€1銆佽嫢鐢叉柟鍦ㄤ箼鏂规病鏈夎繚鍙嶆湰鍗忚鐨勬儏鍐典笅鎻愬墠瑙ｉ櫎鍗忚鎴栫缁欎粬浜猴紝瑙嗕负鐢叉柟杩濈害锛岃礋璐ｈ禂鍋胯繚绾﹂噾_______鍏冦€�

銆€銆€2銆佽嫢涔欐柟鍦ㄧ敳鏂规病鏈夎繚鍙嶆湰鍗忚鐨勬儏鍐典笅鎻愬墠瑙ｉ櫎鍗忚锛岃涓轰箼鏂硅繚绾︼紝涔欐柟璐熻矗璧斿伩杩濈害閲慱_____鍏冦€�

銆€銆€3銆佹壙绉熸柟杩濆弽鍗忚锛屾搮鑷皢鎵跨鎴垮眿杞粰浠栦汉浣跨敤鐨勶紝搴旀敮浠樿繚绾﹂噾______鍏冦€傚鍥犳閫犳垚鎵跨鎴垮眿鎹熷潖鐨勶紝杩樺簲璐熻矗璧斿伩銆�

銆€銆€绗叓鏉″厤璐ｆ潯浠�

銆€銆€鑻ョ璧佹埧灞嬪洜涓嶅彲鎶楀姏鐨勮嚜鐒剁伨瀹冲鑷存崯姣佹垨閫犳垚鎵跨浜烘崯澶辩殑锛屽弻鏂逛簰涓嶆壙鎷呰矗浠汇€傜璧佹湡闂达紝鑻ヤ箼鏂瑰洜涓嶅彲鎶楀姏鐨勮嚜鐒剁伨瀹冲鑷翠笉鑳戒娇鐢ㄧ璧佹埧灞嬶紝涔欐柟闇€绔嬪嵆涔﹂潰閫氱煡鐢叉柟銆�

銆€銆€绗節鏉′簤璁殑瑙ｅ喅鏂瑰紡

銆€銆€鏈崗璁湪灞ヨ涓鍙戠敓浜夎锛屽弻鏂瑰簲鍙嬪ソ鍗忓晢瑙ｅ喅锛屽崗鍟嗕笉鎴愭椂锛屼换浣曚竴鏂瑰潎鍙互鍚戜汉姘戞硶闄㈣捣璇夈€�

銆€銆€鏈崗璁鏈夋湭灏戒簨瀹滐紝涓€寰嬫寜銆婁腑鍗庝汉姘戝叡鍜屽浗缁忔祹鍗忚娉曘€嬬殑鏈夊叧瑙勫畾锛岀粡鐢层€佷箼鍙屾柟鍏卞悓鍗忓晢锛屼綔鍑鸿ˉ鍏呰瀹氾紝琛ュ厖瑙勫畾涓庢湰鍗忚鍏锋湁鍚岀瓑鏁堝姏銆�

銆€銆€鏈崗璁弻鏂圭瀛楃洊绔犲悗鐢熸晥锛屽涓€鏂硅繚绾︼紝鍙︿竴鏂规湁鏉冨悜杩濈害鏂硅姹傝禂鍋胯繚绾﹂噾________鍏冦€�

銆€銆€鏈崗璁叡____椤碉紝____寮廮___浠斤紝鐢层€佷箼鍙屾柟鍚勬墽____浠斤紝鍧囨湁鍚岀瓑娉曞緥鏁堝姏銆�

銆€銆€鐢叉柟(绛惧瓧)锛歘_________________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�)____________韬唤璇佸彿锛歘____________________________

銆€銆€涔欐柟(鎵跨鏂�)____________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€鐢叉柟鍚屾剰鎶奯______________________________瀹ょ殑鎴垮眿绉熺粰涔欐柟锛屽苟淇濊瘉璇ユ埧鐨勫悎娉曞嚭绉熸€с€�

銆€銆€浜屻€佹埧灞嬬敤閫�

銆€銆€涔欐柟鎵€绉熸埧灞嬩粎涓篲____浣跨敤;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__鏃ヨ捣鑷砡_____________骞確_______鏈坃__鏃ユ銆�

銆€銆€绉熻祦鏈熸弧锛屼箼鏂瑰簲濡傛湡灏嗘埧灞嬪綊鍥炵敳鏂广€�

銆€銆€鍥涖€佺閲�

銆€銆€姣忔湀_______鍏冧汉姘戝竵锛岀鎴夸繚璇侀噾______鍏冧汉姘戝竵锛岀浉褰撲簬___涓湀绉熼噾銆�

銆€銆€浜斻€佷粯娆炬柟寮�

銆€銆€1銆佷箼鏂规瘡_____涓湀鏀粯涓€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愭彁鍓峗________澶╁皢涓嬫湡鎴挎鏀粯缁欑敳鏂�;

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甯稿眳浣忕殑鍗°€佽瘉銆侀挜鍖欑瓑浜ょ粰涔欐柟銆�

銆€銆€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＄數璇濊垂鈻＄綉缁滆垂鈻＄叅姘旇垂鈻℃湁绾跨數瑙嗘湀绉熻垂鈻＄墿涓氱鐞嗚垂鈻″叾瀹冭垂鐢�(濡傛湁瑙佽ˉ鍏呭悇椤�)

銆€銆€鍏€佺鎴夸繚璇侀噾

銆€銆€瀛樻斁浜庣敳鏂逛綔涓哄饱绾︿繚璇侀噾锛屼笉璁″埄鎭紝涓昏鐢ㄤ簬瀵瑰悎鍚屾湡婊＄粓姝㈡椂锛岀敳鏂瑰涔欐柟鍦ㄧ璧佹湡鍐呭彂鐢熺殑鍩烘湰璐圭敤锛氬寘鎷埧绉熴€佹埧鍐呯墿鍝佹崯鍧忋€佺煭缂虹瓑鎵ｉ櫎娓呯畻鍚庝竴娆℃€т笉璁″埄鎭€€鍥炰箼鏂广€�

銆€銆€涓冦€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€鍏€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�

銆€銆€鑻ユ按銆佺數銆佺叅姘旂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€(涔欐柟鎼涓磋蛋鍓嶅繀椤绘妸鍗敓鎼炲ソ锛屽惁鍒欐墸闄ゅ崼鐢熸竻鐞嗚垂______鍏�)

銆€銆€涔濄€佽繚绾﹀鐞�

銆€銆€1銆佸涔欐柟杩濆弽鏈悎鍚岀鍏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涓冩潯锛屽簲鎸夌収涓€涓湀绉熼噾鍚戜箼鏂规敮浠樿繚绾﹂噾锛屽苟閫€鍥炲墿浣欐埧娆惧強淇濊瘉閲�;

銆€銆€3銆佸鐢叉柟鎿呰嚜鎻愬墠缁堟鍚堝悓锛屽簲鎸変竴涓湀绉熼噾鍚戜箼鏂规敮浠樿繚绾﹂噾锛屽苟閫€鍥炲墿浣欐埧娆惧強淇濊瘉閲�;

銆€銆€4銆佸涔欐柟鍥犻潪鎴垮眿闂涓€旈€€鎴匡紝椤绘寜涓€涓湀鎴跨鍚戠敳鏂规敮浠樿繚绾﹂噾锛岀敳鏂归€€鍥炲墿浣欑閲戝強淇濊瘉閲戯紝鍚﹀垯锛屾病鏀跺墿浣欐埧绉熼噾鍙婁繚璇侀噾銆�

銆€銆€5銆佸涔欐柟绉熻祦鏈熷凡瓒呰繃锛屼箼鏂规棦涓嶇画绛炬湰鍚堝悓涔熶笉閫€鎴匡紝鐢叉柟瀵硅鎴挎湁鏉冧綔鍑哄鐞嗭紝鍚庢灉鐢变箼鏂硅嚜璐熴€�

銆€銆€鍗併€佽ˉ鍏呮潯娆�

銆€銆€(鏄庣粏娓呭崟)姘磋〃璇绘暟_____搴︼紝鐓ゆ皵琛ㄨ鏁癬____搴︼紝鐢佃〃鎬昏鏁癬____搴︼紝宄癬____搴︼紝璋穇____搴︺€傞槻鐩楅棬閽ュ寵_____鎶婏紝鐢靛瓙闂ㄩ挜鍖檁____鎶婏紝杞﹀簱閽ュ寵_____鎶娿€�

銆€銆€1銆乢________________________________________________________

銆€銆€2銆乢________________________________________________________

銆€銆€鍗佷竴銆佹湰鍚堝悓鏈敖浜嬪疁锛屼竴寰嬫寜銆婁腑鍗庝汉姘戝叡鍜屽浗鍚堝悓娉曘€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€鍗佷簩銆佸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€佷箼鍙屾柟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€鍗佷笁銆佹湰鍚堝悓涓€寮廮____浠斤紝鐢层€佷箼鍙屾柟鍚勬墽_____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(绛惧瓧)锛歘_______________涔欐柟(绛惧瓧)锛歘________________

銆€銆€___________骞確______鏈坃____鏃__________骞確______鏈坃____鏃�

銆€銆€鎺ㄨ崘闃呰锛�

銆€銆€涓汉绠€鏄撶鎴垮悎鍚岃寖鏈�2021

銆€銆€鍗曢棿绉熸埧鍚堝悓妯℃澘涓汉鑼冩湰

銆€銆€绠€鏄撶殑涓汉绉熸埧鍚堝悓鍗忚涔﹁寖鏈�

銆€銆€涓汉绉熸埧鍚堝悓绠€鍗曠増锛堢簿閫�5绡囷級

銆€銆€绠€鍗曚釜浜虹鎴垮悎鍚岃寖鏈簿閫�