Tug‘ilganlik haqida dalolatnoma yozuvini tiklash haqida
A R I Z A
Men, _________________________________________________________________________
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(familiyasi, ismi, otasining ismi)
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tug‘ilganlik haqidagi dalolatnoma yozuvini tiklashingizni va kechiktirib qayd etishingizni so‘rayman.
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O‘zim haqimda quyidagilarni ma’�um qilaman:
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1. Familiya, ism, ota ismi ________________________________________________________
______________________________________________________________________________
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2. Tug‘ilgan vaqti va joyi _______ yil “___” ________________ ________________________
______________________________________________________________________________
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3. Millati ____________________________________________________________________
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4. Doimiy yashash manzili _________________________________________________________
______________________________________________________________________________
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5. Qonuniy nikohda ______________________________________________________________
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(er (xotin)ning familiyasi, ismi, ota ismi)
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____________________________________________________________________
(nikoh tuzilganligi haqidagi d/yo, sanasi va joyi)
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6. Otaci _______________________________________________________________________
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(F.I.O. va millati)
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7. Onasi ______________________________________________________________________
(F.I.O. va millati)
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8. Aka-uka, opa-singillari haqida ma’lumot (F.I.O., tug‘ilgan vaqti va joyi) _______________
__________________________________________________________________________________________________________________________________________________________________________________________________________________________________________
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9. Ish joyi: ____________________________________________________________________
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10. Ilgari yashagan joylari haqida to‘liq ma’lumot: ____________________________________
______________________________________________________________________________
yashagan vaqti, ish, o‘qish, harbiy xizmatda bo‘lgan joyi va h.k. ko‘rsatilgan holda)
____________________________________________________________________________________________________________________________________________________________
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11. Bolalari haqida ma’lumot: _____________________________________________________
______________________________________________________________________________
(ismi, tug‘ilganlik haqida d/yo qachon qaysi FHDY organida qayd etilgan)
______________________________________________________________________________
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Arizamga iltimosimni tasdiqlovchi quyidagi hujjatlarni ilova qilaman:
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1.________________________ 2.______________________
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3.________________________ 4.______________________
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5.________________________ 6.______________________
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Yolg‘on ma’lumot berganlik uchun javobgarlik haqida ogohlantirildim.
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__________ yil “____” ____________
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__________
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____________________
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(imzo)
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(familiya)
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