Ismi, sharifi_____________________________________
Yo`nalishi, guruhi___________________________________________ Telefon raqam____________________
Tug`ilgan yili (kun,oy, yil)________________________
Pasport seriya№__________________ Berilgan sana_____________
Kim tomonidan__________________________________________________________________________
Doimiy yashash manzili (viloyat, shahar yoki tuman, mahalla, ko’cha nomi, uy va xonadon raqami) ___________________________________________________________________________
Oila a’zolari soni ______
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Ijarada yashash manzili ( shahar , mahalla, ko’cha nomi, uy va xonadon raqami) ________________________________________________________________________________
Yashovchilar soni_____
Ijaraga qo`yuvchining ism familiyasi___________________________________________Tel:__________________
Nogironligi bor:
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tayanch harakati a’zolari cheklangan
zaif eshituvchi
ko‘zi ojiz
eshitishda nuqsoni bor
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boshqa turdagi nogironligi bor
Otasi (ismi,sharifi)________________________________________________________________Tel:________________
Ish joyi va lavozimi _______________________________________________________
Onasi(ismi,sharifi)________________________________________________________________Tel:___________
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