Form GN4 "Authorization for Registered Representative to Appear" - New York City (Arabic)

This is a legal form that was released by the New York City Office of Administrative Trials and Hearings - a government authority operating within New York City.

The document is provided in Arabic. As of today, no separate filing guidelines for the form are provided by the issuing department.

Form Details:

  • Released on December 1, 2015;
  • The latest edition provided by the New York City Office of Administrative Trials and Hearings;
  • Easy to use and ready to print;
  • Quick to customize;
  • Compatible with most PDF-viewing applications;

Download a printable version of Form GN4 by clicking the link below or browse more documents and templates provided by the New York City Office of Administrative Trials and Hearings.

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Download Form GN4 "Authorization for Registered Representative to Appear" - New York City (Arabic)

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‫ﻣﺴ ﺠ ّﻞ‬
‫ﻣﻤﺜﻞ‬
‫ﺑﺤﻀﻮﺭ‬
‫ﺗﻔﻮﻳﺾ‬
ً ‫ﻧﻴﺎﺑ ﺔ‬
.
‫ﺍﻟﻨﻤﻮﺫﺝ‬
‫ﻫﺬﺍ‬
‫ﻣﻦ‬
‫ﻣﻜﺘﻤﻠﺔ‬
‫ﻧﺴﺨﺔ‬
‫ﺍﻟﻤﺴﺠّ ﻞ‬
‫ﺍﻟﻤﻤﺜﻞ‬
‫ﻣﻨﺢ‬
‫ﻋﻠﻴﻚ‬
‫ﻳﺘﻌﻴﻦ‬
،‫ﻋﻨﻚ‬
‫ﻟﺪﻯ‬
‫ﺑﺎﻟﺤﻀﻮﺭ‬
‫ﻣﺴ ﺠ ّﻞ‬
‫ﻣﻤﺜﻞ‬
‫ﻟﺘﻔﻮﻳﺾ‬
OATH Hearings Division
.
‫ﺍﻟﻤﺘﻮﻓﺮﺓ‬
‫ﺍﻟﻤﺴﺎﺣﺔ‬
‫ﻓﻲ‬
‫ﺳﺆﺍﻝ‬
‫ﻛﻞ‬
‫ﻋﻦ‬
‫ﺍﻹﺟﺎﺑﺔ‬
‫ﻳﺮﺟﻰ‬
.
‫ﺳﺠﻼﺗﻚ‬
‫ﻣﻦ‬
‫ﻣﻜﺘﻤﻠﺔ‬
‫ﺑﻨﺴﺨﺔ‬
‫ﺍﻻﺣﺘﻔﺎﻅ‬
‫ﺍﻟﻤﺴﺠّ ﻞ‬
‫ﻭﺍﻟﻤﻤﺜﻞ‬
‫ﺃﻧﺖ‬
‫ﻋﻠﻴﻚ‬
‫ﻳﺠﺐ‬
.
‫ﻣﺴ ﺠ ّﻞ‬
‫ﻣﻤﺜﻞ‬
‫ﺃﻱ‬
‫ﺗﺄﻫﻴﻞ‬
‫ﺃﻭ‬
‫ﺍﻋﺘﻤﺎﺩ‬
‫ﻋﻠﻰ‬
‫ﻳﻌﻤﻞ‬
‫ﻻ‬
OATH
(
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻭﺍﻣﺮ‬
)
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻣﺮ‬
‫ﺃﻭ‬
(
‫ﺍﻹﺷﻌﺎﺭﺍﺕ‬
)
‫ﺍﻹﺷﻌﺎﺭ‬
‫ﺣﻮﻝ‬
‫ﻣﻌﻠﻮﻣﺎﺕ‬
___________________________________
:(
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻭﺍﻣﺮ‬
)
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻣﺮ‬
/(
‫ﺍﻹﺷﻌﺎﺭﺍﺕ‬
)
‫ﺍﻹﺷﻌﺎﺭ‬
‫ﻓﻲ‬
‫ﻳﻈﻬﺮ‬
‫ﻛﻤﺎ‬
،‫ﻋﻠﻴﻪ‬
‫ﺍﻟﻤﺪﻋﻰ‬
‫ﺍﺳﻢ‬
_____________________________
.[
‫ﻭﺍﺣ ﺪ ًﺍ‬
‫ﺣﺪﺩ‬
]
‫ﻓﻲ‬
‫ﺑﺎﻟﺤﻀﻮﺭ‬
‫ﺍﻟﻤﺴ ﺠ ّﻞ‬
‫ﺍﻟﻤﻤﺜﻞ‬
‫ﺃﻧﺎ‬
‫ﺃﻓﻮﺽ‬
________________________________________________________________
:
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻣﺮ‬
/
‫ﺍﻹﺷﻌﺎﺭ‬
(
‫ﺃﺭﻗﺎﻡ‬
)
‫ﺭﻗﻢ‬
______________________
‫ﻋﺪﺩ‬
‫ﺇﺟﻤﺎﻟﻲ‬
‫ﺣﺪﺩ‬
.
‫ﺤﻀﻮﺭ‬
‫ﺍﻟ‬
‫ﺃﻭﺍﻣﺮ‬
/
‫ﺍﻹﺷﻌﺎﺭﺍﺕ‬
‫ﺑﺄﺭﻗﺎﻡ‬
‫ﻗﺎﺋﻤﺔ‬
‫ﺇﺭﻓﺎﻕ‬
‫ﻳﺮﺟﻰ‬
،‫ﺍﻟﻤﺴﺎﺣﺔ‬
‫ﻣﻦ‬
‫ﺍﻟﻤﺰﻳﺪ‬
‫ﺇﻟﻰ‬
‫ﺗﺤﺘﺎﺝ‬
‫ﻛﻨﺖ‬
‫ﺇﺫﺍ‬
_________
:
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻭﺍﻣﺮ‬
/
‫ﺍﻹﺷﻌﺎﺭﺍﺕ‬
‫ﺑﺄﻥ‬
‫ﻛﺘﺎﺑ ﻴ ًﺎ‬
‫ﺇﺧﻄﺎﺭ‬
‫ﺣﺎﻟﺔ‬
‫ﻓﻲ‬
‫ﺇﻻ‬
‫ﺳﺎﺭ ﻳ ًﺎ‬
‫ﺍﻟﺘﻔﻮﻳﺾ‬
‫ﻫﺬﺍ‬
‫ﻳﻈﻞ‬
.
‫ﻋﻠﻴﻪ‬
‫ﺍﻟﻤﺪﻋﻰ‬
‫ﺇﻟﻰ‬
‫ﺍﻟﺼﺎﺩﺭﺓ‬
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻭﺍﻣﺮ‬
/
‫ﺍﻹﺷﻌﺎﺭﺍﺕ‬
‫ﻛﻞ‬
OATH Hearings Division
ً ‫ﻧﻴﺎﺑ ﺔ‬
.
‫ﻋﻠﻴﻪ‬
‫ﺍﻟﻤﺪﻋﻲ‬
‫ﻋﻦ‬
‫ﻟﻠﺤﻀﻮﺭ‬
‫ﻣﻔ ﻮ ّ ﺿ ًﺎ‬
‫ﻳﻌﺪ‬
‫ﻟﻢ‬
‫ﺍﻟﻤﺴ ﺠ ّﻞ‬
‫ﺍﻟﻤﻤﺜﻞ‬
‫ﺍﻟﻤﺴﺠّ ﻞ‬
‫ﺍﻟﻤﻤﺜﻞ‬
‫ﺑﺤﻀﻮﺭ‬
‫ﺑﺎﻟﺘﻔﻮﻳﺾ‬
‫ﺍﻟﻘﺎﺋﻢ‬
‫ﺍﻟﺸﺨﺺ‬
‫ﺣﻮﻝ‬
‫ﻣﻌﻠﻮﻣﺎﺕ‬
_________________________________________________________________________________
:
‫ﺍﺳﻤﻚ‬
‫ﻟﺮﻣﺰ‬
‫ﺍ‬
،‫ﻟﻤﺪﻳﻨﺔ‬
‫ﺍ‬
________
___________________
________________________________
:
‫ﺑﺮﻳﺪﻙ‬
‫ﻋﻨﻮﺍﻥ‬
:
‫ﺍﻟﺒﺮﻳﺪﻱ‬
:
‫ﺍﻟﻮﻻﻳﺔ‬
‫ﺍﻟﺒﺮﻳﺪ‬
‫ﻧﻮﺍﻥ‬
‫ﻉ‬
________________________________
________________________________
:
‫ﺍﻟﻬﺎﺗﻒ‬
‫ﻗﻢ‬
‫ﺭ‬
:
‫ﺍﻹﻟﻜﺘﺮﻭﻧﻲ‬
( ‫؟‬
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻭﺍﻣﺮ‬
)
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻣﺮ‬
/(
‫ﺍﻹﺷﻌﺎﺭﺍﺕ‬
)
‫ﺍﻹﺷﻌﺎﺭ‬
‫ﻓﻲ‬
‫ﺍﻟﻤﺬﻛﻮﺭ‬
‫ﻋﻠﻴﻪ‬
‫ﺍﻟﻤﺪﻋﻲ‬
‫ﺃﻧﺖ‬
‫ﻫﻞ‬
‫ﻻ‬
‫ﻧﻌﻡ‬
:
‫ﻧﺤﻮ‬
‫ﺃﻓﻀﻞ‬
‫ﻋﻠﻰ‬
‫ﻫﻮﻳﺘﻚ‬
‫ﺗﺼﻒ‬
‫ﺍﻟﺘﻲ‬
‫ﺍﻟﺨﺎﻧﺔ‬
‫ﺑﺘﺤﺪﻳﺪ‬
‫ﻓﻘﻢ‬
،‫ﺍﻟﻤﺬﻛﻮﺭ‬
‫ﻋﻠﻴﻪ‬
‫ﺍﻟﻤﺪﻋﻲ‬
‫ﺃﻧﺖ‬
‫ﺗﻜﻦ‬
‫ﻟﻢ‬
‫ﺇﺫﺍ‬
‫ﺍﻷﻋﻤﺎﻝ‬
/
‫ﺍﻟﻤﻤﺘﻠﻜﺎﺕ‬
‫ﺻﺎﺣﺐ‬
‫ﻋﻠﻴﻪ‬
‫ﺍﻟﻤﺪﻋﻲ‬
‫ﻟﺪﻯ‬
‫ﻣﻮﻅﻒ‬
‫ﺍﻹﺩﺍﺭﺓ‬
‫ﻭﻛﻴﻞ‬
/
‫ﺍﻟﻌﺎﻡ‬
‫ﺍﻟﻮﻛﻴﻞ‬
‫ﻋﻠﻴﻪ‬
‫ﺍﻟﻤﺪﻋﻲ‬
‫ﺷﺮﻛﺔ‬
‫ﻣﺴﺆﻭﻝ‬
/
‫ﺷﺮﻳﻚ‬
______________
‫ﺍﻟﺗﻭﺿﻳﺢ‬
‫ﻳﺭﺟﻰ‬
،
(...
‫ﺫﻟﻙ‬
‫ﻏﻳﺭ‬
‫ﺃﻭ‬
،‫ﻗﺭﻳﺏ‬
،‫ﺻﺩﻳﻕ‬
)
‫ﺁﺧﺭ‬
‫ﺍﻟﻤﺴ ﺠ ّﻞ‬
‫ﺍﻟﻤﻤﺜﻞ‬
‫ﺣﻮﻝ‬
‫ﻣﻌﻠﻮﻣﺎﺕ‬
(
‫ﺍﻟﻤﺴﺠّ ﻞ‬
‫ﺍﻟﻤﻤﺜﻞ‬
‫ﺑﻮﺍﺳﻄﺔ‬
‫ﺗﻮﻓﻴﺮﻫﺎ‬
‫ﻳﺘﻢ‬
)
‫ﺍﻟﻤﺴﺠّ ﻞ‬
_______________
:
____________________________________
:
‫ﺍﻟﻤﻤﺜﻞ‬
‫ﺍﺳﻢ‬
Registration number
‫ﻟﺮﻣﺰ‬
‫ﺍ‬
،‫ﻟﻤﺪﻳﻨﺔ‬
‫ﺍ‬
________
__________________
____________________________
:
‫ﺍﻟﻌﻤﻞ‬
‫ﺑﺮﻳﺪ‬
‫ﻋﻨﻮﺍﻥ‬
:
‫ﺍﻟﺒﺮﻳﺪﻱ‬
:
‫ﺍﻟﻮﻻﻳﺔ‬
_________________________
:
‫ﺍﻹﻟﻜﺘﺮﻭﻧﻲ‬
‫ﺍﻟﺒﺮﻳﺪ‬
‫ﻧﻮﺍﻥ‬
‫ﻉ‬
_______________________________
_
:
‫ﺍﻟﻬﺎﺗﻒ‬
‫ﺭﻗﻢ‬
‫ﺍﻟﺘﻔﻮﻳﺾ‬
‫ﺑﻴﺎﻥ‬
‫ﺳﺆﺍﻝ‬
‫ﻟﻜﻞ‬
‫ﺍﻟﻤﻼﺋﻤﺔ‬
‫ﺍﻟﺨﺎﻧﺔ‬
‫ﺗﺤﺪﻳﺪ‬
‫ﺍﻟﻤﺴﺠّﻞ‬
‫ﺍﻟﻤﻤﺜﻞ‬
‫ﺑﺘﻔﻮﻳﺾ‬
‫ﺍﻟﻘﺎﺋﻢ‬
‫ﺍﻟﺸﺨﺺ‬
‫ﻋﻠﻰ‬
‫ﻳﺘﻌﻴﻦ‬
:
‫ﻳﻠﻲ‬
‫ﺑﻣﺎ‬
‫ﺃﺑﻠﻐﻧﻲ‬
______________________
[
‫ﺍﻟﻣﺳ ﺟ ّ ﻝ‬
‫ﺍﻟﻣﻣﺛﻝ‬
]
‫ﺑﺄﻥ‬
‫ﺍﻟﻭﺛﻳﻘﺔ‬
‫ﻫﺫﻩ‬
‫ﺑﻣﻭﺟﺏ‬
،
_____________________ [
‫ﺍﺳﻣﻙ‬
]
،‫ﺃﻧﺎ‬
‫ﺃﻗﺭ‬
‫ﻻ‬
‫ﻧﻌﻢ‬
.
OATH
‫ﻟﺪﻯ‬
‫ﻳﻌﻤﻞ‬
‫ﻻ‬
‫ﺍﻟﻤﺴ ﺠ ّﻞ‬
‫ﺍﻟﻤﻤﺜﻞ‬
‫ﺃﻥ‬
1 (
‫ﻻ‬
‫ﻧﻌﻢ‬
.
‫ﺍﻟﻤﺤﺎﻣﺎﺓ‬
‫ﻓﻲ‬
‫ﻳﻌﻤﻞ‬
‫ﻻ‬
‫ﺍﻟﻤﺴ ﺠ ّﻞ‬
‫ﺍﻟﻤﻤﺜﻞ‬
‫ﺃﻥ‬
2 (
‫ﻻ‬
‫ﻧﻌﻢ‬
.
‫ﻣﺴ ﺠ ّﻞ‬
‫ﻣﻤﺜﻞ‬
‫ﻣﺮﺍﻓﻘﺔ‬
‫ﺩﻭﻥ‬
‫ﻟﺪﻯ‬
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﻋﻠﻴﻪ‬
‫ﻟﻠﻤﺪﻋﻲ‬
‫ﻳﺠﻮﺯ‬
‫ﺃﻧﻪ‬
3 (
OATH Hearings Division
‫ﻻ‬
‫ﻧﻌﻢ‬
.
‫ﻋﻠﻴﻪ‬
‫ﺍﻟﻤﺪﻋﻲ‬
‫ﻗﺒﻞ‬
‫ﻣﻦ‬
‫ﺍﻧﺘﻬﺎﻙ‬
‫ﻭﺟﻮﺩ‬
‫ﺗﺒ ﻴ ّﻦ‬
‫ﺣﺎﻟﺔ‬
‫ﻓﻲ‬
( ،
‫ﺍﻻﺗﻬﺎﻣﺎﺕ‬
)
‫ﺍﻻﺗﻬﺎﻡ‬
‫ﻋﻦ‬
‫ﺍﻟﻤﺤﺘﻤﻠﺔ‬
‫ﺍﻟﻌﻘﻮﺑﺔ‬
4 (
‫ﻻ‬
‫ﻧﻌﻢ‬
.
‫ﺁﺧﺮ‬
‫ﺗﺎﺭﻳﺦ‬
‫ﺇﻟﻰ‬
(
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻭﺍﻣﺮ‬
)
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻣﺮ‬
/(
‫ﺍﻹﺷﻌﺎﺭﺍﺕ‬
)
‫ﺍﻹﺷﻌﺎﺭ‬
‫ﺗﺄﺟﻴﻞ‬
‫ﻳﺠﻮﺯ‬
‫ﺃﻧﻪ‬
5 (
‫ﻻ‬
‫ﻧﻌﻢ‬
.
‫ﺍﻟﻤﺴ ﺠ ّ ﻞ‬
‫ﺍﻟﻤﻤﺜﻞ‬
‫ﺳﻴﻄﻠﺒﻬﺎ‬
‫ﺍﻟﺘﻲ‬
‫ﺍﻟﺮﺳﻮﻡ‬
‫ﻣﺒﻠﻎ‬
6 (
‫ﻭﺍﺣﺩ ً ﺍ‬
:[
‫ﺣﺩﺩ‬
]
‫ﻟﺩﻯ‬
‫ﺑﺎﻟﺣﺿﻭﺭ‬
__________________________ [
‫ﺍﻟﻣﺳﺟّ ﻝ‬
‫ﺍﻟﻣﻣﺛﻝ‬
]
‫ﺍﻟﻭﺛﻳﻘﺔ‬
‫ﻫﺫﻩ‬
‫ﺑﻣﻭﺟﺏ‬
‫ﺃﻧﺎ‬
‫ﺃﻓﻭّ ﺽ‬
OATH Hearings Division
‫ﺁﻧ ﻔ ً ﺎ‬
.
‫ﻓﻘﻂ‬
‫ﺗﺄﺟﻴﻞ‬
‫ﻟﻄﻠﺐ‬
.
‫ﺍﻟﻤﺬﻛﻮﺭﺓ‬
(
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻭﺍﻣﺮ‬
)
‫ﻟﺤﻀﻮﺭ‬
‫ﺍ‬
‫ﺃﻣﺮ‬
/(
‫ﺍﻹﺷﻌﺎﺭﺍﺕ‬
)
‫ﺑﺎﻹﺷﻌﺎﺭ‬
‫ﺍﻟﻤﺘﻌﻠﻘﺔ‬
‫ﺍﻟﻤﺴﺎﺋﻞ‬
‫ﻛﻞ‬
‫ﻓﻲ‬
‫ﺃﻣﺮ‬
/(
‫ﺍﻹﺷﻌﺎﺭﺍﺕ‬
)
‫ﺍﻹﺷﻌﺎﺭ‬
‫ﻟﻘﺒﻮﻝ‬
.
‫ﻓﻘﻂ‬
‫ﺗﺴﻮﻳﺔ‬
/
‫ﺍﺗﻔﺎﻕ‬
‫ﺇﻟﻰ‬
‫ﻟﻠﺘﻮﺻﻞ‬
.
‫ﻓﻘﻂ‬
‫ﺟﺪﻭﻟﺔ‬
‫ﺇﻋﺎﺩﺓ‬
‫ﻟﻄﻠﺐ‬
.
‫ﻓﻘﻂ‬
(
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻭﺍﻣﺮ‬
)
‫ﺍﻟﺤﻀﻮﺭ‬
._______________________________________:(
‫ﺍﻟﺗﻭﺿﻳﺢ‬
‫ﻳﺭﺟﻲ‬
)
‫ﺃﺧﺭﻯ‬
___________
__________________________
___
‫ﺍﻟﺘﺎﺭﻳﺦ‬
‫ﺍﻟﺘﻮﻗﻴﻊ‬
12/1/15
‫ﻣﺴ ﺠ ّﻞ‬
‫ﻣﻤﺜﻞ‬
‫ﺑﺤﻀﻮﺭ‬
‫ﺗﻔﻮﻳﺾ‬
ً ‫ﻧﻴﺎﺑ ﺔ‬
.
‫ﺍﻟﻨﻤﻮﺫﺝ‬
‫ﻫﺬﺍ‬
‫ﻣﻦ‬
‫ﻣﻜﺘﻤﻠﺔ‬
‫ﻧﺴﺨﺔ‬
‫ﺍﻟﻤﺴﺠّ ﻞ‬
‫ﺍﻟﻤﻤﺜﻞ‬
‫ﻣﻨﺢ‬
‫ﻋﻠﻴﻚ‬
‫ﻳﺘﻌﻴﻦ‬
،‫ﻋﻨﻚ‬
‫ﻟﺪﻯ‬
‫ﺑﺎﻟﺤﻀﻮﺭ‬
‫ﻣﺴ ﺠ ّﻞ‬
‫ﻣﻤﺜﻞ‬
‫ﻟﺘﻔﻮﻳﺾ‬
OATH Hearings Division
.
‫ﺍﻟﻤﺘﻮﻓﺮﺓ‬
‫ﺍﻟﻤﺴﺎﺣﺔ‬
‫ﻓﻲ‬
‫ﺳﺆﺍﻝ‬
‫ﻛﻞ‬
‫ﻋﻦ‬
‫ﺍﻹﺟﺎﺑﺔ‬
‫ﻳﺮﺟﻰ‬
.
‫ﺳﺠﻼﺗﻚ‬
‫ﻣﻦ‬
‫ﻣﻜﺘﻤﻠﺔ‬
‫ﺑﻨﺴﺨﺔ‬
‫ﺍﻻﺣﺘﻔﺎﻅ‬
‫ﺍﻟﻤﺴﺠّ ﻞ‬
‫ﻭﺍﻟﻤﻤﺜﻞ‬
‫ﺃﻧﺖ‬
‫ﻋﻠﻴﻚ‬
‫ﻳﺠﺐ‬
.
‫ﻣﺴ ﺠ ّﻞ‬
‫ﻣﻤﺜﻞ‬
‫ﺃﻱ‬
‫ﺗﺄﻫﻴﻞ‬
‫ﺃﻭ‬
‫ﺍﻋﺘﻤﺎﺩ‬
‫ﻋﻠﻰ‬
‫ﻳﻌﻤﻞ‬
‫ﻻ‬
OATH
(
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻭﺍﻣﺮ‬
)
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻣﺮ‬
‫ﺃﻭ‬
(
‫ﺍﻹﺷﻌﺎﺭﺍﺕ‬
)
‫ﺍﻹﺷﻌﺎﺭ‬
‫ﺣﻮﻝ‬
‫ﻣﻌﻠﻮﻣﺎﺕ‬
___________________________________
:(
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻭﺍﻣﺮ‬
)
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻣﺮ‬
/(
‫ﺍﻹﺷﻌﺎﺭﺍﺕ‬
)
‫ﺍﻹﺷﻌﺎﺭ‬
‫ﻓﻲ‬
‫ﻳﻈﻬﺮ‬
‫ﻛﻤﺎ‬
،‫ﻋﻠﻴﻪ‬
‫ﺍﻟﻤﺪﻋﻰ‬
‫ﺍﺳﻢ‬
_____________________________
.[
‫ﻭﺍﺣ ﺪ ًﺍ‬
‫ﺣﺪﺩ‬
]
‫ﻓﻲ‬
‫ﺑﺎﻟﺤﻀﻮﺭ‬
‫ﺍﻟﻤﺴ ﺠ ّﻞ‬
‫ﺍﻟﻤﻤﺜﻞ‬
‫ﺃﻧﺎ‬
‫ﺃﻓﻮﺽ‬
________________________________________________________________
:
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻣﺮ‬
/
‫ﺍﻹﺷﻌﺎﺭ‬
(
‫ﺃﺭﻗﺎﻡ‬
)
‫ﺭﻗﻢ‬
______________________
‫ﻋﺪﺩ‬
‫ﺇﺟﻤﺎﻟﻲ‬
‫ﺣﺪﺩ‬
.
‫ﺤﻀﻮﺭ‬
‫ﺍﻟ‬
‫ﺃﻭﺍﻣﺮ‬
/
‫ﺍﻹﺷﻌﺎﺭﺍﺕ‬
‫ﺑﺄﺭﻗﺎﻡ‬
‫ﻗﺎﺋﻤﺔ‬
‫ﺇﺭﻓﺎﻕ‬
‫ﻳﺮﺟﻰ‬
،‫ﺍﻟﻤﺴﺎﺣﺔ‬
‫ﻣﻦ‬
‫ﺍﻟﻤﺰﻳﺪ‬
‫ﺇﻟﻰ‬
‫ﺗﺤﺘﺎﺝ‬
‫ﻛﻨﺖ‬
‫ﺇﺫﺍ‬
_________
:
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻭﺍﻣﺮ‬
/
‫ﺍﻹﺷﻌﺎﺭﺍﺕ‬
‫ﺑﺄﻥ‬
‫ﻛﺘﺎﺑ ﻴ ًﺎ‬
‫ﺇﺧﻄﺎﺭ‬
‫ﺣﺎﻟﺔ‬
‫ﻓﻲ‬
‫ﺇﻻ‬
‫ﺳﺎﺭ ﻳ ًﺎ‬
‫ﺍﻟﺘﻔﻮﻳﺾ‬
‫ﻫﺬﺍ‬
‫ﻳﻈﻞ‬
.
‫ﻋﻠﻴﻪ‬
‫ﺍﻟﻤﺪﻋﻰ‬
‫ﺇﻟﻰ‬
‫ﺍﻟﺼﺎﺩﺭﺓ‬
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻭﺍﻣﺮ‬
/
‫ﺍﻹﺷﻌﺎﺭﺍﺕ‬
‫ﻛﻞ‬
OATH Hearings Division
ً ‫ﻧﻴﺎﺑ ﺔ‬
.
‫ﻋﻠﻴﻪ‬
‫ﺍﻟﻤﺪﻋﻲ‬
‫ﻋﻦ‬
‫ﻟﻠﺤﻀﻮﺭ‬
‫ﻣﻔ ﻮ ّ ﺿ ًﺎ‬
‫ﻳﻌﺪ‬
‫ﻟﻢ‬
‫ﺍﻟﻤﺴ ﺠ ّﻞ‬
‫ﺍﻟﻤﻤﺜﻞ‬
‫ﺍﻟﻤﺴﺠّ ﻞ‬
‫ﺍﻟﻤﻤﺜﻞ‬
‫ﺑﺤﻀﻮﺭ‬
‫ﺑﺎﻟﺘﻔﻮﻳﺾ‬
‫ﺍﻟﻘﺎﺋﻢ‬
‫ﺍﻟﺸﺨﺺ‬
‫ﺣﻮﻝ‬
‫ﻣﻌﻠﻮﻣﺎﺕ‬
_________________________________________________________________________________
:
‫ﺍﺳﻤﻚ‬
‫ﻟﺮﻣﺰ‬
‫ﺍ‬
،‫ﻟﻤﺪﻳﻨﺔ‬
‫ﺍ‬
________
___________________
________________________________
:
‫ﺑﺮﻳﺪﻙ‬
‫ﻋﻨﻮﺍﻥ‬
:
‫ﺍﻟﺒﺮﻳﺪﻱ‬
:
‫ﺍﻟﻮﻻﻳﺔ‬
‫ﺍﻟﺒﺮﻳﺪ‬
‫ﻧﻮﺍﻥ‬
‫ﻉ‬
________________________________
________________________________
:
‫ﺍﻟﻬﺎﺗﻒ‬
‫ﻗﻢ‬
‫ﺭ‬
:
‫ﺍﻹﻟﻜﺘﺮﻭﻧﻲ‬
( ‫؟‬
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻭﺍﻣﺮ‬
)
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻣﺮ‬
/(
‫ﺍﻹﺷﻌﺎﺭﺍﺕ‬
)
‫ﺍﻹﺷﻌﺎﺭ‬
‫ﻓﻲ‬
‫ﺍﻟﻤﺬﻛﻮﺭ‬
‫ﻋﻠﻴﻪ‬
‫ﺍﻟﻤﺪﻋﻲ‬
‫ﺃﻧﺖ‬
‫ﻫﻞ‬
‫ﻻ‬
‫ﻧﻌﻡ‬
:
‫ﻧﺤﻮ‬
‫ﺃﻓﻀﻞ‬
‫ﻋﻠﻰ‬
‫ﻫﻮﻳﺘﻚ‬
‫ﺗﺼﻒ‬
‫ﺍﻟﺘﻲ‬
‫ﺍﻟﺨﺎﻧﺔ‬
‫ﺑﺘﺤﺪﻳﺪ‬
‫ﻓﻘﻢ‬
،‫ﺍﻟﻤﺬﻛﻮﺭ‬
‫ﻋﻠﻴﻪ‬
‫ﺍﻟﻤﺪﻋﻲ‬
‫ﺃﻧﺖ‬
‫ﺗﻜﻦ‬
‫ﻟﻢ‬
‫ﺇﺫﺍ‬
‫ﺍﻷﻋﻤﺎﻝ‬
/
‫ﺍﻟﻤﻤﺘﻠﻜﺎﺕ‬
‫ﺻﺎﺣﺐ‬
‫ﻋﻠﻴﻪ‬
‫ﺍﻟﻤﺪﻋﻲ‬
‫ﻟﺪﻯ‬
‫ﻣﻮﻅﻒ‬
‫ﺍﻹﺩﺍﺭﺓ‬
‫ﻭﻛﻴﻞ‬
/
‫ﺍﻟﻌﺎﻡ‬
‫ﺍﻟﻮﻛﻴﻞ‬
‫ﻋﻠﻴﻪ‬
‫ﺍﻟﻤﺪﻋﻲ‬
‫ﺷﺮﻛﺔ‬
‫ﻣﺴﺆﻭﻝ‬
/
‫ﺷﺮﻳﻚ‬
______________
‫ﺍﻟﺗﻭﺿﻳﺢ‬
‫ﻳﺭﺟﻰ‬
،
(...
‫ﺫﻟﻙ‬
‫ﻏﻳﺭ‬
‫ﺃﻭ‬
،‫ﻗﺭﻳﺏ‬
،‫ﺻﺩﻳﻕ‬
)
‫ﺁﺧﺭ‬
‫ﺍﻟﻤﺴ ﺠ ّﻞ‬
‫ﺍﻟﻤﻤﺜﻞ‬
‫ﺣﻮﻝ‬
‫ﻣﻌﻠﻮﻣﺎﺕ‬
(
‫ﺍﻟﻤﺴﺠّ ﻞ‬
‫ﺍﻟﻤﻤﺜﻞ‬
‫ﺑﻮﺍﺳﻄﺔ‬
‫ﺗﻮﻓﻴﺮﻫﺎ‬
‫ﻳﺘﻢ‬
)
‫ﺍﻟﻤﺴﺠّ ﻞ‬
_______________
:
____________________________________
:
‫ﺍﻟﻤﻤﺜﻞ‬
‫ﺍﺳﻢ‬
Registration number
‫ﻟﺮﻣﺰ‬
‫ﺍ‬
،‫ﻟﻤﺪﻳﻨﺔ‬
‫ﺍ‬
________
__________________
____________________________
:
‫ﺍﻟﻌﻤﻞ‬
‫ﺑﺮﻳﺪ‬
‫ﻋﻨﻮﺍﻥ‬
:
‫ﺍﻟﺒﺮﻳﺪﻱ‬
:
‫ﺍﻟﻮﻻﻳﺔ‬
_________________________
:
‫ﺍﻹﻟﻜﺘﺮﻭﻧﻲ‬
‫ﺍﻟﺒﺮﻳﺪ‬
‫ﻧﻮﺍﻥ‬
‫ﻉ‬
_______________________________
_
:
‫ﺍﻟﻬﺎﺗﻒ‬
‫ﺭﻗﻢ‬
‫ﺍﻟﺘﻔﻮﻳﺾ‬
‫ﺑﻴﺎﻥ‬
‫ﺳﺆﺍﻝ‬
‫ﻟﻜﻞ‬
‫ﺍﻟﻤﻼﺋﻤﺔ‬
‫ﺍﻟﺨﺎﻧﺔ‬
‫ﺗﺤﺪﻳﺪ‬
‫ﺍﻟﻤﺴﺠّﻞ‬
‫ﺍﻟﻤﻤﺜﻞ‬
‫ﺑﺘﻔﻮﻳﺾ‬
‫ﺍﻟﻘﺎﺋﻢ‬
‫ﺍﻟﺸﺨﺺ‬
‫ﻋﻠﻰ‬
‫ﻳﺘﻌﻴﻦ‬
:
‫ﻳﻠﻲ‬
‫ﺑﻣﺎ‬
‫ﺃﺑﻠﻐﻧﻲ‬
______________________
[
‫ﺍﻟﻣﺳ ﺟ ّ ﻝ‬
‫ﺍﻟﻣﻣﺛﻝ‬
]
‫ﺑﺄﻥ‬
‫ﺍﻟﻭﺛﻳﻘﺔ‬
‫ﻫﺫﻩ‬
‫ﺑﻣﻭﺟﺏ‬
،
_____________________ [
‫ﺍﺳﻣﻙ‬
]
،‫ﺃﻧﺎ‬
‫ﺃﻗﺭ‬
‫ﻻ‬
‫ﻧﻌﻢ‬
.
OATH
‫ﻟﺪﻯ‬
‫ﻳﻌﻤﻞ‬
‫ﻻ‬
‫ﺍﻟﻤﺴ ﺠ ّﻞ‬
‫ﺍﻟﻤﻤﺜﻞ‬
‫ﺃﻥ‬
1 (
‫ﻻ‬
‫ﻧﻌﻢ‬
.
‫ﺍﻟﻤﺤﺎﻣﺎﺓ‬
‫ﻓﻲ‬
‫ﻳﻌﻤﻞ‬
‫ﻻ‬
‫ﺍﻟﻤﺴ ﺠ ّﻞ‬
‫ﺍﻟﻤﻤﺜﻞ‬
‫ﺃﻥ‬
2 (
‫ﻻ‬
‫ﻧﻌﻢ‬
.
‫ﻣﺴ ﺠ ّﻞ‬
‫ﻣﻤﺜﻞ‬
‫ﻣﺮﺍﻓﻘﺔ‬
‫ﺩﻭﻥ‬
‫ﻟﺪﻯ‬
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﻋﻠﻴﻪ‬
‫ﻟﻠﻤﺪﻋﻲ‬
‫ﻳﺠﻮﺯ‬
‫ﺃﻧﻪ‬
3 (
OATH Hearings Division
‫ﻻ‬
‫ﻧﻌﻢ‬
.
‫ﻋﻠﻴﻪ‬
‫ﺍﻟﻤﺪﻋﻲ‬
‫ﻗﺒﻞ‬
‫ﻣﻦ‬
‫ﺍﻧﺘﻬﺎﻙ‬
‫ﻭﺟﻮﺩ‬
‫ﺗﺒ ﻴ ّﻦ‬
‫ﺣﺎﻟﺔ‬
‫ﻓﻲ‬
( ،
‫ﺍﻻﺗﻬﺎﻣﺎﺕ‬
)
‫ﺍﻻﺗﻬﺎﻡ‬
‫ﻋﻦ‬
‫ﺍﻟﻤﺤﺘﻤﻠﺔ‬
‫ﺍﻟﻌﻘﻮﺑﺔ‬
4 (
‫ﻻ‬
‫ﻧﻌﻢ‬
.
‫ﺁﺧﺮ‬
‫ﺗﺎﺭﻳﺦ‬
‫ﺇﻟﻰ‬
(
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻭﺍﻣﺮ‬
)
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻣﺮ‬
/(
‫ﺍﻹﺷﻌﺎﺭﺍﺕ‬
)
‫ﺍﻹﺷﻌﺎﺭ‬
‫ﺗﺄﺟﻴﻞ‬
‫ﻳﺠﻮﺯ‬
‫ﺃﻧﻪ‬
5 (
‫ﻻ‬
‫ﻧﻌﻢ‬
.
‫ﺍﻟﻤﺴ ﺠ ّ ﻞ‬
‫ﺍﻟﻤﻤﺜﻞ‬
‫ﺳﻴﻄﻠﺒﻬﺎ‬
‫ﺍﻟﺘﻲ‬
‫ﺍﻟﺮﺳﻮﻡ‬
‫ﻣﺒﻠﻎ‬
6 (
‫ﻭﺍﺣﺩ ً ﺍ‬
:[
‫ﺣﺩﺩ‬
]
‫ﻟﺩﻯ‬
‫ﺑﺎﻟﺣﺿﻭﺭ‬
__________________________ [
‫ﺍﻟﻣﺳﺟّ ﻝ‬
‫ﺍﻟﻣﻣﺛﻝ‬
]
‫ﺍﻟﻭﺛﻳﻘﺔ‬
‫ﻫﺫﻩ‬
‫ﺑﻣﻭﺟﺏ‬
‫ﺃﻧﺎ‬
‫ﺃﻓﻭّ ﺽ‬
OATH Hearings Division
‫ﺁﻧ ﻔ ً ﺎ‬
.
‫ﻓﻘﻂ‬
‫ﺗﺄﺟﻴﻞ‬
‫ﻟﻄﻠﺐ‬
.
‫ﺍﻟﻤﺬﻛﻮﺭﺓ‬
(
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻭﺍﻣﺮ‬
)
‫ﻟﺤﻀﻮﺭ‬
‫ﺍ‬
‫ﺃﻣﺮ‬
/(
‫ﺍﻹﺷﻌﺎﺭﺍﺕ‬
)
‫ﺑﺎﻹﺷﻌﺎﺭ‬
‫ﺍﻟﻤﺘﻌﻠﻘﺔ‬
‫ﺍﻟﻤﺴﺎﺋﻞ‬
‫ﻛﻞ‬
‫ﻓﻲ‬
‫ﺃﻣﺮ‬
/(
‫ﺍﻹﺷﻌﺎﺭﺍﺕ‬
)
‫ﺍﻹﺷﻌﺎﺭ‬
‫ﻟﻘﺒﻮﻝ‬
.
‫ﻓﻘﻂ‬
‫ﺗﺴﻮﻳﺔ‬
/
‫ﺍﺗﻔﺎﻕ‬
‫ﺇﻟﻰ‬
‫ﻟﻠﺘﻮﺻﻞ‬
.
‫ﻓﻘﻂ‬
‫ﺟﺪﻭﻟﺔ‬
‫ﺇﻋﺎﺩﺓ‬
‫ﻟﻄﻠﺐ‬
.
‫ﻓﻘﻂ‬
(
‫ﺍﻟﺤﻀﻮﺭ‬
‫ﺃﻭﺍﻣﺮ‬
)
‫ﺍﻟﺤﻀﻮﺭ‬
._______________________________________:(
‫ﺍﻟﺗﻭﺿﻳﺢ‬
‫ﻳﺭﺟﻲ‬
)
‫ﺃﺧﺭﻯ‬
___________
__________________________
___
‫ﺍﻟﺘﺎﺭﻳﺦ‬
‫ﺍﻟﺘﻮﻗﻴﻊ‬
12/1/15