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    鏈�鏂版埧灞嬫媶杩佽ˉ鍋垮畨缃�鍗忚��涔︽棤璁烘槸鍦ㄥ啘鏉戝湴鍖鸿繕鏄�鍩庨晣鍦板尯杩涜�屾埧灞嬬殑鎷嗚縼锛岄兘蹇呴』瑕佸�硅��鎷嗚縼鎴峰仛濂藉悗鏈熺殑琛ュ伩瀹夌疆宸ヤ綔銆傛�ゆ椂鍙屾柟涔嬮棿涔熼渶瑕佺�捐��涓�浠芥埧灞嬫媶杩佽ˉ鍋垮畨缃�鍗忚��涔︺�備笅闈�锛屾垜浠�灏嗕负鎮ㄥ甫鏉ョ浉鍏冲崗璁�涔︿竴浠斤紝甯�鍔╀綘杩涜�屽叿浣撲簡瑙ｃ��
   鎴垮眿鎷嗚縼琛ュ伩瀹夌疆鍗忚��涔�
  鐢叉柟鍥犲缓璁鹃渶瑕侊紝椤绘媶闄や箼鏂逛娇鐢ㄧ殑鎴垮眿锛屾牴鎹�鍩庡競鎴垮眿鎷嗚縼瀹夌疆琛ュ伩娉曡�勩�佹斂绛栫殑鏈夊叧瑙勫畾锛岀敳涔欏弻鏂圭粡鍗忓晢锛屽氨鎴垮眿鎷嗚縼瀹夌疆琛ュ伩杈炬垚濡備笅鍗忚��銆�
   涓�銆侀」鐩�鍚嶇О銆佸湴鐐�
  寤鸿�鹃」鐩�鍚嶇О_______________锛屽缓璁惧湴鐐筥______________锛屽缓璁惧崟浣峗______________锛屻�婃媶杩佽�稿彲璇併�嬫枃鍙穇________銆�
   浜屻�佹埧灞嬪熀鏈�鐘跺喌
  1.涔欐柟鍦ㄦ媶杩佽寖鍥村唴鏈夋埧灞媉________闂达紝寤虹瓚闈㈢Н_________骞虫柟绫筹紝浣跨敤闈㈢Н_________骞虫柟绫筹紝灞呬綇闈㈢Н_________骞虫柟绫炽��
  2.涔欐柟鏈夋�ｅ紡鎴峰彛_________浜猴紝甯镐綇浜哄彛_________浜猴紝搴斿畨缃�浜哄彛_________浜猴紝鍒嗗埆鏄痏______________銆�
  3.琚�鎷嗚縼鎴垮眿鐨勪骇鏉冨睘浜巁_________________________________________銆�
   涓夈�佹媶杩佸畨缃�
  鐢叉柟瀹夌疆涔欐柟鐨勪綇鎴夸綅浜巁______________锛屽叡_________濂梍________闂达紝_________灞俖________鍙凤紝閰嶆湁_________绛夎�惧�囥��
   鍥涖�佹媶杩佽ˉ鍋�
  1.鎴垮眿鐨勮揣甯佽ˉ鍋块噾棰濅负浜烘皯甯乢______________鍏冩暣;
  2.闄勫睘鐗╄ˉ鍋块噾棰濅负浜烘皯甯乢______________鏁�;
  3.鎼�杩佽ˉ鍔╄垂涓轰汉姘戝竵_______________鍏冩暣;
  4.璁炬柦璁惧�囪縼绉昏垂涓轰汉姘戝竵_______________鍏冩暣;
  5.鍏朵粬璐圭敤涓轰汉姘戝竵_______________鍏冩暣銆�
   浜斻�佹惉杩�
  涔欐柟鍦╛________骞確________鏈坃________鏃ュ墠鎼�杩佽吘绌烘埧灞嬶紝缁忕敳鏂圭‘璁わ紝鏃ф埧鐢辩敳鏂规媶闄ゃ��
   鍏�銆佽ˉ鍋块噾棰濇敮浠樻椂闂村強鏂瑰紡
  鐢叉柟鍦╛________骞確________鏈坃________鏃ュ墠鎸夋湰鍗忚��绗�鍥涙潯瑙勫畾鐨勮ˉ鍋挎�婚�濅竴娆℃敮浠樼粰涔欐柟銆�
   涓冦�佹敞閿�
  涔欐柟搴斿湪_________骞確________鏈坃________鏃ュ墠鍚戠敳鏂圭Щ浜ゆ湁鍏虫埧灞嬨�佸湡鍦拌瘉浠讹紝鐢辩敳鏂圭粺涓�鍚戞埧绠°�佸湡鍦伴儴闂ㄥ姙鐞嗘敞閿�鎵嬬画
  琚�鎷嗚縼鎴垮眿鐨勬按銆佺數銆佺數璇濄�佹湁绾跨數瑙嗐�佸ぉ鐒舵皵绛夎縼绉汇�佽浆鎴枫�侀攢鎴锋墜缁�锛屼箼鏂硅嚜琛屽埌鏈夊叧閮ㄩ棬鐢宠�峰姙鐞嗭紝骞剁粨娓呭凡浣跨敤鐨勬按銆佺數銆佹皵绛夎垂鐢ㄣ��
   鍏�銆佷箼鏂瑰�跺涵鐨勫叏閮ㄦ垚鍛�(18宀佷互涓婅��)_________绛塤______浜轰竴鑷寸�惧瓧鍚屾剰_________浣滀负涔欐柟浠ｈ〃浜猴紝鎺堟潈浠�(濂�)鍦ㄥ崗璁�鏂囨湰鍜屽叾瀹冩枃浠朵笂绛惧瓧銆傜敳鏂逛粯缁欎箼鏂圭殑鍚勯」璐圭敤锛屼竴寰嬬敱涔欐柟浠ｈ〃浜篲________棰嗗彇銆傜敳鏂瑰�逛箼鏂瑰�跺涵鎴愬憳涓�鍙戠敓涓庢媶杩佹埧灞嬫湁鍏崇殑鍒嗗�舵瀽浜с�佺户缁�绾犵悍绛夛紝涓�寰嬩笉璐熻矗浠汇��
   涔濄�佽繚绾﹁矗浠�
  鐢叉柟濡備笉鎸夊崗璁�瑙勫畾鐨勬棩鏈熷悜涔欐柟浜や粯鍚勭�嶈垂鐢�锛岄�炬湡涓�鏃ワ紝搴旀寜鎵�娆犳�鹃�濈殑______%鍚戜箼鏂瑰伩浠樿繚绾﹂噾;鐢叉柟濡備笉鎸夊崗璁�瑙勫畾鐨勫湴鐐瑰拰闈㈢Н銆佸眰娆＄粰涔欐柟瀹夌疆浣忔埧锛屽簲鍚戜箼鏂瑰伩浠榑________鍏冪殑杩濈害閲戯紝涔欐柟鍙�浠ュ悜鏈夌�¤緰鏉冪殑娉曢櫌璧疯瘔锛岃�佹眰鐢叉柟鎸夊崗璁�灞ヨ�屼箟鍔°��
  涔欐柟濡傜粡鐢叉柟鎸夊崗璁�瑙勫畾瀹夌疆浣忔埧鍚庯紝浠嶆嫆涓嶆惉杩佺殑锛岀敱鐢叉柟鐢宠�峰綋鍦版埧鍦颁骇绠＄悊閮ㄩ棬瀵逛箼鏂归檺鏈熸惉鍑猴紝濡傞�炬湡浠嶄笉鎼�杩佺殑锛屾瘡閫炬湡涓�鏃ワ紝搴斿悜鐢叉柟鍋夸粯杩濈害閲� _________鍏冿紝鐢叉柟骞跺彲鍚戞湁绠¤緰鏉冪殑浜烘皯娉曢櫌璧疯瘔銆備箼鏂瑰�傞亣闃撮洦澶╂垨鍏跺畠涓嶅彲鎶楀姏鍘熷洜涓嶈兘鎸夋椂鎼�杩侊紝鏃堕棿椤哄欢锛屼絾蹇呴』鍛婄煡鐢叉柟鎯呭喌銆�
   鍗併�佸０鏄庡強淇濊瘉
  1.鐢叉柟涓轰竴瀹朵緷娉曡�剧珛骞跺悎娉曞瓨缁�鐨勪紒涓氾紝鏈夋潈绛剧讲骞舵湁鑳藉姏灞ヨ�屾湰鍗忚��銆�
  2.鐢叉柟绛剧讲鍜屽饱琛屾湰鍗忚��鎵�闇�鐨勪竴鍒囨墜缁璤________鍧囧凡鍔炲Ε骞跺悎娉曟湁鏁堛��
  3.鍦ㄧ�剧讲鏈�鍗忚��鏃讹紝浠讳綍娉曢櫌銆佷徊瑁佹満鏋勩�佽�屾斂鏈哄叧鎴栫洃绠℃満鏋勫潎鏈�浣滃嚭浠讳綍瓒充互瀵圭敳鏂瑰饱琛屾湰鍗忚��浜х敓閲嶅ぇ涓嶅埄褰卞搷鐨勫垽鍐炽�佽�佸畾銆佽�佸喅鎴栧叿浣撹�屾斂琛屼负銆�
  4.鐢叉柟涓虹�剧讲鏈�鍗忚��鎵�闇�鐨勫唴閮ㄦ巿鏉冪▼搴忓潎宸插畬鎴愶紝鏈�鍗忚��鐨勭�剧讲浜烘槸鐢叉柟鐨勬硶瀹氫唬琛ㄤ汉鎴栨巿鏉冧唬琛ㄤ汉銆傛湰鍗忚��鐢熸晥鍚庡嵆瀵瑰崗璁�鍙屾柟鍏锋湁娉曞緥绾︽潫鍔涖��
   鍗佷竴銆佷繚瀵�
  鍙屾柟淇濊瘉瀵逛粠鍙︿竴鏂瑰彇寰椾笖鏃犳硶鑷�鍏�寮�娓犻亾鑾峰緱鐨勫晢涓氱�樺瘑(鎶�鏈�淇℃伅銆佺粡钀ヤ俊鎭�鍙婂叾浠栧晢涓氱�樺瘑)浜堜互淇濆瘑銆傛湭缁忚�ュ晢涓氱�樺瘑鐨勫師鎻愪緵鏂瑰悓鎰忥紝涓�鏂逛笉寰楀悜浠讳綍绗�涓夋柟娉勯湶璇ュ晢涓氱�樺瘑鐨勫叏閮ㄦ垨閮ㄥ垎鍐呭�广�備絾娉曞緥銆佹硶瑙勫彟鏈夎�勫畾鎴栧弻鏂瑰彟鏈夌害瀹氱殑闄ゅ�栥�備繚瀵嗘湡闄愪负_________骞淬��
  涓�鏂硅繚鍙嶄笂杩颁繚瀵嗕箟鍔＄殑锛屽簲鎵挎媴鐩稿簲鐨勮繚绾﹁矗浠诲苟璧斿伩鐢辨�ら�犳垚鐨勬崯澶便��
   鍗佷簩銆佷笉鍙�鎶楀姏
  鏈�鍗忚��鎵�绉颁笉鍙�鎶楀姏鏄�鎸囦笉鑳介�勮�侊紝涓嶈兘鍏嬫湇銆佷笉鑳介伩鍏嶅苟瀵逛竴鏂瑰綋浜嬩汉閫犳垚閲嶅ぇ褰卞搷鐨勫�㈣�備簨浠讹紝鍖呮嫭浣嗕笉闄愪簬鑷�鐒剁伨瀹冲�傛椽姘淬�佸湴闇囥�佺伀鐏惧拰椋庢毚绛変互鍙婄ぞ浼氫簨浠跺�傛垬浜夈�佸姩涔便�佹斂搴滆�屼负绛夈��
  濡傚洜涓嶅彲鎶楀姏浜嬩欢鐨勫彂鐢熷�艰嚧鍗忚��鏃犳硶灞ヨ�屾椂锛岄亣涓嶅彲鎶楀姏鐨勪竴鏂瑰簲绔嬪嵆灏嗕簨鏁呮儏鍐典功闈㈠憡鐭ュ彟涓�鏂癸紝骞跺簲鍦╛________澶╁唴锛屾彁渚涗簨鏁呰�︽儏鍙婂崗璁�涓嶈兘灞ヨ�屾垨鑰呴渶瑕佸欢鏈熷饱琛岀殑涔﹂潰璧勬枡锛屽弻鏂硅�ゅ彲鍚庡崗鍟嗙粓姝㈠崗璁�鎴栨殏鏃跺欢杩熷崗璁�鐨勫饱琛屻��
   鍗佷笁銆侀�氱煡
  1.鏍规嵁鏈�鍗忚��闇�瑕佸彂鍑虹殑鍏ㄩ儴閫氱煡浠ュ強鍙屾柟鐨勬枃浠跺線鏉ュ強涓庢湰鍗忚��鏈夊叧鐨勯�氱煡鍜岃�佹眰绛夛紝蹇呴』鐢ㄤ功闈㈠舰寮忥紝鍙�閲囩敤_________(涔︿俊銆佷紶鐪熴�佺數鎶ャ�佸綋闈㈤�佷氦绛�)鏂瑰紡浼犻�掋�備互涓婃柟寮忔棤娉曢�佽揪鐨勶紝鏂瑰彲閲囧彇鍏�鍛婇�佽揪鐨勬柟寮忋��
  2.鍚勬柟閫氳��鍦板潃濡備笅锛歘_______________________________________________銆�
  3.涓�鏂瑰彉鏇撮�氱煡鎴栭�氳��鍦板潃锛屽簲鑷�鍙樻洿涔嬫棩璧穇____鏃ュ唴锛屼互涔﹂潰褰㈠紡閫氱煡瀵规柟;鍚﹀垯锛岀敱鏈�閫氱煡鏂规壙鎷呯敱姝よ�屽紩璧风殑鐩稿簲璐ｄ换
   鍗佸洓銆佷簤璁�鐨勫�勭悊
  (涓�)鏈�鍗忚��鍙梍________鍥芥硶寰嬬�¤緰骞舵寜鍏惰繘琛岃В閲娿��
  (浜�)鏈�鍗忚��鍦ㄥ饱琛岃繃绋嬩腑鍙戠敓鐨勪簤璁�锛岀敱鍙屾柟褰撲簨浜哄崗鍟嗚В鍐筹紝涔熷彲鐢辨湁鍏抽儴闂ㄨ皟瑙�;鍗忓晢鎴栬皟瑙ｄ笉鎴愮殑锛屾寜涓嬪垪绗琠_________绉嶆柟寮忚В鍐筹細
  1.鎻愪氦_________浠茶�佸�斿憳浼氫徊瑁�;
  2.渚濇硶鍚戜汉姘戞硶闄㈣捣璇夈��
   鍗佷簲銆佽В閲�
  鏈�鍗忚��鐨勭悊瑙ｄ笌瑙ｉ噴搴斾緷鎹�鍗忚��鐩�鐨勫拰鏂囨湰鍘熶箟杩涜�岋紝鏈�鍗忚��鐨勬爣棰樹粎鏄�涓轰簡闃呰�绘柟渚胯�岃�撅紝涓嶅簲褰卞搷鏈�鍗忚��鐨勮В閲娿��
   鍗佸叚銆佽ˉ鍏呬笌闄勪欢
  鏈�鍗忚��鏈�灏戒簨瀹滐紝渚濈収鏈夊叧娉曞緥銆佹硶瑙勬墽琛岋紝娉曞緥銆佹硶瑙勬湭浣滆�勫畾鐨勶紝鐢蹭箼鍙屾柟鍙�浠ヨ揪鎴愪功闈㈣ˉ鍏呭崗璁�銆傛湰鍗忚��鐨勯檮浠跺拰琛ュ厖鍗忚��鍧囦负鏈�鍗忚��涓嶅彲鍒嗗壊鐨勭粍鎴愰儴鍒嗭紝涓庢湰鍗忚��鍏锋湁鍚岀瓑鐨勬硶寰嬫晥鍔涖��
   鍗佷竷銆佸崗璁�鏁堝姏
  鏈�鍗忚��鑷�鍙屾柟鎴栧弻鏂规硶瀹氫唬琛ㄤ汉鎴栧叾鎺堟潈浠ｈ〃浜虹�惧瓧骞跺姞鐩栧叕绔犱箣鏃ヨ捣鐢熸晥銆傛湁鏁堟湡涓篲______骞达紝鑷猒_____ 骞確_____鏈坃_____鏃ヨ嚦______骞確____鏈坃____鏃ャ�傛湰鍗忚��姝ｆ湰涓�寮廮____浠斤紝鍙屾柟鍚勬墽_____浠斤紝鍏锋湁鍚岀瓑娉曞緥鏁堝姏;鍗忚��鍓�鏈琠____浠斤紝閫乢_______鐣欏瓨涓�浠�
  鐢叉柟(鐩栫珷)锛歘____________銆�銆�涔欐柟(鐩栫珷)锛歘___________
  鎺堟潈浠ｈ〃(绛惧瓧)锛歘________銆�銆�鎺堟潈浠ｈ〃(绛惧瓧)锛歘_______
  _________骞確_____鏈坃_____鏃ャ��銆�________骞確_____鏈坃_____鏃�
  绛捐�㈠湴鐐癸細_________________銆�銆�绛捐�㈠湴鐐癸細________________
  鍏朵腑闇�瑕佽�︾粏璇存槑鎷嗚縼鐨勬儏鍐碉紝浠ュ強鏄�濡備綍瀵硅��鎷嗚縼鎴蜂綔鍑鸿ˉ鍋跨殑锛屽弻鏂瑰繀椤昏�佸湪骞崇瓑銆佽嚜鎰跨殑鍩虹��涔嬩笂绛捐�㈣�ュ崗璁�銆傝�佹槸鍦ㄨ繖鏂归潰閬囧埌浜嗕粈涔堥棶棰樼殑璇濓紝鍙�浠ョ洿鎺ユ潵鐢靛挩璇㈡垜浠�鐨勫湪绾垮緥甯堛��