tag:blogger.com,1999:blog-17414445998326583842024-03-24T11:50:41.464-07:00Dilekçe, dilekçe örnekleri, dilekçe örneği, dilekçe nasıl yazılır, savcılık dilekçe örneğiöğrenci dilekçeleri,savcılık şikayet dilekçesi örneği,savcılığa suç duyurusu dilekçe örneği,savcılık suç duyurusu.http://www.blogger.com/profile/00725884503979681550noreply@blogger.comBlogger50125tag:blogger.com,1999:blog-1741444599832658384.post-31851541662842709622023-11-04T13:13:00.002-07:002023-11-04T13:13:21.901-07:00Elden ödenen kira bedeli kabul olur mu<p> Elden yapılan kira ödemeleri ispat yükü açısından zor olduğundan icra mahkemesince kabul edilmemektedir. Yargıtay kararlarında belirtildiği üzere kira bedelleri banka kanalı ile yapılmalı ve masraf kesilirse kiracı ödemelidir. İcra iflas kanunu 68. Maddesindeki belgelerden biri elinde olmayan kiracı ödeme yaptığını iddia etse de tahliye kararı verilecektir. İcra hukuk mahkemelerine açılan kiralananın tahliyesi davasinda tanık dinletebilecek davalardan olmaması nedeniyle ve WhatsApp yazışmaları gibi basit belgeler de icra iflas kanunu madde 68 de sayılan belgelerden olmadığı için delil olarak kabul edilmemektedir. Bu bağlamda kiracı tarafından yapılan ödemeler banka kanalı veya benzeri resmi belgeler ile iş yeri için fatura/makbuz kesilerek ticari defterlere işletilmesi ispat yükü açısından kolaylık sağlayacaktır.</p>.http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0tag:blogger.com,1999:blog-1741444599832658384.post-23542813350523983362019-01-26T01:02:00.000-08:002019-01-26T01:02:40.187-08:00Karşılıksız çek keşide etme şikayet dilekçesi örneğiÇek kanununda yapılan değişiklik sonrası son olarak yetkili olarak İcra Ceza Mahkemeleri belirlenmiştir.<br />
Çeki bankaya ibraz eden alacaklı, çekin karşılığını alamadığı takdirde icra ceza mahkemesine bir dilekçe ile başvurarak çek keşide eden şirketin/şirket yetkilisinin cezalandırılmasını talep edebilir.<br />
Ayrıca 5941 sayılı kanunun 5. maddesi ve fırkalarına göre çek keşide eden kişinin/şirketin hakkında çek düzenleme ve çek hesabı açma yasağı da talep edilebilmektedir. Bu durumda mahkeme çeki keşide eden ilgiler hakkında Türkiye Bankalar Birliği Risk Merkezi'ne elektronik ortamdan bildirim yapmaktadır. Böylelikle; çek keşide eden kişi hakkında bir nevi caydırıcı olması amacıyla çek keşidecesine ya borcunu ödersin ya da bundan sonra çek düzenlemekten men edilirsin denilmektedir.<br />
Öte yandan karşılıksız çek keşide etme suçunda öncelikle adli para cezası çıkmaktadır.<br />
Adli para cezası nasıl uygulanıyor?<br />
Örneğin bir karşılıksız çek düşünelim. Bedeli 50.000 (Elli Bin) Türk Lirası olsun.<br />
Bu çeki alacaklı taraf bankaya ibraz etti ve karşılıksız olduğu çek arkasına banka tarafından yazıldı.<br />
Genellikle 1500-2000 TL arası banka sorumluluk bedeli ödendikten sonra geriye kalan kısım diyelim ki 48.000 TL karşılıksız kaldı. Bu durumda Mahkeme Hakimi takdirine bağlı olmak üzere her günü 100 TL den olmak üzere 480 gün hapis cezası çıkmaktadır. 480 gün hapis cezası adli para cezasına döndürülerek 48.000 TL adli para cezasına çevrilmektedir.<br />
Çek keşide eden kişinin cezası kesinleştiğinde Cumhuriyet Başsavcılığı İnfaz Bürosu bir ödeme emri göndererek sanığa para cezasını ödemesini emrediyor ve genellikle 10 gün müddet veriliyor. Bu süre içerisinde para cezasını ödemeyen sanık 480 gün hapis yatmak zorunda kalıyor.<br />
Burada başka bir sorun olarak ortaya çıkan durum; adli para cezasını ödeyince borcun ortadan kalkıp kalmadığıdır. Adli para cezası mahkemenin verdiği bir karar olduğu için adli para cezasını ödemek borçluyu borcundan kurtarmıyor. Alacaklıya ödeme yapılmadığı sürece sanık borcundan kurtulamıyor.<br />
Zaten genellikle önce icra takibi yapılıp sonra karşılıksız çek suçuna ilişkin şikayet yapılmaktadır.<br />
Çek bedelini alacaklıya ödeyen borçlu hakkındaki ceza mahkemesi kararının düşmesini sağlamak için müştekiye bu durum bildirip şikayetinden vazgeçmesini talep edebilir.<br />
Görüldüğü üzere ticari hayatın devamlılığını sağlamak için sonra derece etkili bir yasa düzenlemesi yapılmıştır.<br />
çek keşide eden kişi borcunu ödemediği takdirde adeta borcu ikiye katlanmaktadır.<br />
Bazı çek keşidecileri borcunu alacaklıya değilde adli para cezası olarak İnfaz Bürosuna ödemektedir. Bu durumda hapis cezasından kurtulabilir ama borçtan kurtulamaz. Bu durumda en iyi seçenek alacaklı ile anlaşarak borcun tamamının kapatılarak temize çıkılmasıdır.<br />
NOT: çekin bankaya ibrazından 3 ay içinde şikayeti zorunlu olup bu süre dışında yapılan şikayetler mahkemelerce red edilebilmektedir.<br />
DİLEKÇE ÖRNEĞİ:<br />
<b style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;">...........İCRA CEZA MAHKEMESİNE</b><br style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;" /><b style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;"><br /></b><span style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;"></span><b style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;">Müşteki: adı soyadı, t.c no adres:</b><br style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;" /><b style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;">vekili: avukatı varsa ismi yazılır.</b><br style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;" /><b style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;">Şüpheli: adı,soyadı,t.c no. adres</b><br style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;" /><b style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;">vekili: avukatı varsa ismi yazılır.</b><br style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;" /><b style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;">Suç:Karşılıksız çek keşide etmek, (5941 sayılı çek kanunu madde 5/1)</b><br style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;" /><b style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;">Suç tarihi:01/01/2019</b><br style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;" /><b style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;"><br /></b><span style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;"></span><b><span style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;">AÇIKLAMALAR:</span><br style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;" /><span style="color: #666666; font-family: Trebuchet MS, Trebuchet, sans-serif;"><span style="background-color: white; font-size: 13px;">şüpheli tarafından keşide edilen ......bankasının .. numaralı, keşide tarihli, ...tl bedeli çeki keşide etmiştir. çeki ...tarihinde banka ibraz ettiğimizde karşılıksız olduğu banka tarafından şerh düşülmüştür.</span></span></b><div>
<b>5941 sayılı kanunun 5/1 maddesi uyarıca karşılıksız çek keşide eden sanığın cezalandırılmasını ve hakkında çek hesabı açma ve çek düzenleme yasağı konulmasını, yargılama giderinin sanık üzerine bırakılmasına karar verilmesini <span style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;">saygılarımla arz ve talep ederim. .01/01/2019</span></b><br style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;" /><b style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;"> ...............</b><br style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;" /><b style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;"> Ad-Soyad imza </b><br style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;" /><b style="background-color: white; color: #666666; font-family: "Trebuchet MS", Trebuchet, sans-serif; font-size: 13px;"> Müşteki </b> </div>
.http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0tag:blogger.com,1999:blog-1741444599832658384.post-12658113548703019462019-01-11T10:34:00.001-08:002019-01-11T10:34:24.912-08:00Uzun süren yargılamalar için kurulan Adalet Bakanlığı insan hakları tazminat komisyonuAnayasa mahkemesince son zamanlarda verilen kararlarda uzun süren yargılamalar nedeniyle adil uargyargıl hakkinin ihlal edildiğinden bahisle başvurular reddedilmektedir. Çünkü öncesinde Avrupa insan hakları mahkemesi tarafından da iç hukuk yolu olarak gosterilen Adalet bakanlığı tazminat komisyonu bu gorevi ustlenmis durumdadir. Başvurular 9 ayda sonuçlandırılması hedeflenmiş, Anayasa mahkemesine göre neredeyse 3 kat hızlı karar çıkmaktadır. Komisyona başvuru ucretsiz okup sitedeki matbu dilekçe örneğine gerekli bilgiler ve aciklamalar isiginda en yakın savcılık araciligi ile basvuruda bulunabilirsiniz. Posta ucreti de yok!.http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0tag:blogger.com,1999:blog-1741444599832658384.post-33183769465696147972018-01-26T11:35:00.004-08:002018-01-26T11:35:54.166-08:00dosyadan fotokopi alma dilekçe örneği..........MAHKMESİNE<br />
Dosya No:<br />
<br />
Yukarıda yazılı dosyada davacı/davalı olarak bulunmaktayım. Dosyanın bir fotokopisinin tarafıma verilmesini saygılarımla arz ederim.<br />
AD SOYAD İMZA TARİH<br />
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<br />
<br />.http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0tag:blogger.com,1999:blog-1741444599832658384.post-89444795098286346942017-07-17T10:31:00.002-07:002017-07-17T10:31:55.981-07:00Nafakanın ödenmemesi 3 aya kadar hapis cezası ile cezalandırılır.<b>Tarafların boşanması sonrası Aile Mahkemesinden verilen boşanma kararı ile nafaka, velayet, maddi-manevi tazminat gibi konularda kararlar verilmektedir.</b><br />
<b>Verilen bu kararları sorumlu tarafın ödememesi halinde icra takibi yapılarak alacağın tahsili talep edilebilir.</b><br />
<b>Bunlardan birisi de nafakanın ödenmemesine ilişkin anlaşmazlıklardır. Alacaklı taraf nafaka bedelinin ödenmemesini İcra Ceza Mahkemesine vereceği bir şikayet dilekçesi ile talep edebilir. Aile Mahkemesi kararının dilekçe ekine eklenmesi ve icra dosya numarası belirtilmesi yeterlidir.</b><br />
<b>Geriye dönük 6 ay lık nakafa alacağı şikayet edilebilir. yapılacak şikayetler 3 er aylık dilimlerle de olabilir aylık ta olabilir. bu tamamen müştekinin insiyatifindedir. Nafakadan verilen hapis cezası şüphelinin nafaka bedeli ödemesi sonucunda ortadan kalkar. yapılacak ödeme mutlaka icra müdürlüğü hesabına açıklama yapılarak ödenmelidir. nafaka ödenmediği sürece sanık 3 aylık cezasını infaz eder. bu cezada erteleme ve benzeri gibi durumlar söz konusu değildir. çünkü verilen hapis cezası bir nevi disiplin hapsidir. zaten kısa süreli olduğu için erteleme vb. gibi durumlar olması halinde caydırıcılığı kalmayacağı için kanunun bu şekilde düzenlendiği düşünülmektedir. nafaka ödemesi yapılırken açıklamaya hangi aya ilişkin nafaka bedeli ödeniyorsa yazılmalıdır. mesala 2017 ocak nafaka ödemesi gibi. şikayet konusu aylar açıklamaya yazılarak ödeme yapılmaz ise sanık tahliye edilmeyebilir. alacaklı-borçlu kendi arasında ödemeyi alıyorsa mutlaka bu ödemelerdede açıklama kısmına nafaka ödemesi olduğu belirtilmelidir.</b><br />
<b><br /></b>
<b>Dilekçe örneği</b><br />
<b><br /></b>
<b>...........İCRA CEZA MAHKEMESİNE</b><br />
<b><br /></b>
<b>Müşteki: adı soyadı, t.c no adres:</b><br />
<b>vekili: avukatı varsa ismi yazılır.</b><br />
<b>Şüpheli: adı,soyadı,t.c no. adres</b><br />
<b>vekili: avukatı varsa ismi yazılır.</b><br />
<b>Suç:Nafaka hükümlerine uymamak, (icra iflas kanunu madde 344/1)</b><br />
<b>Suç tarihi:01/01/2017</b><br />
<b><br /></b>
<b>AÇIKLAMALAR:</b><br />
<b>...........Aile Mahkemesinin 2017/1 esas, 2017/1 karar sayılı ilamı ile boşanma kararı verilmiştir. Boşanma kararında hükmedilen ... TL nafakanın ödenmemesi nedeniyle ......icra müdürlüğünün 201/... esas sayılı dosyası ile icra takibi yapılmasına rağmen şüpheli 2017 yılı ocak şubat mart aylarına ilişkin nafaka bedellerini ödememiştir.</b><br />
<b>Beliritlen aylara ilişkin nafaka bedellerini ödemeyen sanığın İ.İ.K 344/1. maddesi uyarınca cezalandırılmasını saygılarımla arz ve talep ederim. .01/01/2017</b><br />
<b> ...............</b><br />
<b> Ad-Soyad imza </b><br />
<b> Müşteki </b><br />
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<br />.http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0tag:blogger.com,1999:blog-1741444599832658384.post-72122050516923859242017-01-05T01:46:00.002-08:002017-01-05T01:46:39.395-08:00Bireysel emeklilik sisteminden (BES) cayma(çıkma) dilekçe örneğiBilindiği gibi 01.01.2017 tarihinde resmi gazete yayınlanan yönetmeliğe göre 45 yaş altı çalışan herkes özel sektör veya kamu sektörü farkı gözeltilmeden bireysel emeklilik sistemine kademeli olarak dahil edilecek. Uygulamayı desteklemekle birlikte alt gelir grubunda itiraza yol açtığı gözlemlenmektedir. Bundan dolayı bireysel emeklilik sisteminden cayma (çıkma) hususu sürekli dillendirilmektedir.<br />
Bu hususta dilekçenizi kurumunuzun maaş mutemeliğine muhasebesine veya idari işlemleri yürüten kısıma vermeniz gerekmektedir. Ayrıca mevcut.Bes uyesi.olanlarda bu sisteme dahil edilecektir. Hiçkimse benim bes uyeligim var beni dahil etmezler diye düşünmesin<br />
Yasal süre icinde eger cayma hakkini.kullanamazssanız bir daha cayma.hakkınız yok. 2 tane ayrı bes ödemek zorunda kalabilirsiniz.<br />
..... kurumu maas mutemetliğine<br />
01.01.2017 de resmi.gazetede yayinlanarak yürürlüğe giren zorunlu bireysel emeklilik sistemine dahil edildim. 2 aylıkYasal süre içerisinde cayma hakkımı kullandığımı bildirir sistemenden çıkarılmami saygılarımla arz ederim.<br />
Ad soyad tarih imza.<br />
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Mümkünse 2 suret hazırlayın dilekceyi ve bir suret teslim ettiginiz kişiden kaşe tarih isim soy isim imza tarih alın ki ileride çıkacak olasi sorunlarda elinizde bir belge bulunsun.<br />
Aklınıza takılan soruları yorum olarak sorabilirsiniz..http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0tag:blogger.com,1999:blog-1741444599832658384.post-1218764630494240702016-10-21T13:27:00.000-07:002016-10-21T13:27:10.792-07:00İcra takibine borca faize imzaya kira takibine vb. konularda itiraz dilekçesiBilindiği gibi icra takipleri genelde bir borç yüzünden alacaklı tarafından yapılan bir işlemdir. Alacaklı alacağını talep ederken doğru yol izlemelidir. Bunun içinde işin ehli meslek erbabı kişilerden yardım almalıdır. Eğer yardım alınmadan icra takibi yapılırsa bazen hem alacaklı taraf hem borçlu taraf mağduriyet yaşayabilir. Alacaklı alacağını talep ederken öncelikle asıl alacağını talep eder. Bir örnek verecek olursak;<br />
Alacaklınin elinde 20.000 tl değerinde bir çek yada senet mevcutsa ve ödeme tarihinin üzerinden 1 gün gectiyse icra takibi yapma hakkı doğmaktadır. Eğer daha çok zaman geçtiyse geçen zaman kadar faiz talep edebilir. Bu faizin adı reeskont avans faizidir. Yani ticari faizdir. Eğer borçlu faizin çok yüksek olduğunu düşünüyorsa faize itiraz edebilir ancak faize itirazın iki yönü vardır. Birincisi; eğerki borçluya ödeme emri tebliği yapıldıysa ve itiraz süresi dolmadıysa hem takipten önceki işlemiş faize hemde takipten sonraki geçecek süredeki işleyecek faize itiraz edebilir. Eğer ki tebliğden itibaren itiraz süresini geçirmişse bu durumda işlemiş faizi kabul etmiş sayılır. Ancak borçlunun halen faize ilişkin bir şansı mevcuttur. Ancak bu şans sınırlıdır. Çünkü Bu itirazı takipten sonraki işleyecek faize yapabilir. Takipten sonraki işleyecek faize itirazda bir süre yoktur. Dosya borcu ödenene kadar icra mahkemesine açılacak bir dava ile bu itiraz dile getirilir. Mahkeme genelde dosyayı bilirkişiye hesaplatırırır ve gerçekten talep edilen faiz fazla ise ve borçlunun davası kabul olursa bilirkişi masrafları, harç, avukatlık ücreti vb gibi yargılama giderleri karşı tarafa yüklenir.<br />
İcra takiplerinde genelde ilamsız takiple yapılır. Bu tür takiplerde borçluya örnek 7 ödeme emri gider. Bir icra takibinin ilamsız olduğunu ödeme emrinin sağ üst köşesinde yazan koddan anlarız. Yani örnek 7 den.<br />
Örnek 7 ile yapılan ilamsız icra takibinde borca faize vb. gibi itirazlar icra müdürlüğündeki icra dosyasına verilecek bir itiraz dilekçesiyle mümkündür. Borçlu neye itiraz ediyorsa açıkça dilekçeye yazmalıdır. Mesala faizin fazla talep edildiğini tespit ettiyse faize, takip yetkisiz icra müdürlüğünde yapıldıysa yetkiye itiraz etmelidir. Aksi takdirde haksız yere şekil amacıyla yapılan itirazlarda alacaklı tarafça icra mahkemesine itirazın kaldırılması davası açıldığında yapılan itiraz yersiz ise %20 oranında icra inkar tazminatı ve mahkemedeki yargılama giderleri ödemekle cezalandırılır.<br />
%20 icra inkar tazminatı nedir? Diyelimki asıl alacak 20.000 tl. Borçlu haksız yere itiraz ettiyse alacaklı açtığı davada asıl alacağın yani 20.000 tl nin %20 si kadar icra inkar tazminatı talep edebilir. Mahkeme icra inkar tazminatına hükmettiğinde 20.000 tl lik borç 24.000 tl olur. Ayriyeten avukatlik ücretleri yargılama giderleri harç posta masraflarınıda ödemeye mahkum edilir. Bu sebeple borçlu yapacağı itirazda dikkatli olmalıdır.<br />
Bir başka sık yapılan takip türü kambiyo senetlerine özgü takiptir. Yani örnek 10 takibi. Bu takiplerde alacağın dayanağı çek,senet,bono gibi kıymetli evraklara dayandırılır. Borçlu örnek 10 ile yapılan takiplerde itirazını icra müdürlüğüne değil icra mahkemesine açacağı bir dava ile yapmalıdır. Aksi takdirde magduriyetlere sebep olabilir. Çünkü örnek 10 ile yapılan kambiyo senetlerine özgü icra takibinde icra müdürlüğünün itirazı değerlendirme yetkisi yoktur. Burada görevli icra mahkemesidir. Bu hususa dikkat edilmelidir.<br />
Bir başka takip yolu örnek 4-5 ile yapılan ilamlı icra takibidir. İlamlı icrada takip dayanağı bir mahkeme kararıdır genellikle. Veya mahkeme kararı niteliğinde bir karardır. Mesala tüketici hakem heyetinin verdiği bir kararın icrası için örnek4-5 ödeme emri düzenlenip borcluya gönderilir. İlamlı takiptede itiraz icra mahkemelerine yapılır.<br />
Örnek 13 kira alacağına ilişkin takiplerde itiraz icra müdürlüğüne yapılır. Kira borcu ödeme emri tebliğinden itibaren 30 gün içinde ödenmesse alacaklı icra mahkemesinde ya da sulh hukuk mahkemesinde tahliye davası açabilir. Dava sonuçlandığında tahliyeye hükmedilirse cebri icra yoluyla borçluyu evinden tahliye eder. Yani icra müdürlüğünce adrese gidilir borcluya ait eşyalar yedi emine veya musait bir yere taşınır. Burada yapılacak masraflar borclu tarafa yüklenir. O sebeple kiracı bu durumu göz önüne alarak tshliye işlemini kendisi yaparsa yararına olur.<br />
Şimdilik yazı dizisine burada son veriyorum. Sorusu olan yorum yoluyla sorabilir..http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0tag:blogger.com,1999:blog-1741444599832658384.post-5753406465664525122014-06-28T04:43:00.000-07:002014-06-28T04:46:22.455-07:00kredi tahsis ücreti masrafını iade alma dilekçesi<b>İl ve ilçelerde tüketici hakem heyetlerine başvurarak çektiğiniz ihtiyaç, taşıt, konut ve diğer kredilerden kesilen tahsis ücretini iade almak mümkündür. kredi çektiğiniz banka size mutlaka bir suret vermiştir.
o surette ne kadar tahsis ücreti kesildiği yazar.
Veya internet bankacılığınız var ise hesap hareketlerinden bu kesintiyi görebilirsiniz.
Daha sonra dilekçe ile başvuruda bulunup kesilen tahsis ücretini iade alabiliyorsunuz.
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Örnek,
<blockquote>..........Kaymakamlık/Valilik makamı
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Tüketici Hakem Heyeti Başkanlığına
......Seyhan/Adana
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xx bankasından 2011 yılı eylül ayında xxxxx tl ihtiyaç/konut/taşıt kredisi çektim. Ekte sunduğum surette kesilen xxx tl tahsis ücretinin tarafıma iade edilmesine karar verilmesini saygılarımla arz ederim.
..
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Ad soyad
İmza T.c No
Kimlik fotokopisi
Adres
Telefon no.</blockquote>
</b>.http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0tag:blogger.com,1999:blog-1741444599832658384.post-59561225726181698902012-10-17T12:41:00.000-07:002012-10-17T12:41:11.237-07:00Adalet M.Y.O hakkında bilgiler<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;">Açıköğretim fakültesi adalet meslek yüksek okulundan mezun olan bir kişi hukuk ve hukukun temel kavramlarının yaklaşık olarak yüzde 70 ini öğrenmiş olurlar.Dikey geçiş sınavı ile hukuk fakültesine geçme imkanı da vardır. Ön lisans mezunu olarak KPSS ataması ile başta Adalet Bakanlığı'na bağlı il ve ilçeler de ki adliyeler de zabıt katibi, icra müdürü, icra müdür yardımcısı olma imkanına sahiptirler. Bunun yanı sıra memur ünvanı ile diğer devlet dairelerine de atanma şansı mevcuttur. Eski sistemde yani kredisiz sistemde adalet bölümünde 2 yılda toplam 16 ders okutulurken şimdi yeni kredili sistemde 2 yılda toplam 32 ders okutulacaktır.Öğrenciler güz ve bahar dönemi olmak üzere iki kayıt dönemi kayıt yaptıracaklardır.Her dönemde 8 ders ve 2 sınav olacaktır.Vize ve final sınavlarıdır.Genel ortalaması yıl sonunda 2.00 olmayan öğrenciler CC altında olan derslerden tekrar sorumlu olacaklardır.</span><br style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;" /><span style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;">Kredili sistem nedir? Ne Değildir?</span><br style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;" /><span style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;">Arkadaşlar aşağıdaki metni okuduktan sonra kredili sisteme dair kafanızdaki tüm soruları cevaplamış olacaksınız.</span><br style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;" /><span style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;">Bu sistemde, dersler, yıl hesabına göre düzenlenir. Kredi değerleri, ön koşulları ve yıllara göre dağılımı Fakülte Kurulu kararı ve Senatonun onayı ile belirlenir.</span><br />
<span style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;">Devamı için;</span><br />
<span style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;"><a href="http://acikogretimadalet.blogspot.com/2011/11/ackogretim-fakultesi-adalet-meslek.html">Açıköğretim Adalet MYO hakkında geniş bilgiler</a></span></div>
.http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0tag:blogger.com,1999:blog-1741444599832658384.post-86750744213908682982012-10-17T12:39:00.000-07:002012-10-17T12:39:20.128-07:00Zabıt katibi olmanin şartlari nelerdir?<div dir="ltr" style="text-align: left;" trbidi="on">
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<b><span style="font-family: Arial, Helvetica, sans-serif;"><i>Zabıt Katipliği Hakkında Bilgiler:</i></span></b></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;">Zabıt Katibi kısa adıyla katiplik diğer adıyla yazıcı anlamına gelir. Zabıt katibi kadrolu devlet memuru olarak veya kadro karşılığı sözleşmeli yani 4bli olarak istihdam edilir.Her yıl düzenli olarak az veya çok zabıt katibi alımı Adalet Bakanlığınca ilgili il merkezlerinde ve bazı ağır ceza mahkemesi yani adalet komisyonu olan ilçelerde yapılır.</span></b></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;"><i>Zabıt katibi olmanın bazı özel şartlar</i></span></b></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;">1*Türk vatandaşı olmak, </span></b></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;">2*Sınav günü itibariyle 35 yaşını bitirmemiş olmak, </span></b></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;">3*a<span style="color: black;">skerlikle ilgisi bulunmamak veya askerlik çağına gelmemiş olmak, askerlik çağına gelmiş ise muvazzaf askerlik hizmetini yapmış yahut ertelenmiş ya da yedek sınıfa geçirilmiş olmak,</span></span></b></div>
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<b><span style="color: black;"><span style="font-family: Arial, Helvetica, sans-serif;">4*657 sayılı Kanunun değişik 48/1-A/5 bendinde sayılan suçlardan mahkûm olmamak, </span></span></b></div>
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<b><span style="color: black;"><span style="font-family: Arial, Helvetica, sans-serif;">5*657 sayılı Kanunun 53 üncü maddesi hükümleri saklı kalmak kaydı ile görevini devamlı yapmasına engel olabilecek akıl hastalığı bulunmamak, </span></span></b></div>
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<b><span style="color: black;"><span style="font-family: Arial, Helvetica, sans-serif;">6*Kamu haklarından mahrum olmamak,</span></span></b></div>
<span style="background-color: white; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;"><span style="font-family: Arial, Helvetica, sans-serif;"><b>7*Arşiv araştırması sonucu olumlu olmak.</b></span></span><br style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;" /><div style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px; margin-bottom: 0cm;">
<b><span style="font-family: Arial, Helvetica, sans-serif;"><i>Diğer şartlar ise şu şekildedir;</i></span></b></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;">Zabıt katibi olmak isteyen bir kişinin klavyesi iyi olmak zorundadır.</span></b></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;">Çünkü zabıt katibi olmanın şartlarından bir tanesi de 3 dakikada hatasız 90 kelime yazabilmektir.Daha fazla yazssam yanlışlarım çıksa ne olur?Birşey olmaz fakat en az 90 kelime yazılmalıki mülhakata girme şansı olsun.</span></b></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;"><br /></span></b></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;">Zabıt katibi olmak için öncelikli şart aslında KPSS sınavına girmek ve en az 70 puan almak.</span></b></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;"><i>Peki ben lisans yani 4 yıllık fakülte mezunuyum benimde mi 70 puan almam mı gerekiyor?Örnekle açıklayalım.</i></span></b></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;">Üç tane zabıt katibi adayı olsun.Bunların ismi Ahmet Mehmet ve Ayşe olsun.</span></b></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;">Ahmet Lise mezunu.</span></b></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;">Mehmet Ön lisans yani 2 yıllık bir bölümden mezun.</span></b></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;">Ayşe Lisans yani 4 yıllık bir fakülteden mezun.</span></b></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;">Tüm adaylar kendi mezuniyetlerine göre girdikleri KPSS sınavından 70 puan almalıdır.Mezun olduğunuz okul veya mezuniyet durumunuza göre girdiğiniz KPSS sınavından aldığınız puan kaç ise ona göre sıralama yapılır.</span></b></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;">Yukarıda verdiğimiz örneklere göre bir sıralama yapalım.Mesala Ahmet lise mezunu KPSS den 90 puan aldı. Mehmet Ön lisans mezunu KPSS den 87 aldı. Ayşe lisans mezunu ve KPSS den 92 aldı.</span></b></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;">Bu durumda sıralama nasıl olur?</span></b></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;">1 .Ayşe 92 puan</span></b></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;">2 .Ahmet 90 puan</span></b></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;">3.Mehmet 87 puan.</span></b></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;">Burada görüldüğü üzere Mehmetin ön lisans mezunu olması katiplik için bir avantaj sağlamadı.Herkesin kendi düzeyinde girdiği KPSS sınavından aldığı puana göre sıralamaya konulmaktadır.</span></b></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;">Katipliğe Öncelikle il merkezlerinde bulunan ve Adalet Komisyonu olan yani Ağır Ceza Mahkemeleri olan illerde sınav yapılır. Veya bazı Adalet komisyonu olan ilçelerde de katiplik sınavı yapılır.</span></b></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;">Devamı için;</span></b></div>
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<b><span style="font-family: Arial, Helvetica, sans-serif;"><a href="http://acikogretimadalet.blogspot.com/2012/10/zabt-katipligi-hakknda-genis-bilgi.html">Zabıt katipliği hakkında geniş bilgiler</a></span></b></div>
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.http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0tag:blogger.com,1999:blog-1741444599832658384.post-55992157637242344322012-10-17T12:36:00.003-07:002012-10-17T12:36:52.752-07:00Mübaşirlik nedir?Mübaşirin görevleri ve mübaşir olmanın şartları nelerdir?<div dir="ltr" style="text-align: left;" trbidi="on">
<span style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;">MÜŞABİR NEDİR?</span><br style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;" /><br style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;" /><span style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;">Mübaşir halk dilindeki adıyla çığırtkan adliyede genellikle mahkemelerde çalışan personeldir.Yardımcı hizmet sınıfı kadrosunda yer alan mübaşirler mahkemedeki dosyaların düzeninden, mahkemenin duruşması olduğunda duruşma günü duruşması olan dosyaları sıra koymaktan, dosyaya gelen evrakları düzenli olarak takıp kontrol etmekten sorumlu kişidir.</span><br style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;" /><span style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;">Mübaşir nasıl olunur?Mübaşir olmanın şartları nelerdir?</span><br style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;" /><span style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;">Mübaşir olmak için KPSS puanınız biraz yüksek olması gerekiyor.Çünkü mübaşirliğe başvuran kişiler genel yüksek puanlı adaylar oluyor. Aslında bu adaylardan kaynaklanan bir sorun değil.Mübaşir alımı az olduğu için adayların KPSS puan sıralamasına göre sıraya koydukları için doğal olarak yüksek puanlıları çağırıyorlar.</span><br style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;" /><span style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;">X adliyesine 5 adet mübaşir alınacağını var sayalım.Bunun 5 katı adayda mülahakata çağırılacağını düşünürsek başvuru yapanda toplam 200 kişi olsun.</span><br style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;" /><span style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;">Bu adaylardan KPSS puan sıralamasına göre puanı yüksek olan 50 aday mülahakata çağırılır.</span><br />
<span style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;">Devamı için;</span><br />
<br />
<span style="background-color: white; color: #ca881c; font-family: Arial, Tahoma, Helvetica, FreeSans, sans-serif; font-size: 14px; font-weight: bold; line-height: 19px;"><a href="http://acikogretimadalet.blogspot.com/2012/10/mubasir-nedirne-is-yapar-sartlar-nedir.html">Mübaşir nedir?</a></span><br />
<br />
<a href="http://acikogretimadalet.blogspot.com/"><b>Adalet Meslek Yüksek Okulu Hakkında Bilgiler</b></a></div>
.http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0tag:blogger.com,1999:blog-1741444599832658384.post-90281558992036106772012-10-08T09:30:00.001-07:002012-10-08T09:30:15.887-07:00DİPLOMA KAYIP DİLEKÇE ÖRNEĞİ<br />
<div align="CENTER" style="margin-bottom: 0cm;">
<b>AÇIK ÖĞRETİM LİSESİ
MÜDÜRLÜĞÜNE</b></div>
<div style="margin-bottom: 0cm; margin-left: 9.99cm;">
<u><b>ANKARA</b></u></div>
<div style="margin-bottom: 0cm;">
<br />
</div>
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Açık
Öğretim Lisesinin …..………………… numaralı öğrencisi
iken mezun oldum. Ekte sunduğum belge(ler) doğrultusunda, aşağıda
kutucuğunu işaretlediğim belgenin tarafıma verilmesini arz
ederim.</div>
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</div>
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Çıkma Belgesi</div>
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Diploma (<b>İADE</b> : Basılmış ve AÖL Müdürlüğüne geri
gönderilmiş diploma)</div>
<div align="JUSTIFY" style="margin-bottom: 0.07cm; margin-left: 1.59cm; margin-top: 0.07cm;">
Diploma (<b>MAZERET</b> : Belge – bilgi eksikliğinden dolayı
basılamamış diploma)</div>
<div align="JUSTIFY" style="margin-bottom: 0.07cm; margin-left: 1.59cm; margin-top: 0.07cm;">
Diploma. Çıkma Belgemi kaybettim.(<i>Kayıp ilanı vermediğimden
dolayı doğabilecek hukuki sorumluluk tarafıma aittir</i>.)
</div>
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Diploma Kayıp</div>
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Diploma Kayıp (<i>Diploma kayıp ilanı vermediğimden dolayı
doğabilecek hukuki sorumluluk tarafıma aittir</i>.)</div>
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….. / ….. / 20 .....</div>
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<br />
</div>
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<u><b>KENDİSİ</b></u><b> </b><u><b>VELİSİ</b></u><b> </b><u><b>VEKİLİ</b></u></div>
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<br />
</div>
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Adı
– soyadı Adı – soyadı Adı -
soyadı</div>
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imza imza imza</div>
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<br />
</div>
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<br />
</div>
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<b>Ek(ler)
:</b></div>
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<b>1.</b></div>
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<b>2.</b></div>
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<br />
</div>
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<b>Adres :
</b>………………………………………………………………</div>
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<br />
</div>
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………………………………………………………………
<b>İlçesi</b> : ………... …. <b>İli</b> : ……………</div>
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<br />
</div>
<div style="margin-bottom: 0cm;">
<b>Telefon : 0 </b>…….. - ………
…… ……<b><br />(</b><i>Alan kodu ile birlikte yazınız</i>)</div>
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<br />
</div>
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<u><b>Öğrencinin Kimlik
Bilgileri</b></u></div>
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<b>T.C.
Kimlik No : </b>………………………………</div>
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<b>Adı
ve Soyadı : </b>………………………………</div>
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<b>Baba
Adı :</b> ………………………………</div>
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<b>Ana
Adı :</b> ………………………………</div>
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<b>Doğum
Tarihi :</b> …… / …… / ………………</div>
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<br />
</div>
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<b>DİKKAT!</b></div>
<ul>
<li><div align="JUSTIFY" style="margin-bottom: 0cm;">
Yukarıda adı geçen
belgeler,</div>
</li>
</ul>
<ol>
<li><div align="JUSTIFY" style="margin-bottom: 0cm;">
<u>18 yaşını
doldurmuş</u> öğrencinin kendisi veya noterden vekil tayin ettiği
kişi,</div>
</li>
</ol>
<div style="margin-bottom: 0cm; text-indent: 1.25cm;">
<br />
</div>
<ol start="2">
<li><div align="JUSTIFY" style="margin-bottom: 0cm;">
<u>18 yaşını
doldurmamış öğrencinin</u>, veli (anne-baba) veya velinin
noterden vekil tayin ettiği kişi tarafından alınabilecektir.</div>
</li>
</ol>
.http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0tag:blogger.com,1999:blog-1741444599832658384.post-44506626130918584432012-10-08T09:27:00.002-07:002012-10-08T09:27:44.659-07:00üniversite öğrencileri için dilekçe örnekleri<br />
<div align="CENTER" style="line-height: 150%;">
<br />
</div>
<div align="CENTER" style="line-height: 150%;">
<u style="font-family: Arial, sans-serif; line-height: 150%;"><b>DİLEKÇE
ÖRNEKLERİ</b></u></div>
<div align="LEFT" style="line-height: 150%;">
<br />
</div>
<ol>
<li><div align="JUSTIFY" style="line-height: 150%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><b>ÖĞRENCİ
İLİŞİK KESME DİLEKÇESİ</b></span></span></div>
</li>
<li><div align="JUSTIFY" style="line-height: 150%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><b>KAYIT
DONDURMA DİLEKÇESİ</b></span></span></div>
</li>
<li><div align="JUSTIFY" style="line-height: 150%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><b>MUAFİYET
DİLEKÇESİ</b></span></span></div>
</li>
<li><div align="LEFT" style="line-height: 150%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><b>DERS
BAŞARI NOTUNA İTİRAZ</b></span><span style="font-family: Arial, sans-serif;"><b>
</b></span><span style="font-family: Arial, sans-serif;"><b>DİLEKÇESİ</b></span></span></div>
</li>
<li><div align="LEFT" style="line-height: 150%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><b>PASAPORT
HARCI MUAFİYET VE VİZE İŞLEMİ BAŞVURU DİLEKÇESİ</b></span></span></div>
</li>
<li><div align="LEFT" style="line-height: 150%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><b>SINAV
HAKKI İSTEK DİLEKÇESİ</b></span></span></div>
</li>
<li><div align="LEFT" style="line-height: 150%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><b>MUAFİYET
DİLEKÇESİ</b></span></span></div>
</li>
<li><div align="LEFT" style="line-height: 150%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><b>KONTENJAN
ARTTIRIMI DİLEKÇESİ</b></span></span></div>
</li>
<li><div align="LEFT" style="line-height: 150%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><b>KREDİ
ARTTIRIMI DİLEKÇESİ</b></span></span></div>
</li>
<li><div align="LEFT" style="line-height: 150%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><b>KREDİ
AZALTMA DİLEKÇESİ</b></span></span></div>
</li>
<li><div align="LEFT" style="line-height: 150%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><b>MAZERET
DİLEKÇESİ</b></span></span></div>
</li>
<li><div align="LEFT" style="line-height: 150%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><b>YAZ
ÖĞRETİMİNDE DERS AÇTIRMA TALEBİ</b></span></span></div>
</li>
<li><h3 align="LEFT" class="western" style="line-height: 150%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: small;">13
- BELGE İSTEK DİLEKÇESİ (MEZUN OLMUŞ ÖĞRENCİLER İÇİN)</span></span></h3>
</li>
</ol>
<div align="LEFT" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
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<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
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<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;"><b>DİLEKÇE
NO: 1</b></span></span><span style="font-family: Arial, sans-serif;"><b> </b></span></span>
</div>
<div align="LEFT" style="margin-left: 6.25cm; text-indent: 1.25cm;">
</div>
<div align="LEFT" style="margin-left: 6.25cm; text-indent: 1.25cm;">
<br />
</div>
<div align="CENTER">
<br />
</div>
<div align="CENTER">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><b>İTÜ
MADEN FAKÜLTESİ </b></span></span></span>
</div>
<div align="CENTER">
<span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><b>ÖĞRENCİ
İLİŞİK KESME </b></span></span>
</div>
<div align="CENTER">
<span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><b>DİLEKÇESİ</b></span></span></div>
<h3 class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
</h3>
<h3 class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;"> ......./........../.........</span></span></h3>
<div align="CENTER">
<br />
</div>
<div align="CENTER">
<br />
</div>
<div align="CENTER">
<br />
</div>
<div align="LEFT" style="text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;">Fakülteden
ilişiğimin kesilmesini istiyorum.</span></div>
<div align="LEFT">
<span style="font-family: Arial, sans-serif;"> </span></div>
<div align="LEFT" style="text-indent: 1.25cm;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;">Bilgilerinize
arz ederim. </span></span>
</div>
<div align="LEFT" style="text-indent: 1.25cm;">
<br />
</div>
<div align="LEFT" style="text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;">Saygılarımla,</span></div>
<div align="JUSTIFY">
<br />
</div>
<div align="JUSTIFY">
<br />
</div>
<div align="JUSTIFY">
<br />
</div>
<div align="JUSTIFY" style="margin-left: 9.99cm; text-indent: 1.25cm;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><b> </b></span></span><span style="font-family: Arial, sans-serif;">İMZA</span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><b> </b></span></span></span></div>
<div align="JUSTIFY" style="line-height: 200%; margin-left: 9.99cm; text-indent: 1.25cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">ÖĞRENCİ
NO:__________________________________________________________________________</span></span></span></div>
<div style="line-height: 200%; page-break-after: avoid;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">ADI
SOYADI
___________________________________________________________________________</span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">BÖLÜMÜ:______________________________________________________________________________</span></span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">GSM :(_____)
____________________</span></span></div>
<h2 class="western" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><span style="font-weight: normal;">E-posta :
________________________________________________________________</span></span></span></h2>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">İLİŞİK
KESME NEDENİ </span></span><span style="font-family: Symbol, serif;"><span style="font-size: x-small;"></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">
</span></span></span>
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm; text-indent: 1.25cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm; text-indent: 1.25cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm; text-indent: 1.25cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm; text-indent: 1.25cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;"><b>DİLEKÇE
NO: 2</b></span></span></span></div>
<div align="LEFT" style="margin-left: 7.49cm;">
</div>
<h3 class="western">
<span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">İTÜ
MADEN FAKÜLTESİ</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">
KAYIT DONDURMA DİLEKÇESİ</span></span></h3>
<div align="LEFT">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;">________________________________________________________________________</span></span></div>
<h3 class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
</h3>
<h3 class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">......./........../............</span></span></h3>
<div align="LEFT">
<br />
</div>
<div align="LEFT" style="margin-left: 1.25cm; text-indent: 1.25cm;">
<br />
</div>
<div align="LEFT" style="margin-left: 1.25cm; text-indent: 1.25cm;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;">İTÜ MADEN FAKÜLTESİ
DEKANLIĞINA</span><span style="font-family: Arial, sans-serif;"><b>,</b></span></span></div>
<div align="CENTER">
<br />
</div>
<div align="LEFT">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
…………………<span style="font-size: small;"><span style="font-family: Arial, sans-serif;">..Eğitim
- Öğretim yılı …………yarıyılında……………………………………
nedeniyle, kaydımı dondurmak istiyorum. </span></span>
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%; text-indent: 1.25cm;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;">Bilgilerinize
arz ederim. </span></span>
</div>
<div align="JUSTIFY" style="line-height: 200%; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;">Saygılarımla, </span></div>
<div align="JUSTIFY" style="line-height: 200%; margin-left: 9.99cm; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;">İMZA</span></div>
<div align="JUSTIFY" style="line-height: 200%;">
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">ÖĞRENCİ
NO:____________________________________________________________________________</span></span></span></div>
<div style="line-height: 200%; page-break-after: avoid;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">ADI
SOYADI
_____________________________________________________________________________</span></span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">BÖLÜMÜ:______________________________________________________________________________</span></span></span></div>
<div style="line-height: 200%; page-break-after: avoid;">
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">GSM :
____________________</span></span></span></div>
<h2 class="western" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><span style="font-weight: normal;">E-posta :
____________________________________________________________________</span></span></span></h2>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b>Not :
Mazeretini belgelemeyenlerin dilekçesi değerlendirmeye
alınmayacaktır.</b></span></span></span></div>
<div align="LEFT" style="margin-left: 7.49cm;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"> </span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">
</span></span></span>
</div>
<h3 align="JUSTIFY" class="western">
<span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"> </span></span></h3>
<div align="LEFT">
<br />
</div>
<h3 align="RIGHT" class="western">
<span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"> </span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">DİLEKÇE
NO:3</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"> </span></span></h3>
<div align="LEFT">
<br />
</div>
<h3 class="western">
<span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">İTÜ
MADEN FAKÜLTESİ</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">
MUAFİYET DİLEKÇESİ</span></span></h3>
<h3 align="LEFT" class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
</h3>
<h3 class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">......./........../.........</span></span></h3>
<div align="LEFT">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"> </span></span></div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="CENTER" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;">MADEN
FAKÜLTESİ DEKANLIĞI’NA</span></div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;">.....................Eğitim
- Öğretim.yılında başarılı olduğum aşağıda isimleri
belirtilen ekte onaylı not dökümü ve onaylı içerikleri
bulunan dersten /derslerden muaf olmak istiyorum. </span></span>
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;">Bilgilerinize
arz ederim. </span></span>
</div>
<div align="LEFT" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;">Saygılarımla,</span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"> </span></div>
<div align="JUSTIFY" style="line-height: 200%; margin-left: 9.99cm; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;">İMZA</span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">ÖĞRENCİ
NO</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b>:__________________________________________________________________________</b></span></span></span></div>
<div style="line-height: 200%; page-break-after: avoid;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">ADI
SOYADI
___________________________________________________________________________</span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">BÖLÜMÜ</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b>:______________________________________________________________________________</b></span></span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">GSM :___________________________</span></span></span></div>
<h2 class="western" style="font-weight: normal; line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">E-posta :
_________________________________________________</span></span></h2>
<h5 class="western" style="line-height: 200%;">
</h5>
<h5 class="western" style="line-height: 200%;">
</h5>
<h5 class="western" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><u><b>MUAF
OLMAK İSTENEN DERSİN/DERSLERİN ADI </b></u></span></span>
</h5>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">1.
</span></span></span>
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">2.
</span></span></span>
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">3.</span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;">4.</span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">EK:</span></span></div>
<ol>
<li><div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Onaylı
ders içeriği (………sayfa)</span></span></span></div>
</li>
<li><div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Onaylı
Not Dökümü
</span></span></span>
</div>
</li>
</ol>
<div align="JUSTIFY" style="line-height: 200%; margin-left: 0.64cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%; margin-left: 0.64cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%; margin-left: 0.64cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 11.24cm; text-indent: 1.25cm;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;"><b>DİLEKÇE
NO: 4</b></span></span></span></div>
<div align="LEFT" style="margin-left: 7.49cm;">
</div>
<div align="CENTER">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><b>İTÜ
MADEN FAKÜLTESİ </b></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><b>DERS
BAŞARI NOTUNA</b></span></span></span></div>
<div align="CENTER">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><b>İTİRAZ</b></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><b>
</b></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><b>DİLEKÇESİ</b></span></span></span></div>
<div align="LEFT" style="line-height: 180%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">______________________________________________________________________________</span></span></span></div>
<h3 class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
</h3>
<h3 class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
…<span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">.../…../.....</span></span></h3>
<h3 align="LEFT" class="western" style="line-height: 200%;">
</h3>
<div align="CENTER" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: small;"><b>MADEN
FAKÜLTESİ DEKANLIĞI’NA,</b></span></span></div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;">....................................Eğitim
- Öğretim yılı …………yarıyılında almış olduğum,
aşağıda belirttiğim dersin/derslerin </span><span style="font-family: Arial, sans-serif;"><b>ders
başarı</b></span><span style="font-family: Arial, sans-serif;"> </span><span style="font-family: Arial, sans-serif;"><b>notunun</b></span><span style="font-family: Arial, sans-serif;">
</span><span style="font-family: Arial, sans-serif;"><b>yeniden değerlendirilmesini</b></span><span style="font-family: Arial, sans-serif;">
istiyorum.</span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;">Bilgilerinize
arz ederim. </span></span>
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;">Saygılarımla,</span></div>
<div align="JUSTIFY" style="line-height: 200%; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;"> </span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"> İMZA</span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">ÖĞRENCİ
NO:__________________________________________________________________________</span></span></span></div>
<div style="line-height: 200%; page-break-after: avoid;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">ADI
SOYADI
___________________________________________________________________________</span></span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">BÖLÜMÜ
:_____________________________________________________________________________</span></span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">GSM :(_____)
____________________</span></span></div>
<h2 class="western" style="font-weight: normal; line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">E-posta :
_________________________________________________</span></span></h2>
<h5 class="western" style="line-height: 200%;">
</h5>
<h5 class="western" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><u><b>İNCELENMESİ
İSTENEN DERSİN ADI DERS KODU CRN DERSİN
ÖĞRETİM ELEMANI : </b></u></span></span>
</h5>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">1.
</span></span></span>
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">2.
</span></span></span>
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">______________________________________________________________________________________</span></span></span></div>
<form name="WW-Standard">
<div align="JUSTIFY">
<div style="line-height: 150%;">
<input name="Onay kutusu4" style="height: 0.32cm; width: 0.32cm;" type="CHECKBOX" value="" />
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b>DERSİN
ÖĞRETİM ELEMANININ/ELEMANLARININ GÖRÜŞÜ </b></span></span></span>
</div>
</div>
</form>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="LEFT" style="margin-left: 11.24cm; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;"><b>DİLEKÇE
NO: 5</b></span></span></div>
<div align="LEFT" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="LEFT" style="line-height: 150%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><b>İTÜ
MADEN FAKÜLTESİ PASAPORT HARCI MUAFİYET VE</b></span></span></span></div>
<div align="LEFT" style="line-height: 150%; margin-left: 2.5cm; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><b>VİZE İŞLEMİ
BAŞVURU DİLEKÇESİ</b></span></span></div>
<h3 align="LEFT" class="western" style="margin-left: 9.99cm;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><span style="font-weight: normal;"> </span></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"> </span></span><span style="font-family: Arial, sans-serif;">
</span><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">….../…../..... </span></span></h3>
<div align="LEFT" style="line-height: 150%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b> </b></span></span><span style="font-family: Arial, sans-serif;">MADEN
FAKÜLTESİ DEKANLIĞI’NA</span></span></div>
<div align="LEFT" style="line-height: 150%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b> </b></span></span></div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
………………………………………
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;">nedeniyle yurt dışına
çıkmak istiyorum. Pasaport harcı muafiyetinden yararlanmak için
onayınıza arz ederim. </span></span>
</div>
<div align="LEFT" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;">Saygılarımla.
</span>
</div>
<div align="JUSTIFY" style="line-height: 200%; margin-left: 9.99cm; text-indent: 1.25cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%; margin-left: 9.99cm; text-indent: 1.25cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%; margin-left: 9.99cm; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;">İMZA</span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">ÖĞRENCİ
NO:_________________________________________________________________________________</span></span></span></div>
<div style="line-height: 200%; page-break-after: avoid;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">ADI
SOYADI
_________________________________________________________________________________</span></span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">BÖLÜMÜ:______________________________________________________________________________</span></span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">GSM
:(_____) ____________________</span></span></span></div>
<h2 class="western" style="font-weight: normal; line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">E-posta :
_________________________________________________</span></span></h2>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"> </span></span></div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 150%;">
<br />
</div>
<div align="LEFT" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;"><b>DİLEKÇE
NO: 6</b></span></span><span style="font-family: Arial, sans-serif;"><b> </b></span></span>
</div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><b>İTÜ
MADEN FAKÜLTESİ</b></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><b>
SINAV HAKKI İSTEK DİLEKÇESİ</b></span></span></span></div>
<div align="LEFT" style="margin-left: 5cm; text-indent: 1.25cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 180%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">______________________________________________________________________________</span></span></span></div>
<h3 class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
</h3>
<h3 class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">......../........../.........</span></span></h3>
<div align="CENTER" style="line-height: 200%;">
<br />
</div>
<div align="CENTER" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;">MADEN
FAKÜLTESİ DEKANLIĞI’NA</span><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b>,</b></span></span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<span style="font-family: Arial, sans-serif;">Normal
öğrenimim sonunda adet vizeli başarısız (FF) dersim
kaldı. Bu derslerden Ek-1-2 sınav hakkı kullanmak istiyorum.</span></div>
<div align="JUSTIFY">
<br />
</div>
<div align="JUSTIFY">
<span style="font-family: Arial, sans-serif;">Bilgilerinize
arz ederim. </span>
</div>
<div align="JUSTIFY">
<br />
</div>
<div align="JUSTIFY">
<span style="font-family: Arial, sans-serif;">Saygılarımla,</span></div>
<div align="JUSTIFY" style="line-height: 200%; margin-left: 9.99cm; text-indent: 1.25cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%; margin-left: 9.99cm; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;">İMZA</span></div>
<div align="JUSTIFY" style="line-height: 200%; margin-left: 9.99cm; text-indent: 1.25cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">ÖĞRENCİ
NO:__________________________________________________________________________</span></span></span></div>
<div style="line-height: 200%; page-break-after: avoid;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">ADI
SOYADI
___________________________________________________________________________</span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">BÖLÜMÜ:_____________________________________________________________________________</span></span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">GSM :(_____)
____________________</span></span></div>
<h2 class="western" style="font-weight: normal; line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">E-posta :
_________________________________________________</span></span></h2>
<h5 class="western" style="line-height: 200%;">
</h5>
<h5 class="western" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><u><b>SINAV
HAKKI İSTENEN DERSİN / DERSLERİN ADI
</b></u></span>
</h5>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">1.
</span></span></span>
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">2.</span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">3.
</span></span></span>
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;">4.</span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;">5._____________________________________________________________________</span></span></div>
<div align="LEFT">
<br />
</div>
<div align="LEFT" style="line-height: 150%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b>Not:
Dilekçeye transcript ve mezuniyetime nekaldı eklenecektir</b></span></span></span></div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;"><b>DİLEKÇE
NO: 7</b></span></span></div>
<div align="LEFT" style="margin-left: 7.49cm;">
<br />
</div>
<div align="LEFT" style="margin-left: 7.49cm;">
</div>
<h3 class="western" style="margin-left: 1.25cm;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">İTÜ
MADEN FAKÜLTESİ </span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">
MUAFİYET DİLEKÇESİ</span></span></h3>
<div align="LEFT">
<br />
</div>
<h3 class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">......../........../............</span></span></h3>
<h3 align="LEFT" class="western">
</h3>
<div align="CENTER">
<span style="font-family: Arial, sans-serif;">MADEN
FAKÜLTESİ DEKANLIĞI’NA,</span></div>
<div align="LEFT">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
…………<span style="font-size: small;"><span style="font-family: Arial, sans-serif;">.…….Üniversitesinde
başarılı olduğum derslerden muaf sayılabilmem için gereğini
bilgilerinize arz ederim.</span></span></div>
<div align="JUSTIFY">
<br />
</div>
<div align="JUSTIFY">
<br />
</div>
<div align="JUSTIFY">
<span style="font-family: Arial, sans-serif;">Saygılarımla,</span></div>
<div align="LEFT">
<br />
</div>
<div align="JUSTIFY" style="margin-left: 12.49cm; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;">İMZA</span></div>
<div align="JUSTIFY" style="line-height: 180%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">ÖĞRENCİ
NO:__________________________________________________________________________</span></span></span></div>
<div style="line-height: 180%; page-break-after: avoid;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">ADI
SOYADI
___________________________________________________________________________</span></span></div>
<div align="JUSTIFY" style="line-height: 180%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">BÖLÜMÜ:______________________________________________________________________________</span></span></span></div>
<div align="JUSTIFY" style="line-height: 180%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 180%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">GSM :
____________________</span></span></span></div>
<h2 class="western" style="font-weight: normal; line-height: 180%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">E-posta :
_________________________________________________</span></span></h2>
<div align="LEFT">
<br />
</div>
<h5 class="western" style="line-height: 180%;">
</h5>
<h5 class="western" style="line-height: 180%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><u><b>DAHA
ÖNCE ALINMIŞ OLAN DERS / DERSLERİN ADI </b></u></span></span>
</h5>
<table border="1" bordercolor="#000000" cellpadding="7" cellspacing="0" style="width: 522px;">
<colgroup><col width="56"></col>
<col width="234"></col>
<col width="74"></col>
<col width="100"></col>
</colgroup><tbody>
<tr valign="TOP">
<td width="56">
<h5 class="western">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">KODU</span></span></h5>
</td>
<td width="234">
<h5 class="western">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">DERSİN
ADI</span></span></h5>
</td>
<td width="74">
<h5 class="western">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">KREDİSİ</span></span></h5>
</td>
<td width="100">
<h5 class="western">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">BAŞARI
NOTU</span></span></h5>
</td>
</tr>
<tr valign="TOP">
<td width="56">
<h5 class="western">
</h5>
</td>
<td width="234">
<h5 class="western">
</h5>
</td>
<td width="74">
<h5 class="western">
</h5>
</td>
<td width="100">
<h5 class="western">
</h5>
</td>
</tr>
<tr valign="TOP">
<td width="56">
<h5 class="western">
</h5>
</td>
<td width="234">
<h5 class="western">
</h5>
</td>
<td width="74">
<h5 class="western">
</h5>
</td>
<td width="100">
<h5 class="western">
</h5>
</td>
</tr>
<tr valign="TOP">
<td width="56">
<h5 class="western">
</h5>
</td>
<td width="234">
<h5 class="western">
</h5>
</td>
<td width="74">
<h5 class="western">
</h5>
</td>
<td width="100">
<h5 class="western">
</h5>
</td>
</tr>
</tbody></table>
<h5 class="western" style="line-height: 180%;">
</h5>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="LEFT" style="line-height: 150%;">
<br />
</div>
<div align="LEFT" style="line-height: 150%;">
<br />
</div>
<div align="LEFT" style="line-height: 150%;">
<br />
</div>
<div align="LEFT" style="line-height: 150%;">
<br />
</div>
<div align="LEFT" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;"><b>DİLEKÇE
NO: 8</b></span></span><span style="font-family: Arial, sans-serif;"><b> </b></span></span>
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="CENTER">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><b>İTÜ
MADEN FAKÜLTESİ </b></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><b>KONTENJAN
ARTTIRIMI DİLEKÇESİ</b></span></span></span></div>
<h3 class="western" style="margin-left: 5cm; text-indent: 1.25cm;">
</h3>
<div align="JUSTIFY" style="line-height: 180%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">______________________________________________________________________________</span></span></span></div>
<h3 class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
</h3>
<h3 class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
</h3>
<h3 class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">........./........../............</span></span></h3>
<div align="CENTER" style="line-height: 200%;">
<br />
</div>
<div align="CENTER" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;">İTÜ
MADEN FAKÜLTESİ DEKANLIĞI’NA</span></div>
<div align="CENTER" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%; margin-left: 1.25cm;">
………………<span style="font-size: small;"><span style="font-family: Arial, sans-serif;">..eğitim
öğretim yılı ………………yarıyılında açılmış olan
………..CRN, ……........... kodlu …………………………………………dersinin
kontenjanının arttırılmasını istiyorum.</span></span></div>
<div align="LEFT" style="line-height: 200%; text-indent: 1.25cm;">
<br />
</div>
<div align="LEFT" style="line-height: 200%; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;">Bilgilerinize
arz ederim. </span>
</div>
<div align="LEFT" style="line-height: 200%; text-indent: 1.25cm;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;">Saygılarımla,</span></span></div>
<div align="JUSTIFY" style="line-height: 200%; text-indent: 1.25cm;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"> </span></span></div>
<div align="JUSTIFY" style="line-height: 200%; margin-left: 12.49cm; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;">İMZA</span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">ÖĞRENCİ
NO:__________________________________________________________________________</span></span></span></div>
<div style="line-height: 200%; page-break-after: avoid;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">ADI
SOYADI
__________________________________________________________________________</span></span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">BÖLÜMÜ:______________________________________________________________________________</span></span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">GSM :(_____)
____________________</span></span></div>
<h2 class="western" style="font-weight: normal; line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">E-posta :
_________________________________________________</span></span></h2>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b>___________________________________________________________________________________</b></span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;"><b>DİLEKÇE
NO: 9</b></span></span><span style="font-family: Arial, sans-serif;"><b> </b></span></span>
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="CENTER">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><b>İTÜ
MADEN FAKÜLTESİ </b></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><b>KREDİ
ARTTIRIMI DİLEKÇESİ</b></span></span></span></div>
<h3 class="western" style="margin-left: 5cm; text-indent: 1.25cm;">
</h3>
<div align="JUSTIFY" style="line-height: 180%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">______________________________________________________________________________</span></span></span></div>
<h3 class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
</h3>
<h3 class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
</h3>
<h3 class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">........./........../............</span></span></h3>
<div align="CENTER" style="line-height: 200%;">
<br />
</div>
<div align="CENTER" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;">İTÜ
MADEN FAKÜLTESİ DEKANLIĞI’NA</span></div>
<div align="LEFT" style="line-height: 200%; margin-left: 1.25cm;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;">200
- 200 Eğitim Öğretim yılı ………. Yarıyılında kredi
yükümün ‘dan ‘ye yükseltilmesini saygılarımla
arz ederim.</span></span></div>
<div align="JUSTIFY" style="line-height: 200%; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;"> </span></div>
<div align="JUSTIFY" style="line-height: 200%; margin-left: 12.49cm; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;">İMZA</span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">ÖĞRENCİ
NO:__________________________________________________________________________</span></span></div>
<div style="line-height: 200%; page-break-after: avoid;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">ADI
SOYADI
__________________________________________________________________________</span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">BÖLÜMÜ:______________________________________________________________________________</span></span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">GSM :(_____)
____________________</span></span></div>
<h2 class="western" style="font-weight: normal; line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">E-posta :
_________________________________________________</span></span></h2>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b>___________________________________________________________________________________</b></span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b>Ek.
1 adet not durumu</b></span></span></div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;"><b>DİLEKÇE
NO: 10</b></span></span><span style="font-family: Arial, sans-serif;"><b> </b></span></span>
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="CENTER">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><b>İTÜ
MADEN FAKÜLTESİ </b></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><b>KREDİ
AZALTMA DİLEKÇESİ</b></span></span></span></div>
<h3 class="western" style="margin-left: 5cm; text-indent: 1.25cm;">
</h3>
<div align="JUSTIFY" style="line-height: 180%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">______________________________________________________________________________</span></span></span></div>
<h3 class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
</h3>
<h3 class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
</h3>
<h3 class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">........./........../............</span></span></h3>
<div align="CENTER" style="line-height: 200%;">
<br />
</div>
<div align="CENTER" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;">İTÜ
MADEN FAKÜLTESİ DEKANLIĞI’NA</span></div>
<div align="LEFT" style="line-height: 200%; margin-left: 1.25cm;">
<br />
</div>
<div align="LEFT" style="line-height: 200%; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;">200
- 200 Eğitim Öğretim yılı ………. Yarıyılında kredi
yükümün 15 krediden …….krediye düşürülmesini saygılarımla
arz ederim.</span></div>
<div align="JUSTIFY" style="line-height: 200%; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;"> </span></div>
<div align="JUSTIFY" style="line-height: 200%; margin-left: 12.49cm; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;">İMZA</span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">ÖĞRENCİ
NO:__________________________________________________________________________</span></span></div>
<div style="line-height: 200%; page-break-after: avoid;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">ADI
SOYADI
__________________________________________________________________________</span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">BÖLÜMÜ:______________________________________________________________________________</span></span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">GSM :(_____)
____________________</span></span></div>
<h2 class="western" style="font-weight: normal; line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">E-posta :
_________________________________________________</span></span></h2>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b>___________________________________________________________________________________</b></span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;"><b>DİLEKÇE
NO: 11</b></span></span><span style="font-family: Arial, sans-serif;"><b> </b></span></span>
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="LEFT">
<br />
</div>
<div align="RIGHT">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b> </b></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Tarih:
…../…./200</span></span></span></div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
<br />
</div>
<div align="CENTER">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b>İ.T.Ü.
MADEN FAKÜLTESİ DEKANLIĞI’NA</b></span></span></span></div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
<br />
</div>
<div align="LEFT" style="line-height: 150%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Ekli
belgede belirtilen mazeretim nedeniyle final sınavına giremediğim
dersin/derslerin mazeret sınavına girebilmem için gereken iznin
verilmesini saygılarımla arz ederim.</span></span></div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">İmza :</span></span></div>
<div align="LEFT">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Adı,
Soyadı : </span></span>
</div>
<div align="LEFT">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Fakülte
No :</span></span></div>
<div align="LEFT">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Bölümü :</span></span></div>
<div align="LEFT">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">Telefon
No :</span></span></div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b>Mazeret
Nedeni :</b></span></span></div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><u><b>Mazeret
Nedeniyle Final Sınavına Girilemeyen Ders/Dersler:</b></u></span></span></div>
<div align="LEFT">
<span style="font-size: small;"><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><u><b>Dersin
Adı </b></u></span></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b> </b></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><u><b>Öğretim
Üyesi</b></u></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b> </b></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><u><b>Sınav
Tarihi </b></u></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b> </b></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><u><b>Saati</b></u></span></span></span></div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
………………<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b>. ……………….. ………………. …………….</b></span></span></div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
………………<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b>. ……………….. ………………. …………….</b></span></span></div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
………………<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b>. ……………….. ………………. …………….</b></span></span></div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
………………<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b>. ……………….. ………………. …………….</b></span></span></div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><u><b>Mazereti
Süresince “Mazeret Sınavı Talep Ettiği Ders/Derslere” Girip
Girmediği:</b></u></span></span></div>
<div align="LEFT">
<br />
</div>
<table border="1" bordercolor="#000000" cellpadding="7" cellspacing="0" frame="VOID" rules="GROUPS" style="width: 607px;">
<colgroup>
<col width="9"></col>
</colgroup>
<colgroup>
<col width="209"></col>
</colgroup>
<colgroup>
<col width="10"></col>
<col width="324"></col>
</colgroup>
<tbody>
<tr valign="TOP">
<td width="9">
<div align="LEFT">
<br />
</div>
</td>
<td width="209">
<div align="LEFT">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b>EVET
GİRDİM</b></span></span></div>
</td>
<td width="10">
<div align="LEFT">
<br />
</div>
</td>
<td rowspan="2" width="324">
<div align="LEFT">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b>HAYIR
GİRMEDİM</b></span></span></div>
</td>
</tr>
<tr valign="TOP">
<td colspan="3" width="256">
<div align="LEFT">
<br />
</div>
</td>
</tr>
</tbody></table>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><u><b>Mazereti
Süresince Girdiği Diğer Sınavları :</b></u></span></span></div>
<div align="LEFT">
<span style="font-size: small;"><span style="color: black;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><u><b>Dersin
Adı </b></u></span></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b> </b></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><u><b>Öğretim
Üyesi</b></u></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b> </b></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><u><b>Sınav
Tarihi </b></u></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b> </b></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><u><b>Saati</b></u></span></span></span></div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
………………<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b>. ……………….. ………………. …………….</b></span></span></div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
………………<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b>. ……………….. ………………. …………….</b></span></span></div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
………………<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b>. ……………….. ………………. …………….</b></span></span></div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b>Ek:
Sağlık Raporu</b></span></span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;"><b>DİLEKÇE
NO: 12</b></span></span><span style="font-family: Arial, sans-serif;"><b> </b></span></span>
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%;">
<br />
</div>
<div align="CENTER">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><b>İTÜ
MADEN FAKÜLTESİ </b></span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><b>YAZ
ÖĞRETİMİNDE DERS AÇTIRMA TALEBİ</b></span></span></span></div>
<h3 class="western" style="margin-left: 5cm; text-indent: 1.25cm;">
</h3>
<div align="JUSTIFY" style="line-height: 180%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">______________________________________________________________________________</span></span></span></div>
<h3 class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
</h3>
<h3 class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
</h3>
<h3 class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;">........./........../............</span></span></h3>
<div align="CENTER" style="line-height: 200%;">
<br />
</div>
<div align="CENTER" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;">İTÜ
MADEN FAKÜLTESİ DEKANLIĞI’NA</span></div>
<div align="LEFT" style="line-height: 200%; margin-left: 1.25cm;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;">200
- 200 Eğitim Öğretim yılı Yaz Öğretiminde aşağıda
……………………..dersin açılmasını istiyorum. </span>
</div>
<div align="LEFT" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;">Gereğinin
yapılmasını saygılarımla arz ederim.</span></div>
<div align="JUSTIFY" style="line-height: 200%; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;"> </span></div>
<div align="JUSTIFY" style="line-height: 200%; margin-left: 12.49cm; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;">İMZA</span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">ÖĞRENCİ
NO:__________________________________________________________________________</span></span></div>
<div style="line-height: 200%; page-break-after: avoid;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">ADI
SOYADI
__________________________________________________________________________</span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">BÖLÜMÜ:______________________________________________________________________________</span></span></span></div>
<div align="JUSTIFY" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">GSM :(_____)
____________________</span></span></div>
<h2 class="western" style="font-weight: normal; line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">E-posta :
_________________________________________________</span></span></h2>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b>___________________________________________________________________________________</b></span></span></div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="LEFT" style="line-height: 200%;">
<br />
</div>
<div align="JUSTIFY" style="line-height: 150%; margin-left: 13.74cm;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;"><b>DİLEKÇE
NO: 13</b></span></span></span></div>
<div align="LEFT" style="margin-left: 5cm; text-indent: 1.25cm;">
<br />
</div>
<h3 class="western">
</h3>
<h3 class="western">
</h3>
<h3 class="western">
<span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">İTÜ
MADEN FAKÜLTESİ </span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: medium;">BELGE
İSTEK DİLEKÇESİ</span></span></h3>
<div align="CENTER">
<span style="font-family: Arial, sans-serif;"><span style="font-size: medium;"><b>(MEZUN
OLMUŞ ÖĞRENCİLER İÇİN)</b></span></span></div>
<div align="JUSTIFY" style="line-height: 180%;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">_____________________________________________________________________________________</span></span></span></div>
<h3 class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
</h3>
<h3 class="western" style="margin-left: 7.49cm; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">...../....../.....</span></span></h3>
<h3 align="LEFT" class="western">
</h3>
<div align="CENTER" style="margin-left: 1.25cm; text-indent: 1.25cm;">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">İTÜ
MADEN FAKÜLTESİ DEKANLIĞINA</span></span><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><b>,</b></span></span></span></div>
<div align="CENTER">
<br />
</div>
<div align="CENTER">
<br />
</div>
<div align="CENTER" style="line-height: 200%;">
<br />
</div>
<table border="0" cellpadding="5" cellspacing="0" style="width: 638px;">
<colgroup><col width="628"></col>
</colgroup><tbody>
<tr>
<td height="32" valign="TOP" width="628">
<span style="font-family: Arial, sans-serif;">İTÜ Maden
Fakültesi……………………….............................................mezunuyum.
Aşağıda belirttiğim belgenin/belgelerin düzenlenerek tarafıma
verilmesini saygılarımla arz ederim.</span><br />
<br />
<br />
<br />
<br />
<div align="CENTER" style="margin-left: 9.99cm; text-indent: 1.25cm;">
<span style="font-family: Arial, sans-serif;">İMZA</span></div>
<br />
<br />
</td>
</tr>
<tr>
<td height="32" valign="TOP" width="628">
<div align="JUSTIFY">
<br />
</div>
<div align="JUSTIFY">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">ÖĞRENCİ
NO:_________________________________________________________________________</span></span></div>
<div style="page-break-after: avoid;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">ADI
SOYADI
___________________________________________________________________________</span></span></div>
<div style="page-break-after: avoid;">
</div>
<div align="LEFT">
<br />
</div>
<div align="LEFT">
<br />
</div>
<div align="JUSTIFY">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">GSM :(_____)
____________________</span></span></div>
<h2 class="western" style="font-weight: normal;">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">E-posta :
_________________________________________________</span></span></h2>
<br />
<br />
</td>
</tr>
<tr>
<td height="32" valign="TOP" width="628">
<h5 class="western">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><u><b>İSTENEN
BELGE/BELGELER
</b></u></span></span>
</h5>
<div align="JUSTIFY">
<span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">1.
</span></span></span>
</div>
<div align="JUSTIFY">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">2.</span></span></div>
<div align="JUSTIFY">
<span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;">3.</span></span></div>
<br />
<br />
</td>
</tr>
</tbody></table>
<div align="JUSTIFY" style="line-height: 200%;">
<span style="font-family: Arial, sans-serif;"> </span></div>
.http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0tag:blogger.com,1999:blog-1741444599832658384.post-33548831785936225792012-10-08T09:23:00.002-07:002012-10-08T09:23:38.353-07:00Arsa Vergisi Dilekçesi Formu<table border="0" cellspacing="0" cols="10" frame="VOID" rules="NONE">
<colgroup><col width="37"></col><col width="29"></col><col width="121"></col><col width="68"></col><col width="68"></col><col width="151"></col><col width="37"></col><col width="89"></col><col width="68"></col><col width="68"></col></colgroup>
<tbody>
<tr>
<td align="CENTER" colspan="10" height="39" valign="MIDDLE" width="734"><span style="font-family: Helvetica; font-size: xx-small;">EMLAK VERGİSİ BİLDİRİMİ ( ARSA )</span></td>
</tr>
<tr>
<td align="CENTER" colspan="10" height="39" valign="MIDDLE"><b><span style="font-family: Helvetica; font-size: small;">ZEYTİNBURNU BELEDİYE BAŞKANLIĞI'NA</span></b></td>
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<td align="CENTER" colspan="5" height="34" rowspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><b><span style="font-family: Helvetica; font-size: xx-small;">T.C. Kimlik No:………………………………………….</span></b></td>
<td align="CENTER" colspan="5" rowspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><b><span style="font-family: Helvetica; font-size: xx-small;">Sicil No:…………………………………………………………………</span></b></td>
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<td align="LEFT" colspan="4" height="26" style="border-bottom: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">TABLO 11-KİMLİK BİLDİRİMİ</span></td>
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<td align="CENTER" height="234" rowspan="10" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">MÜKELLEFİN</span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Soyadı</span></td>
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<td align="CENTER" rowspan="6" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">İKAMETGAH ADRESİ</span></td>
<td align="LEFT" colspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Mahalle / Semt :</span></td>
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<td align="LEFT" colspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Cadde / Sokak:</span></td>
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<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Baba Adı</span></td>
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<td align="LEFT" colspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Kapı No: Daire No:</span></td>
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<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Ana Adı</span></td>
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<td align="LEFT" colspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">İL / İLÇE :</span></td>
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<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Doğum Yeri ve Tarihi</span></td>
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<td align="LEFT" colspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Telefon :</span></td>
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<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Nüfusa K.Olduğu Yer</span></td>
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<td align="LEFT" colspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Mahalle / Semt :</span></td>
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<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Uyruğu</span></td>
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<td align="CENTER" rowspan="4" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">İŞYERİ ADRESİ</span></td>
<td align="LEFT" colspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Cadde / Sokak:</span></td>
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<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Cilt No</span></td>
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<td align="LEFT" colspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Kapı No: Daire No:</span></td>
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<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Aile Sıra No</span></td>
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<td align="LEFT" style="border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Cinsiyeti Kadın</span></td>
<td align="LEFT" colspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">İL / İLÇE :</span></td>
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<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Sıra No</span></td>
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<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"> Erkek</span></td>
<td align="LEFT" colspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Telefon :</span></td>
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<td align="LEFT" colspan="4" height="58" style="border-bottom: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
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<td align="CENTER" colspan="5" height="30" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">ARSAYA AİT BİLGİLER </span></td>
<td align="CENTER" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">1.ARSA</span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">2.ARSA </span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">3.ARSA</span></td>
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<td align="CENTER" height="108" rowspan="3" style="border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">ADRES BİLGİLERİ</span></td>
<td align="CENTER" sdnum="1055;" sdval="1" style="border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">1</span></td>
<td align="LEFT" colspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Belediye sınırları veya mücavir alanlar içinde ise belediyenin adı</span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-left: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
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<td align="CENTER" sdnum="1055;" sdval="2" style="border-left: 1px solid #000000; border-right: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">2</span></td>
<td align="LEFT" colspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Bulunduğu köy veya mahallenin adı</span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-left: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
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<td align="CENTER" sdnum="1055;" sdval="3" style="border-left: 1px solid #000000; border-right: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">3</span></td>
<td align="LEFT" colspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Cadde veya sokağı ( değer bakımından farklı bölgede ise farklı bölgenin adı)</span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-left: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
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<td align="CENTER" height="66" rowspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">TAPU BİLGİLERİ</span></td>
<td align="CENTER" rowspan="3" sdnum="1055;" sdval="4" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">4</span></td>
<td align="CENTER" rowspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Tapuda Kaydını Olduğu</span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Pafta No:</span></td>
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<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
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<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Ada; Parsel No</span></td>
<td align="CENTER" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
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<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Cilt / Sahire No:</span></td>
<td align="CENTER" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
</tr>
<tr>
<td align="CENTER" height="185" rowspan="6" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">VERGİLENDİRMEYE İLİŞKİN BİLGİLER</span></td>
<td align="CENTER" sdnum="1055;" sdval="5" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">5</span></td>
<td align="LEFT" colspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Arsanın ( parsel) yüzölçümü ( m2 )</span></td>
<td align="CENTER" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
</tr>
<tr>
<td align="CENTER" sdnum="1055;" sdval="6" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">6</span></td>
<td align="LEFT" colspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Hisseli ise hisse nisbeti</span></td>
<td align="CENTER" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
</tr>
<tr>
<td align="CENTER" sdnum="1055;" sdval="7" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">7</span></td>
<td align="LEFT" colspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Hisseye isabet eden arsanın yüzölçümü ( m2 )</span></td>
<td align="CENTER" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
</tr>
<tr>
<td align="CENTER" sdnum="1055;" sdval="8" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">8</span></td>
<td align="LEFT" colspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Arsanın iktisap tarihi</span></td>
<td align="CENTER" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
</tr>
<tr>
<td align="CENTER" sdnum="1055;" sdval="9" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">9</span></td>
<td align="LEFT" colspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Kısıtlılık hali varsa başlangıç tarihi</span></td>
<td align="CENTER" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
</tr>
<tr>
<td align="CENTER" sdnum="1055;" sdval="10" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">10</span></td>
<td align="LEFT" colspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Varsa muafiyetin başlangıç yılı ve uygulama süresi</span></td>
<td align="CENTER" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
</tr>
<tr>
<td align="CENTER" height="34" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Bildirimde Bulunanın</span></td>
</tr>
<tr>
<td align="CENTER" height="15" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">Adı,Soyadı ve imza </span></td>
</tr>
<tr>
<td align="CENTER" height="17" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" style="border-left: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" style="border-right: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
</tr>
<tr>
<td align="CENTER" height="17" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" style="border-left: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" style="border-right: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
</tr>
<tr>
<td align="CENTER" height="15" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Helvetica; font-size: xx-small;">…./…./20…</span></td>
</tr>
</tbody>
</table>
.http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0tag:blogger.com,1999:blog-1741444599832658384.post-69973057336559845112012-10-08T09:22:00.003-07:002012-10-08T09:22:47.300-07:00Ruhsat Dilekçesi<br />
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<b>ZEYTİNBURNU BELEDİYE
BAŞKANLIĞI</b></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<b>Ruhsat ve Denetim
Müdürlüğüne</b></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
……………………………………<b>.Mahallesi
………………………..……. </b>
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
……<b>..Sokak ………… nolu
yerde bulunan…………………………. olarak faaliyet </b>
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<b>gösterdiğim işyerime hafta
tatili ruhsatı almak istiyorum.</b></div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<b> Gereğini arz
ederim.</b></div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<b>../../20</b></div>
<div style="margin-bottom: 0cm;">
<b>Adı Soyadı Unvan)</b></div>
.http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0tag:blogger.com,1999:blog-1741444599832658384.post-30615642597102140512012-10-08T09:22:00.000-07:002012-10-08T09:22:00.465-07:00Adres Dilekçesi<br />
<div align="CENTER" style="margin-bottom: 0cm;">
……<b>/……/20</b></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<b>ZEYTİNBURNU BELEDİYE
BAŞKANLIĞI</b></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<b>İmar ve Şehircilik
Müdürlüğüne</b></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div align="JUSTIFY" style="margin-bottom: 0cm;">
<br />
</div>
<div align="JUSTIFY" style="margin-bottom: 0cm; text-indent: 1.25cm;">
Zeytinburnu,
…………………………..Mah. ……..……. pafta, …..…….
ada, ………..parsel sayılı taşınmazın adresinin ilgili makama
verilmek üzere tarafıma verilmesini arz ederim.</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
</div>
<div style="margin-bottom: 0cm; margin-left: 8.74cm;">
<u><b>Adı-Soyadı</b></u> <b>
</b>
</div>
<div style="margin-bottom: 0cm;">
<b> </b></div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<u><b>ADRES:</b></u></div>
<div style="margin-bottom: 0cm;">
<br />
</div>
.http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0tag:blogger.com,1999:blog-1741444599832658384.post-2714857267279895192012-10-08T09:18:00.001-07:002012-10-08T09:18:19.226-07:00KAPIDAN SATIŞ FİRMASI ŞİKAYET DİLEKÇESİ <br />
<h2 align="CENTER" class="western" lang="tr-TR" style="margin-left: 0cm; text-indent: 0cm;">
</h2>
<h2 align="CENTER" class="western" lang="tr-TR" style="margin-left: 0cm; text-indent: 0cm;">
</h2>
<h2 align="CENTER" class="western" lang="tr-TR" style="margin-left: 0cm; text-indent: 0cm;">
…………… <span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;">(il
yazılacak)</span></span><span style="font-family: Verdana, sans-serif;"><span style="font-size: small;">
Sanayi ve Ticaret İl Müdürlüğü’ne</span></span></h2>
<div class="western" style="margin-left: 2.5cm; text-indent: 1.25cm;">
<br />
</div>
<div class="western">
<br />
</div>
<div class="western">
<br />
</div>
<div class="western">
<span style="font-family: Times New Roman, serif;"><span style="font-size: small;"><span style="font-family: Verdana, sans-serif;"><u><b>ŞİKAYET
EDEN :</b></u></span><span style="font-family: Verdana, sans-serif;"> Tüketicinin
adı soyadı adresi</span></span></span></div>
<div class="western">
<br />
</div>
<div class="western">
<br />
</div>
<div class="western">
<br />
</div>
<div class="western">
<br />
</div>
<div class="western">
<span style="font-family: Times New Roman, serif;"><span style="font-size: small;"><span style="font-family: Verdana, sans-serif;"><u><b>ŞİKAYET
EDİLEN :</b></u></span><span style="font-family: Verdana, sans-serif;"> Şikayet
edilen kişi/ler yada kurum/ların adı
soyadı,unvanı,adresi(sorumluluk açısından birden fazla
olabilir.)</span></span></span></div>
<div class="western">
<br />
</div>
<div class="western">
<br />
</div>
<div class="western">
<br />
</div>
<div class="western">
<span style="font-family: Times New Roman, serif;"><span style="font-size: small;"><span style="font-family: Verdana, sans-serif;"><u><b>ŞİKAYET
KONUSU :</b></u></span><span style="font-family: Verdana, sans-serif;"> Kapıdan
satış firması hakkında</span></span></span></div>
<div class="western">
<br />
</div>
<div class="western">
<br />
</div>
<div class="western">
<br />
</div>
<div class="western">
<br />
</div>
<div align="JUSTIFY" class="western" lang="tr-TR" style="line-height: 0.4cm;">
<span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;"><u><b>OLAYLAR :</b></u></span></span><span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;"><b>
</b></span></span><span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;">Örneğin;
..../..../2005 tarihinde ...saatinde kapıma gelen satıcılardan
alışveriş yaptım. Yedi günlük cayma hakkımı iadeli taahhütlü
posta / noter vasıtasıyla kullandım. Ancak söz konusu firma cayma
hakkımı dikkate almayarak maddi ve manevi mağduriyetime neden
olmuştur. ……….” Gibi şikayete konu olan olay, </span></span><span style="color: black;"><span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;">yaşadığınız
hadiseler; net, fazla ayrıntıdan uzak ama olayı tam olarak ifade
etmelidir</span></span></span><span style="color: black;"><span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;"><i>.
(1, 2, 3, şeklinde Madde madde anlatmanızı öneririz.)</i></span></span></span></div>
<div class="western">
<br />
</div>
<div class="western">
<br />
</div>
<div class="western" lang="tr-TR" style="line-height: 0.4cm;">
<br /></div>
<div class="western">
<span style="font-family: Times New Roman, serif;"><span style="font-size: small;"><span style="font-family: Arial, sans-serif;"><span style="font-size: x-small;"><span lang="tr-TR"><span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;"><u><b>Netice-i
Talep</b></u></span></span></span></span></span><span style="color: black;"><span style="font-family: Verdana, sans-serif;"><u><b> </b></u></span></span><span style="color: black;"><span style="font-family: Verdana, sans-serif;"><b>:
</b></span></span><span style="color: black;"><span style="font-family: Verdana, sans-serif;">Söz
konusu kapıdan satış firması cayma hakkımı kullanmama rağmen
vermiş olduğu ürünü geri almamaktadır. Gerekli incelemenin
yapılarak firma hakkında ceza-i işlem uygulanmasının
saygılarımla arz ve talep ederim. </span></span></span></span>
</div>
<div class="western">
<span style="color: black;">…<span style="font-family: Times New Roman, serif;"><span style="font-size: small;"><span style="font-family: Verdana, sans-serif;">./
…. 20.. </span></span><span style="color: black;"><span style="font-family: Verdana, sans-serif;"><i>(tarih)</i></span></span></span></span></div>
<div class="western" lang="tr-TR" style="line-height: 0.4cm; margin-left: 3.75cm; text-indent: -3.75cm;">
<br />
</div>
<div class="western" lang="tr-TR" style="line-height: 0.4cm; margin-left: 3.75cm; text-indent: -3.75cm;">
<br />
</div>
<div class="western" lang="tr-TR" style="line-height: 0.4cm; margin-left: 3.75cm; text-indent: -3.75cm;">
<br />
</div>
<div class="western" lang="tr-TR" style="line-height: 0.4cm; margin-left: 3.75cm; text-indent: -3.75cm;">
<span style="color: black;"> </span></div>
<div align="RIGHT" class="western" lang="tr-TR" style="line-height: 0.4cm; margin-left: 3.75cm; text-indent: -3.75cm;">
<span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;"><b>Ad, Soyad, </b></span></span>
</div>
<div align="CENTER" class="western" lang="tr-TR" style="line-height: 0.4cm; margin-left: 3.75cm; text-indent: -3.75cm;">
<span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;"><b>
imza</b></span></span></div>
.http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0tag:blogger.com,1999:blog-1741444599832658384.post-10413696566285845442012-10-08T09:17:00.000-07:002012-10-08T09:17:00.424-07:00Aile Yardım Bildirimi Formu<table border="0" cellspacing="0" cols="18" frame="VOID" rules="NONE">
<colgroup><col width="164"></col><col width="111"></col><col width="73"></col><col width="15"></col><col width="40"></col><col width="41"></col><col width="41"></col><col width="42"></col><col width="32"></col><col width="34"></col><col width="25"></col><col width="71"></col><col width="58"></col><col width="64"></col><col width="33"></col><col width="25"></col><col width="82"></col><col width="126"></col></colgroup>
<tbody>
<tr>
<td align="CENTER" colspan="18" height="45" valign="MIDDLE" width="1078"><span style="font-family: Arial; font-size: medium;">AİLE YARDIMI BİLDİRİMİ</span></td>
</tr>
<tr>
<td align="LEFT" height="101" rowspan="4" style="border-bottom: 1px solid #000000; border-left: 3px solid #000000; border-right: 1px solid #000000; border-top: 3px solid #000000;" valign="MIDDLE">Bildirimi Verenin</td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-top: 3px solid #000000;">Memuriyeti :</td>
<td align="CENTER" colspan="8" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 3px solid #000000;"><br /></td>
<td align="LEFT" colspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 3px solid #000000;" valign="MIDDLE"><span style="font-family: Arial;">Dairesi</span></td>
<td align="LEFT" colspan="5" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 3px solid #000000; border-top: 3px solid #000000;" valign="MIDDLE">İst.Üniv. Fen Fakültesi</td>
</tr>
<tr>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-top: 1px solid #000000;">Adı-soyadı :</td>
<td align="CENTER" colspan="8" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><br /></td>
<td align="LEFT" colspan="3" rowspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 3px solid #000000;" valign="MIDDLE"><span style="font-family: Arial;">Ödemeyi yapacak saymanlığın adı : </span></td>
<td align="LEFT" colspan="5" rowspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 3px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE">İ.Ü.strateji Geliştirme Daire Başkanlığı</td>
</tr>
<tr>
<td align="LEFT" style="border-left: 1px solid #000000; border-top: 1px solid #000000;">T.C Numarası</td>
<td align="CENTER" colspan="8" style="border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><br /></td>
</tr>
<tr>
<td align="CENTER" colspan="2" style="border-bottom: 3px solid #000000; border-left: 3px solid #000000; border-right: 3px solid #000000; border-top: 3px solid #000000;" valign="MIDDLE">Medeni hali</td>
<td align="CENTER" colspan="2" style="border-bottom: 3px solid #000000; border-right: 3px solid #000000; border-top: 3px solid #000000;" valign="MIDDLE"> Bekar</td>
<td align="CENTER" style="border-bottom: 3px solid #000000; border-left: 3px solid #000000; border-right: 3px solid #000000; border-top: 3px solid #000000;" valign="MIDDLE"><br /></td>
<td align="CENTER" style="border-bottom: 3px solid #000000; border-left: 3px solid #000000; border-right: 3px solid #000000; border-top: 3px solid #000000;" valign="MIDDLE">Evli</td>
<td align="CENTER" style="border-bottom: 3px solid #000000; border-left: 3px solid #000000; border-right: 3px solid #000000; border-top: 3px solid #000000;" valign="MIDDLE"><br /></td>
<td align="CENTER" style="border-bottom: 3px solid #000000; border-left: 3px solid #000000; border-right: 3px solid #000000; border-top: 3px solid #000000;" valign="MIDDLE">Dul</td>
<td align="LEFT" style="border-bottom: 3px solid #000000; border-left: 3px solid #000000; border-right: 3px solid #000000; border-top: 3px solid #000000;"><br /></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 3px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial;">İlgili olduğu ay ve yıl :</span></td>
<td align="CENTER" style="border-bottom: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial;"><br /></span></td>
<td align="CENTER" style="border-bottom: 1px solid #000000; border-right: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial;"><br /></span></td>
<td align="LEFT" colspan="5" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 3px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><br /></td>
</tr>
<tr>
<td align="CENTER" colspan="17" height="20" style="border-left: 3px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: small;">AİLE YARDIMI İÇİN EŞİN</span></td>
<td align="LEFT" style="border-right: 3px solid #000000;"><br /></td>
</tr>
<tr>
<td align="LEFT" colspan="3" height="37" style="border-bottom: 1px solid #000000; border-left: 3px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE">Adı- Soyadı :</td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;">Evlenme Tarihi</span></td>
<td align="LEFT" colspan="4" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;">Aile Cüzdanının</td>
<td align="CENTER" colspan="4" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE">İş Durumu</td>
<td align="LEFT" colspan="5" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 3px solid #000000; border-top: 1px solid #000000;">Beyan Sahibinin Eşi Çalışıyor ise Kurum veya Özel Sektörün Adı</td>
</tr>
<tr>
<td align="LEFT" colspan="3" height="51" rowspan="3" style="border-bottom: 1px solid #000000; border-left: 3px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE">T.C Numarası :</td>
<td align="LEFT" colspan="2" rowspan="3" sdnum="1055;0;DD/MM/YYYY" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;">Tarihi</td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;">No.su</td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-left: 1px solid #000000; border-top: 1px solid #000000;">Çalışıyor</td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-top: 1px solid #000000;"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-right: 1px solid #000000; border-top: 1px solid #000000;"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" colspan="5" rowspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 3px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial;"><br /></span></td>
</tr>
<tr>
<td align="LEFT" colspan="2" rowspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" rowspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-left: 1px solid #000000;">Çalışmıyor</td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-right: 1px solid #000000;"><br /></td>
</tr>
<tr>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000;">Emekli</td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-bottom: 1px solid #000000;"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-bottom: 1px solid #000000; border-right: 1px solid #000000;"><br /></td>
</tr>
<tr>
<td align="CENTER" colspan="17" height="17" style="border-bottom: 1px solid #000000; border-left: 3px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;">YARDIM ALINACAK ÖZ, ÜVEY VEYA EVLAT EDİNİLMİŞ ÇOCUKLARIN</td>
<td align="LEFT" style="border-right: 3px solid #000000;"><br /></td>
</tr>
<tr>
<td align="CENTER" height="105" rowspan="3" style="border-bottom: 1px solid #000000; border-left: 3px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial;">Adı- Soyadı</span></td>
<td align="CENTER" rowspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial;">T.C Numarası</span></td>
<td align="CENTER" colspan="2" rowspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;">Doğum tarihi ( ay / gün / yıl şeklinde yazılacaktır. )</span></td>
<td align="CENTER" rowspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;">Cinsiyeti</span></td>
<td align="LEFT" colspan="2" rowspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;">Babasının adı</span></td>
<td align="LEFT" colspan="2" rowspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;">Anasının adı</span></td>
<td align="LEFT" colspan="2" rowspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;">Öz,üvey veya evlat edinilmiş mi olduğu</span></td>
<td align="LEFT" colspan="5" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;">Yüksek Öğrenime Devam Ediyorsa</td>
<td align="CENTER" rowspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;">Daire ve kurumların öğrenim giderleri üstlenilmiş veye kendisine burs verilmekte midir?</span></td>
<td align="CENTER" rowspan="3" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 3px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><b>(7) Açıklama (Çocuk İçin)</b></td>
</tr>
<tr>
<td align="CENTER" rowspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;">Hangi Tarihte Kaydedildiği</span></td>
<td align="CENTER" colspan="2" rowspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE">Okulun adı</td>
<td align="CENTER" rowspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;">sınıfı</span></td>
<td align="CENTER" rowspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;">No</span></td>
</tr>
<tr>
</tr>
<tr>
<td align="LEFT" height="27" style="border-bottom: 1px solid #000000; border-left: 3px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="CENTER" sdnum="1055;0;DD/MM/YYYY" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 3px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
</tr>
<tr>
<td align="LEFT" height="27" style="border-bottom: 1px solid #000000; border-left: 3px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="CENTER" sdnum="1055;0;DD/MM/YYYY" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 3px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
</tr>
<tr>
<td align="LEFT" height="27" style="border-bottom: 1px solid #000000; border-left: 3px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="CENTER" sdnum="1055;0;DD/MM/YYYY" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="CENTER" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 3px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
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<td align="LEFT" height="27" style="border-bottom: 1px solid #000000; border-left: 3px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
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<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 3px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
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<td align="LEFT" height="27" style="border-bottom: 1px solid #000000; border-left: 3px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 3px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
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<td align="LEFT" height="27" style="border-bottom: 1px solid #000000; border-left: 3px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 3px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
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<td align="LEFT" height="27" style="border-bottom: 1px solid #000000; border-left: 3px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 3px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
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<tr>
<td align="LEFT" height="27" style="border-bottom: 1px solid #000000; border-left: 3px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" colspan="2" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 1px solid #000000; border-top: 1px solid #000000;"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" style="border-bottom: 1px solid #000000; border-left: 1px solid #000000; border-right: 3px solid #000000; border-top: 1px solid #000000;" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
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<tr>
<td align="LEFT" bgcolor="#FFFFFF" height="17" style="border-left: 3px solid #000000;"><span style="font-family: Arial; font-size: xx-small;">Arka sayfada yazılı husuları da gözönüne almak suretiyle düzenlediğim aile yardımına ait bildirimdir.</span></td>
<td align="LEFT" bgcolor="#FFFFFF"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" valign="MIDDLE"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-right: 3px solid #000000;"><br /></td>
</tr>
<tr>
<td align="LEFT" bgcolor="#FFFFFF" height="12" style="border-left: 3px solid #000000;"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" valign="MIDDLE"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-right: 3px solid #000000;"><br /></td>
</tr>
<tr>
<td align="LEFT" bgcolor="#FFFFFF" height="12" style="border-left: 3px solid #000000;"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" valign="MIDDLE"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-right: 3px solid #000000;"><br /></td>
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<tr>
<td align="LEFT" bgcolor="#FFFFFF" colspan="5" height="17" style="border-left: 3px solid #000000;">Yukarıdaki bildirim kağıdını düzenleyen </td>
<td align="LEFT" bgcolor="#FFFFFF" colspan="6">...................................................</td>
<td align="LEFT" bgcolor="#FFFFFF">ait bildirimdir.</td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-right: 3px solid #000000;"><br /></td>
</tr>
<tr>
<td align="LEFT" bgcolor="#FFFFFF" height="10" style="border-left: 3px solid #000000;"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-right: 3px solid #000000;"><br /></td>
</tr>
<tr>
<td align="LEFT" bgcolor="#FFFFFF" height="10" style="border-left: 3px solid #000000;"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
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<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-right: 3px solid #000000;"><br /></td>
</tr>
<tr>
<td align="LEFT" bgcolor="#FFFFFF" height="17" style="border-left: 3px solid #000000;">Daire amirinin </td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" colspan="6" rowspan="2"><b><span style="font-family: Arial; font-size: small;"><br /></span></b></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF">Beyan Sahibinin Adı Soyadı </td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-right: 3px solid #000000;"><br /></td>
</tr>
<tr>
<td align="LEFT" bgcolor="#FFFFFF" height="17" style="border-left: 3px solid #000000;">Adı-soyadı. :</td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" valign="MIDDLE"><span style="font-family: Arial; font-size: xx-small;"><br /></span></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-right: 3px solid #000000;"><br /></td>
</tr>
<tr>
<td align="LEFT" bgcolor="#FFFFFF" height="20" style="border-left: 3px solid #000000;">Ünvanı :</td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="CENTER" bgcolor="#FFFFFF" colspan="4" rowspan="3" style="border-bottom: 3px solid #000000;"><b><span style="font-family: Arial; font-size: small;"><br /></span></b></td>
<td align="CENTER" bgcolor="#FFFFFF"><b><span style="font-family: Arial; font-size: small;"><br /></span></b></td>
<td align="CENTER" bgcolor="#FFFFFF"><b><span style="font-family: Arial; font-size: small;"><br /></span></b></td>
<td align="CENTER" bgcolor="#FFFFFF"><b><span style="font-family: Arial; font-size: small;"><br /></span></b></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF">İmzası</td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-right: 3px solid #000000;"><br /></td>
</tr>
<tr>
<td align="LEFT" bgcolor="#FFFFFF" height="20" style="border-left: 3px solid #000000;">İmzası : </td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="CENTER" bgcolor="#FFFFFF"><b><span style="font-family: Arial; font-size: small;"><br /></span></b></td>
<td align="CENTER" bgcolor="#FFFFFF"><b><span style="font-family: Arial; font-size: small;"><br /></span></b></td>
<td align="CENTER" bgcolor="#FFFFFF"><b><span style="font-family: Arial; font-size: small;"><br /></span></b></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-right: 3px solid #000000;"><br /></td>
</tr>
<tr>
<td align="LEFT" bgcolor="#FFFFFF" height="33" style="border-bottom: 3px solid #000000; border-left: 3px solid #000000;"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-bottom: 3px solid #000000;"><br /></td>
<td align="CENTER" bgcolor="#FFFFFF" style="border-bottom: 3px solid #000000;"><b><span style="font-family: Arial; font-size: small;"><br /></span></b></td>
<td align="CENTER" bgcolor="#FFFFFF" style="border-bottom: 3px solid #000000;"><b><span style="font-family: Arial; font-size: small;"><br /></span></b></td>
<td align="CENTER" bgcolor="#FFFFFF" style="border-bottom: 3px solid #000000;"><b><span style="font-family: Arial; font-size: small;"><br /></span></b></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-bottom: 3px solid #000000;"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-bottom: 3px solid #000000;"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-bottom: 3px solid #000000;"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-bottom: 3px solid #000000;"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-bottom: 3px solid #000000;"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-bottom: 3px solid #000000;"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-bottom: 3px solid #000000;"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-bottom: 3px solid #000000;"><br /></td>
<td align="LEFT" bgcolor="#FFFFFF" style="border-bottom: 3px solid #000000; border-right: 3px solid #000000;"><br /></td>
</tr>
<tr>
<td align="LEFT" height="17"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
</tr>
<tr>
<td align="LEFT" height="17"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
</tr>
<tr>
<td align="LEFT" height="17"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
</tr>
<tr>
<td align="LEFT" height="17"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
<td align="LEFT"><br /></td>
</tr>
<tr>
<td align="CENTER" colspan="18" height="35" valign="MIDDLE"><b><span style="font-family: Times New Roman; font-size: medium;">AİLE YARDIMI BİLDİRİMİ</span></b></td>
</tr>
<tr>
<td align="LEFT" colspan="18" height="60" valign="MIDDLE"><span style="font-family: Times New Roman; font-size: small;">1- Bu bildirim personelin ilk işe girişinde verilir. Personelin aile yardımından yararlanan eş veya çocuk durumunda bir değişiklik meydana gelmesi halinde veya yer değiştirme suretiyle atama halinde yeniden bildirim verilir.</span></td>
</tr>
<tr>
<td align="LEFT" colspan="18" height="60" valign="MIDDLE"><span style="font-family: Times New Roman; font-size: small;">2- Evlat Edinilmiş çocuklara ait ilamın verildiği mahkemenin adı ile tarih ve sayısı gösterilir.</span></td>
</tr>
<tr>
<td align="LEFT" colspan="18" height="60" valign="MIDDLE"><span style="font-family: Times New Roman; font-size: small;">3- Üvey çocuklar için nafaka alınıp alınmadığı gösterilir.</span></td>
</tr>
<tr>
<td align="LEFT" colspan="18" height="60" valign="MIDDLE"><span style="font-family: Times New Roman; font-size: small;">4- Aile yardımından yararlanacak çocuklardan çalışamayacak derecede malul olmaları nedeniyle sürekli olarak yardımdan yararlanacaklara ait olanların bu durumunu gösteren resmi sağlık kurumu raporu bu bildirime eklenir.</span></td>
</tr>
<tr>
<td align="LEFT" colspan="18" height="60" valign="MIDDLE"><span style="font-family: Times New Roman; font-size: small;">5- Boşanma veya ayrılma halinde çocuklara ait aile yardımından yararlanacak olan eşin buna ilişkin mahkeme kararının onaylı örneği bildirime eklenir.</span></td>
</tr>
<tr>
<td align="LEFT" colspan="18" height="60" valign="MIDDLE"><span style="font-family: Times New Roman; font-size: small;">6- 193 Sayılı Kanunun gereği, asgari geçim indiriminden faydalananların bakmakla yükümlü oldukları çocuklarının 18 yaşını veya tahsilde olup 25 yaşını doldurmamış çocukları, kapsar.</span></td>
</tr>
<tr>
<td align="LEFT" colspan="18" height="60" valign="MIDDLE"><span style="font-family: Times New Roman; font-size: small;">7- Eşlerin her ikisinin çalışması halinde asgari geçim indiriminden(Çocuk için) yanlızca biri yararlanacağı için Ön kısımdaki Çocuk hanesinin Açıklama kısmına Eşinin (Çocuk için ) Asgari geçim indiriminden faydalanıp , faydalanmadığını belirtmesi gerekmektedir. </span></td>
</tr>
</tbody>
</table>
.http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0tag:blogger.com,1999:blog-1741444599832658384.post-33383457188788463402012-10-08T09:16:00.002-07:002012-10-08T09:16:21.362-07:00Mezuniyet Belgesi Talep Dilekçe Örneği<br />
<div align="RIGHT" style="line-height: 100%; margin-bottom: 0.49cm;">
<span style="font-family: Times New Roman, serif;"><span style="font-size: small;"><strong>Tarih
</strong></span></span>
</div>
<div align="CENTER" style="line-height: 100%; margin-bottom: 0.49cm; margin-top: 0.49cm;">
<strong> <span style="font-family: Times New Roman, serif;"><span style="font-size: small;">İSTANBUL
ÜNİVERSİTESİ FEN FAKÜLTESİ DEKANLIĞI'NA</span></span></strong></div>
<div style="line-height: 100%; margin-bottom: 0.49cm; margin-top: 0.49cm;">
</div>
<div style="line-height: 100%; margin-bottom: 0.49cm; margin-top: 0.49cm;">
<span style="font-family: Times New Roman, serif;">Fakülteniz...........................................................Bölümü.....................numaralı
öğrencinizim. .........................tarihinde mezun oldum.
Mezuniyetimin onaylanarak Mezuniyet Belgemin düzenlenmesini arz
ederim.</span></div>
<div style="line-height: 100%; margin-bottom: 0.49cm; margin-top: 0.49cm;">
</div>
<div align="RIGHT" style="line-height: 100%; margin-bottom: 0.49cm; margin-top: 0.49cm;">
<strong> </strong>
</div>
<div align="RIGHT" style="line-height: 100%; margin-bottom: 0.49cm; margin-top: 0.49cm;">
<span style="font-family: Times New Roman, serif;"><span style="font-size: small;"><strong><u>Adı
Soyadı ve İmzası </u></strong></span></span>
</div>
<div style="line-height: 100%; margin-bottom: 0.49cm; margin-top: 0.49cm;">
<br /><br />
</div>
<div style="line-height: 100%; margin-bottom: 0.49cm; margin-top: 0.49cm;">
<span style="font-family: Times New Roman, serif;"><span style="font-size: small;"><strong>Adres:</strong></span></span></div>
<div align="RIGHT" style="line-height: 100%; margin-bottom: 0.49cm; margin-top: 0.49cm;">
<br /><br />
</div>
.http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0tag:blogger.com,1999:blog-1741444599832658384.post-61238154690463449352012-10-08T09:15:00.005-07:002012-10-08T09:15:53.940-07:00Öğrenci Belgesi Talep Dilekçe Örneği<br />
<div align="RIGHT" style="line-height: 100%; margin-bottom: 0.49cm;">
<strong> <span style="font-family: Times New Roman, serif;"><span style="font-size: small;">Tarih
</span></span></strong>
</div>
<div align="CENTER" style="line-height: 100%; margin-bottom: 0.49cm; margin-top: 0.49cm;">
<strong> <span style="font-family: Times New Roman, serif;"><span style="font-size: small;">İSTANBUL
ÜNİVERSİTESİ FEN FAKÜLTESİ DEKANLIĞI'NA</span></span></strong></div>
<div style="line-height: 100%; margin-bottom: 0.49cm; margin-top: 0.49cm;">
</div>
<div style="line-height: 100%; margin-bottom: 0.49cm; margin-top: 0.49cm;">
<span style="font-family: Times New Roman, serif;">Fakültenizin
......................... Bölümü...........................
numaralı öğrencisiyim
............................................................ verilmek
üzere öğrenci belgesinin hazırlanıp tarafıma verilmesini
saygılarımla arz ederim.</span></div>
<div style="line-height: 100%; margin-bottom: 0.49cm; margin-top: 0.49cm;">
<br /><br />
</div>
<div style="line-height: 100%; margin-bottom: 0.49cm; margin-top: 0.49cm;">
<br /><br />
</div>
<div align="RIGHT" style="line-height: 100%; margin-bottom: 0.49cm; margin-top: 0.49cm;">
<strong> </strong>
<span style="font-family: Times New Roman, serif;"><span style="font-size: small;"><strong><u>Adı
Soyadı ve İmzası </u></strong></span></span>
</div>
<div style="line-height: 100%; margin-bottom: 0.49cm; margin-top: 0.49cm;">
<span style="font-family: Times New Roman, serif;"><br /><strong>Adres:</strong></span></div>
<div style="line-height: 100%; margin-bottom: 0.49cm; margin-top: 0.49cm;">
<span style="font-family: Times New Roman, serif;"><span style="font-size: small;"><strong>Tel:</strong></span></span></div>
<div style="margin-bottom: 0cm;">
<br />
</div>
.http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0tag:blogger.com,1999:blog-1741444599832658384.post-45830472505142404452012-10-08T09:15:00.002-07:002012-10-08T09:15:22.535-07:00Sağlık Karnesi Talep Formu<br />
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><b>İstanbul
Üniversitesi Rektörlüğü</b></span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><b>SAĞLIK
KARNESİ TALEP FORMU</b></span></div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Adı ve Soyadı :</span></div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Kadrosunun Olduğu Yer :</span></div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Çalıştığı Birim :</span></div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Kadro Ünvanı :</span></div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Kadro Derecesi :</span></div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Kurum Sicil No :</span></div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Emekli Sicil No :</span></div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Sağlık Karnesi Seri
No :</span></div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<dl>
<dd>
<table border="1" bordercolor="#000000" cellpadding="5" cellspacing="0" style="width: 589px;">
<colgroup><col width="89"></col>
<col width="94"></col>
<col width="86"></col>
<col width="87"></col>
<col width="86"></col>
<col width="85"></col>
</colgroup><tbody>
<tr valign="TOP">
<td height="100" width="89">
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<b>FOTOĞRAF</b></div>
<div style="margin-bottom: 0cm;">
<b>(KENDİSİ)</b></div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<br />
<br />
</td>
<td width="94">
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
FOTOĞRAF</div>
<div align="CENTER">
<br />
</div>
</td>
<td width="86">
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
FOTOĞRAF</div>
<div align="CENTER">
<br />
</div>
</td>
<td width="87">
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
FOTOĞRAF</div>
<div align="CENTER">
<br />
</div>
</td>
<td width="86">
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
FOTOĞRAF</div>
<div align="CENTER">
<br />
</div>
</td>
<td width="85">
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
FOTOĞRAF</div>
<div align="CENTER">
<br />
</div>
</td>
</tr>
</tbody></table>
</dd></dl>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<b>Tedavi Yardımından Yararlanacak
Olan Aile Fertlerinin</b></div>
<div style="margin-bottom: 0cm; margin-left: -0.32cm; text-indent: 0.32cm;">
<br />
</div>
<table border="1" bordercolor="#000000" cellpadding="5" cellspacing="0" style="width: 613px;">
<colgroup><col width="114"></col>
<col width="86"></col>
<col width="86"></col>
<col width="86"></col>
<col width="88"></col>
<col width="92"></col>
</colgroup><tbody>
<tr valign="TOP">
<td width="114">
<br />
<br />
</td>
<td width="86">
<div align="CENTER">
<br />
</div>
</td>
<td width="86">
<div align="CENTER">
<br />
</div>
</td>
<td width="86">
<div align="CENTER">
<br />
</div>
</td>
<td width="88">
<div align="CENTER">
<br />
</div>
</td>
<td width="92">
<div align="CENTER">
<br />
</div>
</td>
</tr>
<tr valign="TOP">
<td width="114">
<span style="font-size: x-small;">Soyadı</span><br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="88">
<br />
<br />
</td>
<td width="92">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="114">
<span style="font-size: x-small;">Adı</span><br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="88">
<br />
<br />
</td>
<td width="92">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="114">
<span style="font-size: x-small;">Baba Adı</span><br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="88">
<br />
<br />
</td>
<td width="92">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="114">
<span style="font-size: x-small;">Ana Adı</span><br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="88">
<br />
<br />
</td>
<td width="92">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="114">
<span style="font-size: x-small;">Yakınlığı</span><br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="88">
<br />
<br />
</td>
<td width="92">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="114">
<span style="font-size: x-small;">Meşguliyeti</span><br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="88">
<br />
<br />
</td>
<td width="92">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="114">
<span style="font-size: x-small;">Doğum Yeri</span><br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="88">
<br />
<br />
</td>
<td width="92">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="114">
<span style="font-size: x-small;">Doğum Tarihi</span><br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="88">
<br />
<br />
</td>
<td width="92">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="114">
<span style="font-size: x-small;">Mede</span><span style="font-size: x-small;">ni Hali</span><br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="88">
<br />
<br />
</td>
<td width="92">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="114">
<span style="font-size: x-small;">Kan Grubu</span><br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="88">
<br />
<br />
</td>
<td width="92">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="114">
<span style="font-size: x-small;">Sağlık Karnesi.Seri No</span><br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="88">
<br />
<br />
</td>
<td width="92">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="114">
<span style="font-size: x-small;">Kaçıncı Kez Verildiği</span><br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="88">
<br />
<br />
</td>
<td width="92">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="114">
<span style="font-size: x-small;">Veriliş Nedeni</span><br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="88">
<br />
<br />
</td>
<td width="92">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="114">
<span style="font-size: x-small;">Veriliş Tarihi</span><br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="86">
<br />
<br />
</td>
<td width="88">
<br />
<br />
</td>
<td width="92">
<br />
<br />
</td>
</tr>
</tbody></table>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
</div>
<div style="margin-bottom: 0cm; text-indent: 1.25cm;">
<span style="font-size: x-small;">Formdaki
bilgilerin doğruluğunu onaylarım. ...../...../2002</span></div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;"> </span></div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm; text-indent: 1.25cm;">
<span style="font-size: x-small;">Talep
Sahibinin Personel Birimi</span></div>
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;"> Adı, Soyadı,
İmzası Yetkili Amiri</span></div>
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;"> Adı, Soyadı,
İmzası</span></div>
.http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0tag:blogger.com,1999:blog-1741444599832658384.post-23991027817979823192012-10-08T09:14:00.003-07:002012-10-08T09:14:36.957-07:00Yeşil Pasaport Talep Formu<br />
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">T.C</span></div>
<h2 class="western" style="font-weight: normal;">
<span style="font-size: x-small;">İstanbul
Üniversitesi Rektörlüğü</span></h2>
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Personel Daire
Başkanlığı</span></div>
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Sayı:</span></div>
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Konu: Hususi Damgalı
Pasaport Talep Formu</span></div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">İSTANBUL
EMNİYET MÜDÜRLÜĞÜNE </span>
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="JUSTIFY" style="margin-bottom: 0cm; text-indent: 1.25cm;">
<span style="font-size: x-small;">5682
sayılı Pasaport Kanunu gereği aşağıda açık kimliği, görev
unvanı ve kadro derecesi belirtilen personele, eş ve çocuklarına
hususi pasaport verilmesini arz/rica ederim. </span>
</div>
<div style="margin-bottom: 0cm;">
</div>
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Yetkili
Amir </span>
</div>
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;">
İmzası</span></div>
<dl>
<dl>
<dl>
<dd>
<table border="1" bordercolor="#000000" cellpadding="5" cellspacing="0" style="width: 601px;">
<colgroup><col width="121"></col>
<col width="110"></col>
<col width="110"></col>
<col width="110"></col>
<col width="98"></col>
</colgroup><tbody>
<tr valign="TOP">
<td height="114" width="121">
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">FOTOĞRAF</span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">(KENDİSİ)</span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">(Mutlaka
Dolacak)</span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">(Mühür)</span></div>
<div align="CENTER">
<br />
</div>
</td>
<td width="110">
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">FOTOĞRAF</span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">(EŞİ)</span></div>
<div align="CENTER">
<span style="font-size: x-small;">(Mühür)</span></div>
</td>
<td width="110">
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">FOTOĞRAF</span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">(ÇOCUK)</span></div>
<div align="CENTER">
<span style="font-size: x-small;">(Mühür)</span></div>
</td>
<td width="110">
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">FOTOĞRAF</span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">(ÇOCUK)</span></div>
<div align="CENTER">
<span style="font-size: x-small;">(Mühür)</span></div>
</td>
<td width="98">
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">FOTOĞRAF</span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">(ÇOCUK)</span></div>
<div align="CENTER">
<span style="font-size: x-small;">(Mühür)</span></div>
</td>
</tr>
</tbody></table>
</dd></dl>
</dl>
</dl>
<h1 class="western">
N Ü F U S - H Ü V İ Y E T K A Y D I
</h1>
<table border="1" bordercolor="#000000" cellpadding="5" cellspacing="0" style="width: 725px;">
<colgroup><col width="111"></col>
<col width="125"></col>
<col width="110"></col>
<col width="110"></col>
<col width="110"></col>
<col width="97"></col>
</colgroup><tbody>
<tr valign="TOP">
<td height="10" width="111">
<br />
<br />
</td>
<td width="125">
<div align="CENTER">
<br />
</div>
</td>
<td width="110">
<div align="CENTER">
<br />
</div>
</td>
<td width="110">
<div align="CENTER">
<br />
</div>
</td>
<td width="110">
<div align="CENTER">
<br />
</div>
</td>
<td width="97">
<div align="CENTER">
<br />
</div>
</td>
</tr>
<tr valign="TOP">
<td height="32" width="111">
<br />
<br />
</td>
<td width="125">
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Çalışan</span></div>
<div align="CENTER">
<span style="font-size: x-small;">(Mutlaka
Dolacak)</span></div>
</td>
<td width="110">
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Çalışanın
Eşi</span></div>
<div align="CENTER">
<span style="font-size: x-small;">(Alacaksa)</span></div>
</td>
<td width="110">
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Çocuk
</span>
</div>
<div align="CENTER">
<span style="font-size: x-small;">(Alacaksa)</span></div>
</td>
<td width="110">
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Çocuk
</span>
</div>
<div align="CENTER">
<span style="font-size: x-small;">(Alacaksa)</span></div>
</td>
<td width="97">
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Çocuk
</span>
</div>
<div align="CENTER">
<span style="font-size: x-small;">(Alacaksa)</span></div>
</td>
</tr>
<tr valign="TOP">
<td height="11" width="111">
<span style="font-size: x-small;">T.C. Kimlik No</span><br />
</td>
<td width="125">
<div align="CENTER">
<br />
</div>
</td>
<td width="110">
<div align="CENTER">
<br />
</div>
</td>
<td width="110">
<div align="CENTER">
<br />
</div>
</td>
<td width="110">
<div align="CENTER">
<br />
</div>
</td>
<td width="97">
<div align="CENTER">
<br />
</div>
</td>
</tr>
<tr valign="TOP">
<td width="111">
<span style="font-size: x-small;">Soyadı</span><br />
</td>
<td width="125">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="97">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td height="13" width="111">
<span style="font-size: x-small;">Adı </span>
<br />
</td>
<td width="125">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="97">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td height="12" width="111">
<span style="font-size: x-small;">Baba Adı</span><br />
</td>
<td width="125">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="97">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="111">
<span style="font-size: x-small;">Ana Adı</span><br />
</td>
<td width="125">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="97">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="111">
<span style="font-size: x-small;">Doğum Yeri</span><br />
</td>
<td width="125">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="97">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="111">
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Doğum
Tarihi</span></div>
<span style="font-size: x-small;">(Gün-Ay-Yıl)</span><br />
</td>
<td width="125">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="97">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="111">
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Ad</span><span style="font-size: x-small;">-Soyad-Yaş</span></div>
<span style="font-size: x-small;">Değişikliği Var mı</span><br />
</td>
<td width="125">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="97">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td height="14" width="111">
<span style="font-size: x-small;">Medeni Hali </span>
<br />
</td>
<td width="125">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="97">
<br />
<br />
</td>
</tr>
<tr>
<td colspan="6" height="8" valign="TOP" width="713">
<div align="CENTER">
<span style="font-size: x-small;"><b>N Ü F U S</b></span><span style="font-size: x-small;"><b>
A K A Y I T L I O L D U Ğ U Y E R B İ L G İ L E R İ</b></span></div>
</td>
</tr>
<tr valign="TOP">
<td width="111">
<span style="font-size: x-small;">İli</span><br />
</td>
<td width="125">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="97">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="111">
<span style="font-size: x-small;">İlçesi</span><br />
</td>
<td width="125">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="97">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="111">
<span style="font-size: x-small;">Mahalle/Köy</span><br />
</td>
<td width="125">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="97">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="111">
<span style="font-size: x-small;">Cilt No.</span><br />
</td>
<td width="125">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="97">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="111">
<span style="font-size: x-small;">Aile Sıra No.</span><br />
</td>
<td width="125">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="97">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="111">
<span style="font-size: x-small;">Sıra No.</span><br />
</td>
<td width="125">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="97">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="111">
<span style="font-size: x-small;">Verildiği Yer</span><br />
</td>
<td width="125">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="97">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="111">
<span style="font-size: x-small;">Veriliş Tarihi</span><br />
</td>
<td width="125">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="97">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="111">
<span style="font-size: x-small;">Cüzdan Seri-No.</span><br />
</td>
<td width="125">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="97">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="111">
<span style="font-size: x-small;">Kurum Sicil No</span><br />
</td>
<td width="125">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="97">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="111">
<span style="font-size: x-small;">Emekli Sicil No</span><br />
</td>
<td width="125">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="110">
<br />
<br />
</td>
<td width="97">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="111">
<span style="font-size: x-small;">MEMURUN GÖREV ÜNVANI</span><br />
</td>
<td colspan="5" width="593">
………………………………………<span style="font-family: Arial, sans-serif;"><span style="font-size: xx-small;"><b>..…….(Örneğin:Öğretmen,
Şube Müdürü, Daire Başkanı, Uzmun Doktur gibi)</b></span></span><br />
</td>
</tr>
<tr valign="TOP">
<td rowspan="5" width="111">
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<span style="font-size: x-small;">KADRO DERECESİ</span><br />
</td>
<td colspan="5" width="593">
<span style="font-size: x-small;"><b>1- 657 Sayılı
D.M.K.'ya tabi ……….(1. veya 2. veya 3.) derece kadrodadır.</b></span><br />
</td>
</tr>
<tr>
<td colspan="5" width="593">
<span style="font-size: x-small;"><b>2- 657 Sayılı
D.M.K.'ya tabi ……….(1. veya 2. veya 3.) kadro derece
karşılığı sözleşmeli memurdur.</b></span><br />
</td>
</tr>
<tr>
<td colspan="5" width="593">
<span style="font-size: x-small;"><b>3- Kadro karşılığı
olmaksızın sözleşmeli personel olup kesenekleri ……(1. veya
2. veya 3.) dereceden kesilerek T.C. Emekli Sandığına
yatırılmaktadır.</b></span><br />
</td>
</tr>
<tr valign="TOP">
<td colspan="5" width="593">
<span style="font-size: x-small;"><b>4- Diğerleri:
Örnek(Belediye Bşk. vb.)</b></span><br />
</td>
</tr>
<tr valign="TOP">
<td colspan="5" width="593">
<span style="font-size: x-small;"><b>(BOŞ BIRAKILAN ALANA
MEMUR HANGİ KADRO DERECEDE ÇALIŞIYOR İSE ÇALIŞTIĞI KADRO
DERECESİ YAZILACAKTIR.)</b></span><br />
</td>
</tr>
</tbody></table>
<div align="RIGHT" style="margin-bottom: 0cm;">
<br />
</div>
<div align="RIGHT" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Formdaki
bilgilerin doğruluğunu onaylarım</span>.</div>
<div align="CENTER" style="margin-bottom: 0cm;">
……../………./……….</div>
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Talep
Sahibinin</span>
MÜHÜR</div>
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Adı,Soyadı
,İmzası</span> </div>
<div style="margin-bottom: 0cm;">
Personel Birim Amiri</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<table border="1" bordercolor="#000000" cellpadding="7" cellspacing="0" style="width: 730px;">
<colgroup><col width="714"></col>
</colgroup><tbody>
<tr>
<td height="302" valign="TOP" width="714">
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm; margin-left: 0.25cm; margin-right: 0.25cm;">
<b>PASAPORT ALACAK REŞİT ÇOCUK VARSA HAK SAHİBİ TARAFINDAN
DOLDURULACAKTIR.</b></div>
<div align="CENTER" style="margin-bottom: 0cm; margin-left: 0.25cm; margin-right: 0.25cm;">
<b>(TAAHHÜT BELGESİ)</b></div>
<div align="CENTER" style="margin-bottom: 0cm; margin-right: 0.25cm;">
<br />
</div>
<div align="JUSTIFY" style="margin-bottom: 0cm; margin-right: 0.25cm;">
Kendisine hususi damgalı pasaport talebinde bulunduğum
ergin ve veya/ergin olmayan çocuğum/çocuklarımın öğrenci
olduğunu, herhangi bir işte çalışmadığını, öğrenciliği
hariç birlikte yaşadığımızı, bekar olduğunu ayrıca bu
hususların değişmesi halinde çocuğuma aldığım/alacağım
pasaportu iade edeceğimi taahhüt ederim.
...../...../....... </div>
<div align="JUSTIFY" style="margin-bottom: 0cm; margin-right: 0.25cm;">
Hak Sahibinin
Adı Soyadı
</div>
<div align="JUSTIFY" style="margin-bottom: 0cm; margin-right: 0.25cm;">
<br />
</div>
<div align="JUSTIFY">
İMZASI </div>
</td>
</tr>
<tr>
<td height="8" valign="TOP" width="714">
<span style="font-size: x-small;"><b>HAK SAHİBİNİN İKAMET ADRESİ:</b></span><br />
</td>
</tr>
<tr>
<td height="70" valign="TOP" width="714">
<div style="margin-bottom: 0cm; margin-right: 0.25cm;">
<span style="font-size: x-small;"><b>EV
TEL NO : </b></span></div>
<div style="margin-bottom: 0cm; margin-right: 0.25cm;">
<span style="font-size: x-small;"><b>İŞ
TEL NO : </b></span></div>
<div style="margin-bottom: 0cm; margin-right: 0.25cm;">
<span style="font-size: x-small;"><b>CEP
TEL NO: </b></span></div>
<span style="font-size: x-small;"><b>E-MAİL ADRESİ :</b></span><br />
</td>
</tr>
<tr>
<td height="7" valign="TOP" width="714">
<span style="font-size: x-small;"><b>ÖĞRENİM GÖREN ÇOCUĞUN ADRESİ :</b></span><br />
</td>
</tr>
</tbody></table>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="color: black;"><span style="font-size: x-small;"><b>GEREKLİ
OLAN BELGELER</b></span></span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="JUSTIFY" style="margin-bottom: 0cm; margin-right: 0.25cm;">
<span style="font-size: x-small;"><b>1-
Üzerinde T.C. Kimlik Numarası yazılı nüfus cüzdanı aslı ve
fotokopileri(Hak Sahibi ve Pasaport alacağı aile fertlerin 15
yaşından büyük çocukların nüfus cüzdanlarında fotoğraf
olması gerkmektedir.)</b></span></div>
<div align="JUSTIFY" style="margin-bottom: 0cm; margin-right: 0.25cm;">
<span style="font-size: x-small;"><b>2-
Pasaport alacak her kişi için iki adet Biometrik Fotoğraf(Cepheden
çekilmiş, arka fon regi beyaz ve ICAO Standartlarına uygun)</b></span></div>
<div align="JUSTIFY" style="margin-bottom: 0cm; margin-right: 0.25cm;">
<span style="font-size: x-small;"><b>3-
Maliye Bakanlığınca her yıl belirlenen cüzdan bedelinin
yatırıldığına dair dekont.</b></span></div>
<div align="JUSTIFY" style="margin-bottom: 0cm; margin-right: 0.25cm;">
<span style="font-size: x-small;"><b>4-
Daha önce herhangi bir pasaport alınmışsa getirilmesi.</b></span></div>
<div align="JUSTIFY" style="margin-bottom: 0cm; margin-right: 0.25cm;">
<span style="font-size: x-small;"><b>5-
Reşit olmayan çocuklar için kanuni mümessillerinin
muvafakatnamesi.</b></span></div>
<div align="JUSTIFY" style="margin-bottom: 0cm; margin-right: 0.25cm;">
<span style="font-size: x-small;"><b>6-
Öğrenim gören çocuklar için öğrenim belgesi (Öğrenim
belgesinin aslı gerekmektedir.)</b></span></div>
<div align="JUSTIFY" style="margin-bottom: 0cm; margin-right: 0.25cm;">
<span style="font-size: x-small;"><b>7-
Bedensel, Zihinsel veya ruhsal özürlerinden en az biri nedeniyle
sürekli bakıma muhtaç durumda bulunan çocuklar için resmi sağlık
kurumlarının düzenlediği sürekli bakıma muhtaç raporu ve
velayet veya vasi kararı.</b></span></div>
<div align="JUSTIFY" style="margin-bottom: 0cm; margin-right: 0.25cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="color: black;"><span style="font-size: x-small;"><b>DİĞER
HUSUSLAR</b></span></span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="JUSTIFY" style="margin-bottom: 0cm; margin-right: 0.25cm;">
<span style="font-size: x-small;"><b>*Bu
form düzenlendiği tarihten itibaren onbeş (15) gün
geçerlidir. </b></span></div>
<div align="JUSTIFY" style="margin-bottom: 0cm; margin-right: 0.25cm;">
<span style="font-size: x-small;"><b>*Bu
form üzerindeki bilgilerin eksik veya hatalı olması durumunda
formu düzenleyen kurum sorumludur. </b></span></div>
<div align="JUSTIFY" style="margin-bottom: 0cm; margin-right: 0.25cm;">
<span style="font-size: x-small;"><b>*Formun
ön ve arka yüzü tek sayfada olmalıdır. </b></span></div>
<div align="JUSTIFY" style="margin-bottom: 0cm; margin-right: 0.25cm;">
<span style="font-size: x-small;"><b>*Merkez
teşkilatları imza sirkülerini her yılın ocak ayının son gününe
kadar 81 İl Emniyet Müdürlüğüne göndermeleri
gerekmektedir. </b></span></div>
<div align="JUSTIFY" style="margin-bottom: 0cm; margin-right: 0.25cm;">
<span style="font-size: x-small;"><b>*Taşra
Teşkilatında görev yapan personel için, hususi damgalı pasaport
talep formunu imzalamaya yetkili kılınan kişilerin imza
sirkülerini her yılın ocak ayının son gününe kadar
bulundukları İl Emniyet Müdürlüğüne göndermeleri
gerekmektedir. </b></span></div>
<div align="JUSTIFY" style="margin-bottom: 0cm; margin-right: 0.25cm;">
<span style="font-size: x-small;"><b>*Talep
formu imzalamaya yetkili kılınan kişilerce imzalanmalı ve mühürlü
olmalıdır. </b></span></div>
<div align="JUSTIFY" style="margin-bottom: 0cm; margin-right: 0.25cm;">
<span style="font-size: x-small;"><b>*Talep
formunu imzalamaya yetkili kılınan kişinin değişmesi halinde
derhal kurumun bulunduğu İl Emniyet Müdürlüğüne
gönderilecektir. </b></span></div>
<div align="JUSTIFY" style="margin-bottom: 0cm; margin-right: 0.25cm;">
<span style="font-size: x-small;"><b>*Müracaat
edecek kişi hangi İl Emniyet Müdürlüğünden müracaat edecekse
müracaat edilecek, İl Emniyet Müdürlüğüne hitaben
yazılmalıdır. </b></span></div>
<div align="JUSTIFY" style="margin-bottom: 0cm; margin-right: 0.25cm;">
<span style="font-size: x-small;"><b>*Hususi
damgalı pasaport almış çalışan personelin kadro derecesinin
değişmesi, başka bir kuruma geçmesi ve eşlerinden boşanmaları
durumunda kurum tarafından derhal pasaport aldıkları il Emniyet
Müdürlüğüne bildirilecektir. </b></span></div>
<div align="JUSTIFY" style="margin-bottom: 0cm; margin-right: 0.25cm;">
<span style="font-size: x-small;"><b>*Bu
form hükümlü ve tutuklular için doldurulmaz.(Eş ve Çocuklar
Dahil) </b></span></div>
<div style="line-height: 100%; margin-bottom: 0cm;">
<span style="font-family: Calibri, sans-serif;"><span style="font-size: x-small;"><span style="font-family: Times New Roman, serif;"><span style="font-size: x-small;"><b>*Hususi
damgalı pasaport almış personelden hükümlü veya tutuklanmış
olan var ise derhal pasaport aldıkları İl Emniyet Müdürlüğüne
bildirilecektir. .</b></span></span></span></span></div>
.http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0tag:blogger.com,1999:blog-1741444599832658384.post-74077415628802639262012-10-08T09:14:00.000-07:002012-10-08T09:14:04.524-07:00Gri Pasaport Talep Formu<br />
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><b>T.C</b></span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><b>İSTANBUL
ÜNİVERSİTESİ REKTÖRLÜĞÜ</b></span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><b>PERSONEL
DAİRESİ BAŞKANLIĞI</b></span></div>
<div align="JUSTIFY" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><span lang="tr-TR">Sayı
: B.30.2.İST.0.</span></span><span style="font-size: x-small;"><span lang="tr-TR">71.00.00/ ...../......./…. </span></span></div>
<div align="JUSTIFY" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><span lang="tr-TR">Konu:Hizmet
Damgalı Pasaport talebi.</span></span><span lang="tr-TR"> </span>
</div>
<div style="margin-bottom: 0cm;">
<span lang="fr-FR"><b> </b></span><span style="font-size: x-small;"><span lang="fr-FR"><b>İSTANBUL
EMNİYET MÜDÜRLÜĞÜNE</b></span></span></div>
<div align="CENTER" lang="fr-FR" style="margin-bottom: 0cm;">
<br />
</div>
<div align="JUSTIFY" style="margin-bottom: 0cm; margin-left: 1.27cm; text-indent: -1.27cm;">
<span style="font-size: x-small;"><b>İLGİ : </b></span><span style="font-size: x-small;"><span lang="tr-TR">5682
sayılı Pasaport Kanunu </span></span><span style="font-size: x-small;"><span lang="tr-TR">14/B
maddesi</span></span><span style="font-size: x-small;"><span lang="tr-TR"><b> </b></span></span><span style="font-size: x-small;"><span lang="tr-TR">gereği
a</span></span><span style="font-size: x-small;"><span lang="tr-TR">şağıda açık
kimliği, görev unvanı ve kadro derecesi belirtilen görevli, </span></span>
</div>
<div align="JUSTIFY" lang="tr-TR" style="margin-bottom: 0cm; margin-left: 1.27cm;">
<span style="font-size: x-small;">eş ve çocuklarına hizmet damgalı pasaport
verilmesini arz/rica ederim.</span></div>
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Yetkili
Amir ve imzası</span></div>
<dl>
<dl>
<dl>
<dd>
<table border="1" bordercolor="#000000" cellpadding="5" cellspacing="0" style="width: 591px;">
<colgroup><col width="119"></col>
<col width="108"></col>
<col width="108"></col>
<col width="108"></col>
<col width="96"></col>
</colgroup><tbody>
<tr valign="TOP">
<td height="94" width="119">
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"> </span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">FOTOĞRAF</span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">(KENDİSİ)</span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">(Mutlaka
Dolacak)</span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">(Mühür)</span></div>
<div align="CENTER">
<br />
</div>
</td>
<td width="108">
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">FOTOĞRAF</span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">(EŞİ)</span></div>
<div align="CENTER">
<span style="font-size: x-small;">(Mühür)</span></div>
</td>
<td width="108">
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">FOTOĞRAF</span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">(ÇOCUK)</span></div>
<div align="CENTER">
<span style="font-size: x-small;">(Mühür)</span></div>
</td>
<td width="108">
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">FOTOĞRAF</span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">(ÇOCUK)</span></div>
<div align="CENTER">
<span style="font-size: x-small;">(Mühür)</span></div>
</td>
<td width="96">
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">FOTOĞRAF</span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">(ÇOCUK)</span></div>
<div align="CENTER">
<span style="font-size: x-small;">(Mühür)</span></div>
</td>
</tr>
</tbody></table>
</dd></dl>
</dl>
</dl>
<h1 align="CENTER" class="western">
<span style="font-weight: normal;">(Fotoğraflar
talep formunu düzenleyen kurum tarafından mühürlenecektir)</span></h1>
<h1 align="CENTER" class="western">
N Ü F U S - H Ü V İ Y E T K
A Y D I</h1>
<table border="1" bordercolor="#000000" cellpadding="5" cellspacing="0" style="width: 709px;">
<colgroup><col width="104"></col>
<col width="123"></col>
<col width="108"></col>
<col width="108"></col>
<col width="108"></col>
<col width="95"></col>
</colgroup><tbody>
<tr valign="TOP">
<td height="31" width="104">
<br />
<br />
</td>
<td width="123">
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Çalışan</span></div>
<div align="CENTER">
<span style="font-size: x-small;">(Mutlaka
Dolacak)</span></div>
</td>
<td width="108">
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Çalışanın
Eşi</span></div>
<div align="CENTER">
<span style="font-size: x-small;">(Alacaksa)</span></div>
</td>
<td width="108">
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Çocuk
</span>
</div>
<div align="CENTER">
<span style="font-size: x-small;">(Alacaksa)</span></div>
</td>
<td width="108">
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Çocuk
</span>
</div>
<div align="CENTER">
<span style="font-size: x-small;">(Alacaksa)</span></div>
</td>
<td width="95">
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Çocuk
</span>
</div>
<div align="CENTER">
<span style="font-size: x-small;">(Alacaksa)</span></div>
</td>
</tr>
<tr valign="TOP">
<td height="11" width="104">
<span style="font-size: x-small;">T.C. Kimlik No</span><br />
</td>
<td width="123">
<div align="CENTER">
<br />
</div>
</td>
<td width="108">
<div align="CENTER">
<br />
</div>
</td>
<td width="108">
<div align="CENTER">
<br />
</div>
</td>
<td width="108">
<div align="CENTER">
<br />
</div>
</td>
<td width="95">
<div align="CENTER">
<br />
</div>
</td>
</tr>
<tr valign="TOP">
<td width="104">
<span style="font-size: x-small;">Soyadı</span><br />
</td>
<td width="123">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="95">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td height="13" width="104">
<span style="font-size: x-small;">Adı </span>
<br />
</td>
<td width="123">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="95">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td height="12" width="104">
<span style="font-size: x-small;">Baba Adı</span><br />
</td>
<td width="123">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="95">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="104">
<span style="font-size: x-small;">Ana Adı</span><br />
</td>
<td width="123">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="95">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="104">
<span style="font-size: x-small;">Doğum Yeri</span><br />
</td>
<td width="123">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="95">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="104">
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Doğum
Tarihi</span></div>
<span style="font-size: x-small;">(Gün-Ay-Yıl)</span><br />
</td>
<td width="123">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="95">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td height="14" width="104">
<span style="font-size: x-small;">Medeni Hali </span>
<br />
</td>
<td width="123">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="95">
<br />
<br />
</td>
</tr>
<tr>
<td colspan="6" height="8" valign="TOP" width="697">
<div align="CENTER">
<span style="font-size: x-small;"><b>N Ü F U S</b></span><span style="font-size: x-small;"><b>
A K A Y I T L I O L D U Ğ U Y E R B İ L G İ L E R İ</b></span></div>
</td>
</tr>
<tr valign="TOP">
<td width="104">
<span style="font-size: x-small;">İli</span><br />
</td>
<td width="123">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="95">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="104">
<span style="font-size: x-small;">İlçesi</span><br />
</td>
<td width="123">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="95">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="104">
<span style="font-size: x-small;">Mahalle/Köy</span><br />
</td>
<td width="123">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="95">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="104">
<span style="font-size: x-small;">Cilt No.</span><br />
</td>
<td width="123">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="95">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="104">
<span style="font-size: x-small;">Aile Sıra No.</span><br />
</td>
<td width="123">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="95">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="104">
<span style="font-size: x-small;">Sıra No.</span><br />
</td>
<td width="123">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="95">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="104">
<span style="font-size: x-small;">Verildiği Yer</span><br />
</td>
<td width="123">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="95">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="104">
<span style="font-size: x-small;">Veriliş Tarihi</span><br />
</td>
<td width="123">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="95">
<br />
<br />
</td>
</tr>
<tr valign="TOP">
<td width="104">
<span style="font-size: x-small;">Cüzdan Seri-No.</span><br />
</td>
<td width="123">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="108">
<br />
<br />
</td>
<td width="95">
<br />
<br />
</td>
</tr>
</tbody></table>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><b>PASAPORT
ALACAK PERSONELİN</b></span></div>
<table border="1" bordercolor="#000000" cellpadding="5" cellspacing="0" style="width: 709px;">
<colgroup><col width="61"></col>
<col width="86"></col>
<col width="134"></col>
<col width="98"></col>
<col width="86"></col>
<col width="86"></col>
<col width="86"></col>
</colgroup><tbody>
<tr valign="TOP">
<td height="15" width="61">
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Adı
Soyadı</span></div>
<div align="CENTER">
<br />
</div>
</td>
<td colspan="4" width="434">
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER">
<br />
</div>
</td>
<td colspan="2" width="182">
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Kadro
Derecesi</span></div>
<div align="CENTER">
<br />
</div>
</td>
</tr>
<tr valign="TOP">
<td height="17" rowspan="2" width="61">
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Görev
Unvanı</span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER">
<br />
</div>
</td>
<td colspan="2" rowspan="2" width="230">
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER">
<br />
</div>
</td>
<td colspan="2" rowspan="2" width="194">
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Kamu Personelidir
</span></div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Kamu Personeli Değildir
</span></div>
<div align="CENTER">
<br />
</div>
</td>
<td width="86">
<div align="CENTER">
<span style="font-size: x-small;">Rakamla</span></div>
</td>
<td width="86">
<div align="CENTER">
<span style="font-size: x-small;">Yazıyla</span></div>
</td>
</tr>
<tr valign="TOP">
<td colspan="2" width="182">
<div style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER">
<br />
</div>
</td>
</tr>
<tr valign="TOP">
<td colspan="2" height="5" rowspan="2" width="157">
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER">
<span style="font-size: x-small;">Yurtdışında Görevlendirildiği
Tarih</span></div>
</td>
<td colspan="2" width="242">
<div align="CENTER">
<span style="font-size: x-small;"><b>Başlangıç</b></span></div>
</td>
<td colspan="3" width="278">
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><b>Bitiş</b></span></div>
<div align="CENTER">
<br />
</div>
</td>
</tr>
<tr valign="TOP">
<td colspan="2" width="242">
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER">
…<span style="font-size: x-small;"><b>./…./…. (Gün/Ay/Yıl)</b></span></div>
</td>
<td colspan="3" width="278">
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER">
…<span style="font-size: x-small;"><b>./…./…. (Gün/Ay/Yıl)</b></span></div>
</td>
</tr>
<tr valign="TOP">
<td colspan="2" height="28" width="157">
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Gideceği
Ülke</span></div>
<div align="CENTER">
<br />
</div>
</td>
<td colspan="5" width="530">
<div align="CENTER">
<br />
</div>
</td>
</tr>
<tr valign="TOP">
<td colspan="2" height="27" width="157">
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Hak
Sahibinin İkametgah Adresi ve İş/Ev Tel. No. </span>
</div>
<div align="CENTER">
<span style="font-size: x-small;">E-Posta Adresi</span></div>
</td>
<td colspan="5" width="530">
<div align="CENTER">
<br />
</div>
</td>
</tr>
</tbody></table>
<div align="JUSTIFY" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">Formdaki
bilgilerin doğruluğunu</span> <span style="font-size: x-small;">onaylarım.</span></div>
<div style="margin-bottom: 0cm; margin-left: 11.24cm; text-indent: 1.25cm;">
<span dir="LTR" id="Çerçeve1" style="background: #ffffff; border: 1px solid #ffffff; float: left; height: 1.62cm; padding: 0.14cm 0.26cm; width: 7.64cm;">
</span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Times2 New Roman, Times New Roman, serif;"><span style="font-size: x-small;">Yukarıdaki
bilgilerin doğruluğunu beyan ederim.</span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Times2 New Roman, Times New Roman, serif;"><span style="font-size: x-small;">Hak
sahibinin Adı, Soyadı, İmzası</span></span>
</div>
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;">(Hak
Sahibi Mutlaka İmzalayacak)</span></div>
<span style="font-size: x-small;">Yetkili Amir</span>
<br />
<div style="margin-bottom: 0cm; margin-left: 11.24cm; text-indent: 1.25cm;">
<span style="font-size: x-small;">Adı soyadı İmzası</span></div>
<div style="margin-bottom: 0cm; margin-left: 11.24cm; text-indent: 1.25cm;">
…<span style="font-size: x-small;">../…../…..</span></div>
<div align="JUSTIFY" style="margin-bottom: 0cm;">
</div>
<div align="JUSTIFY" style="margin-bottom: 0cm;">
<br />
</div>
<div align="JUSTIFY" style="margin-bottom: 0cm;">
<br />
</div>
<div align="JUSTIFY" style="margin-bottom: 0cm;">
<br />
</div>
<div align="JUSTIFY" style="margin-bottom: 0cm;">
<br />
</div>
<table border="1" bordercolor="#000000" cellpadding="7" cellspacing="0" style="width: 718px;">
<colgroup><col width="702"></col>
</colgroup><tbody>
<tr>
<td height="159" valign="TOP" width="702">
<div align="CENTER" lang="tr-TR" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">PASAPORT
ALACAK REŞİT ÇOCUK VARSA HAK SAHİBİ TARAFINDAN
DOLDURULACAKTIR.</span></div>
<div align="CENTER" lang="tr-TR" style="margin-bottom: 0cm;">
<span style="font-size: x-small;">(TAAHHÜT
BELGESİ) </span>
</div>
<div align="JUSTIFY" lang="tr-TR" style="margin-bottom: 0cm; text-indent: 0.83cm;">
<span style="font-size: x-small;">Kendisine hizmet damgalı pasaport talebinde
bulunduğum ergin ve veya/ergin olmayan çocuğum/çocuklarımın
öğrenci olduğunu, herhangi bir işte çalışmadığını,
öğrenciliği hariç birlikte yaşadığımızı, bekar olduğunu
ayrıca bu hususların değişmesi halinde çocuğuma
aldığım/alacağım pasaportu iade edeceğimi taahhüt ederim.
…./…./….
</span>
</div>
<div align="JUSTIFY" style="margin-bottom: 0cm; text-indent: 0.83cm;">
</div>
<div align="CENTER" lang="tr-TR" style="margin-bottom: 0cm; margin-left: 9.99cm;">
<span style="font-size: x-small;">Hak Sahibinin</span></div>
<div align="CENTER" lang="tr-TR" style="margin-bottom: 0cm; margin-left: 9.99cm;">
<span style="font-size: x-small;">Adı Soyadı</span></div>
<div align="CENTER" lang="tr-TR" style="margin-bottom: 0cm; margin-left: 9.99cm;">
<span style="font-size: x-small;"><b>İMZA</b></span></div>
<div lang="tr-TR">
<br />
</div>
</td>
</tr>
<tr>
<td height="68" valign="TOP" width="702">
<div lang="tr-TR">
<span style="font-size: x-small;">ÖĞRENİM GÖREN ÇOCUĞUN ADRESİ:</span></div>
</td>
</tr>
</tbody></table>
<div lang="tr-TR" style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><span lang="tr-TR"><b>GEREKLİ
OLAN BELGELER</b></span></span></div>
<div align="JUSTIFY" lang="tr-TR" style="margin-bottom: 0cm; margin-left: 0.64cm; text-indent: -0.32cm;">
<span style="font-size: x-small;"><b>1-T.C. Kimlik Numarası yazılı
nüfus cüzdanı aslı (Hak Sahibi ve pasaport alacağı aile
fertlerinin 15 yaşından büyük çocukların nüfus cüzdanlarında
fotoğraf olması gerekmektedir.) </b></span>
</div>
<div align="JUSTIFY" lang="tr-TR" style="margin-bottom: 0cm; margin-left: 0.64cm; text-indent: -0.32cm;">
<span style="font-size: x-small;"><b>2-Pasaport alacak her kişi
için iki adet Biometrik Fotoğraf (Cepheden çekilmiş, arka fon
rengi beyaz ve ICAO Standartlarına uygun) </b></span>
</div>
<div align="JUSTIFY" lang="tr-TR" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><b>3-Maliye
Bakanlığınca her yıl belirlenen cüzdan bedelinin yatırıldığına
dair dekont.</b></span></div>
<div align="JUSTIFY" lang="tr-TR" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><b>4-Daha
önce herhangi bir pasaport alınmışsa getirilmesi. </b></span>
</div>
<div align="JUSTIFY" lang="tr-TR" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><b>5-Reşit
olmayan çocuklar için kanuni mümessillerinin muvafakat namesi.</b></span></div>
<div align="JUSTIFY" lang="tr-TR" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><b>6-Öğrenim
gören çocuklar için öğrenim belgesinin aslı.</b></span></div>
<div align="JUSTIFY" lang="tr-TR" style="margin-bottom: 0cm; margin-left: 0.64cm; text-indent: -0.64cm;">
<span style="font-size: x-small;"><b>7-Bedensel, zihinsel veya
ruhsal özürlerinden en az biri nedeniyle sürekli bakıma muhtaç
durumda bulunan çocuklar için resmi sağlık kurumlarının
düzenlediği sürekli bakıma muhtaç ibareli sağlık kurulu
raporu.</b></span></div>
<div align="JUSTIFY" lang="tr-TR" style="margin-bottom: 0cm; margin-left: 0.64cm; text-indent: -0.64cm;">
<span style="font-size: x-small;"><b>8-Mahkemelerce verilen
velayet veya vasi kararları.</b></span></div>
<div align="JUSTIFY" lang="tr-TR" style="margin-bottom: 0cm;">
<br />
</div>
<div lang="tr-TR" style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><span lang="tr-TR"><b>DİĞER
HUSUSLAR</b></span></span></div>
<ul>
<li><div lang="tr-TR" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><b>Hizmet
Damgalı Pasaportlar, 5682 sayılı Pasaport Kanununun 14/B
maddesinde belirtilen kişilere verilir</b></span></div>
</li>
<li><div lang="tr-TR" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><b>Hizmet
Damgalı Pasaportlar ilgilinin görev süresi dikkate alınarak
düzenlenir.</b></span></div>
</li>
<li><div align="JUSTIFY" lang="tr-TR" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><b>Hizmet
Damgalı Pasaport Talep Formu üzerindeki bilgilerin eksik veya
hatalı olması durumunda formu düzenleyen kurum sorumludur. </b></span>
</div>
</li>
<li><div lang="tr-TR" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><b>Hizmet
Damgalı Pasaport Talep Formunun ön ve arka yüzü tek sayfada
olmalıdır.</b></span></div>
</li>
<li><div align="JUSTIFY" lang="tr-TR" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><b>Merkez
teşkilatları imza sirkülerini her yılın ocak ayının son
gününe kadar 81 İl Emniyet Müdürlüğüne göndermeleri
gerekmektedir, değişiklikler ise beklenmeksizin anında
bildirilecektir.</b></span></div>
</li>
<li><div align="JUSTIFY" lang="tr-TR" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><b>Taşra
Teşkilatında görev yapan personel için, hizmet damgalı pasaport
talep formunu imzalamaya yetkili kılınan kişilerin imza
sirkülerini her yılın 1 Ocak tarihinde bulundukları İl Emniyet
Müdürlüğünde olacak şekilde göndermeleri gerekmektedir.</b></span></div>
</li>
<li><div lang="tr-TR" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><b>Hizmet
Damgalı Pasaport Talep Formu imzalamaya yetkili kılınan kişilerce
imzalanmalı ve mühürlü olmalıdır.</b></span></div>
</li>
<li><div align="JUSTIFY" lang="tr-TR" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><b>Hizmet
Damgalı Pasaport Talep Formunu imzalamaya yetkili kılınan kişinin
değişmesi halinde yetkili kılınan kişilerin imza sirküleri
kurumun bulunduğu İl Emniyet Müdürlüğüne gönderilecektir.</b></span></div>
</li>
<li><div align="JUSTIFY" lang="tr-TR" style="margin-bottom: 0cm;">
<span style="color: black;"><span style="font-size: x-small;"><b>Hizmet
Damgalı Pasaport Talep Formu müracaat edilecek, İl Emniyet
Müdürlüğüne hitaben yazılmalıdır.</b></span></span></div>
</li>
<li><div align="JUSTIFY" lang="tr-TR" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><b>Hizmet
Damgalı Pasaport Talep Formunun ön yüzündeki kadro derece bölümü
boş bırakılamaz. </b></span>
</div>
</li>
<li><div align="JUSTIFY" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><span lang="tr-TR"><b>Hizmet
damgalı pasaport almış çalışan personelin kadro derecesinin
değişmesi, başka bir kuruma geçmesi ve eşlerinden boşanmaları
durumunda kurum tarafından</b></span></span><span style="color: red;"><span style="font-size: x-small;"><span lang="tr-TR"><b>
</b></span></span></span><span style="font-size: x-small;"><span lang="tr-TR"><b>pasaport
aldıkları İl Emniyet Müdürlüğüne bildirilecektir.</b></span></span></div>
</li>
<li><div align="JUSTIFY" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><span lang="tr-TR"><b>Hizmet
Damgalı Pasaportun süresi olsa dahi, daha sonra farklı bir göreve
gidişte Hizmet Damgalı Pasaport formu kurumca tanzim edilerek,
sisteme kaydedilmek üzere ilgili Emniyet Müdürlüklerine
gönderilmelidir. Form getirilmeden çıkış yapılırsa, illegal
çıkıştan şahıs ve pasaportu kullandıran </b></span></span><span style="color: black;"><span style="font-size: x-small;"><span lang="tr-TR"><b>kurum
sorumlu olacaktır.</b></span></span></span></div>
</li>
<li><div align="JUSTIFY" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><span lang="tr-TR"><b>Adlarına
görev süresinden daha uzun süreli hizmet damgalı pasaport
düzenlenen </b></span></span><span style="color: black;"><span style="font-size: x-small;"><span lang="tr-TR"><b>görevli,
eş ve çocuklarının</b></span></span></span><span style="font-size: x-small;"><span lang="tr-TR"><b>
görevle ilgili seyahatini tamamlamasını takiben, geçerliliği
devam eden hizmet damgalı pasaportlar birimlerinde muhafaza
edilecektir. </b></span></span><span style="color: black;"><span style="font-size: x-small;"><span lang="tr-TR"><b>Hizmet
damgalı pasaportun özel seyahatlerde kullanılması halinde şahıs
ve pasaportu kullandıran kurum sorumludur.</b></span></span></span></div>
</li>
<li><div align="JUSTIFY" lang="tr-TR" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><b>Kurumlarca
muhafaza altına alınan süresi biten pasaportlar, pasaport
müracaatında bulunan İl Emniyet Müdürlüğüne gönderilecektir.</b></span></div>
</li>
<li><div align="JUSTIFY" lang="tr-TR" style="margin-bottom: 0cm;">
<span style="font-size: x-small;"><b>Hizmet
Damgalı Pasaport Talep Formu Gideceği Ülke bölümüne görevlinin
gideceği ülkelerden en az bir tanesi yazılacaktır. </b></span>
</div>
</li>
</ul>
<div lang="tr-TR" style="margin-bottom: 0cm;">
<br />
</div>
<div align="JUSTIFY" style="margin-bottom: 0cm;">
<br />
</div>
.http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0tag:blogger.com,1999:blog-1741444599832658384.post-48054256312088827532012-10-08T09:12:00.003-07:002012-10-08T09:12:53.653-07:00Rapor Düzeltimi için Dilekçe Örneği<br />
<div style="margin-bottom: 0.49cm;">
<strong><span style="color: #444444;"><span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;">Rapor
Düzeltimi için Dilekçe Örneği;</span></span></span></strong></div>
<div align="CENTER" style="margin-bottom: 0.49cm; margin-top: 0.49cm;">
<span style="color: #444444;"><span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;">T.C
</span></span></span>
</div>
<div align="CENTER" style="margin-bottom: 0.49cm; margin-top: 0.49cm;">
<span style="color: #444444;"><span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;">SOSYAL
GÜVENLİK KURUMU BAŞKANLIĞI</span></span></span></div>
<div align="CENTER" style="margin-bottom: 0.49cm; margin-top: 0.49cm;">
<span style="color: #444444;"><span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;">İSTANBUL
SAĞLIK İŞLERİ İL MÜDÜRLÜĞÜ</span></span></span></div>
<div align="CENTER" style="margin-bottom: 0.49cm; margin-top: 0.49cm;">
<br /><br />
</div>
<table border="1" bordercolor="#000000" cellpadding="5" cellspacing="0" style="width: 626px;">
<colgroup><col width="181"></col>
<col width="423"></col>
</colgroup><tbody>
<tr valign="BOTTOM">
<td height="23" width="181">
<span style="color: #333333;"><span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;">Hastanın
Kurumu:</span></span></span><br />
</td>
<td width="423">
<br />
</td>
</tr>
<tr valign="BOTTOM">
<td height="25" width="181">
<span style="color: #333333;"><span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;">Hasta
adı soyadı: </span></span></span>
<br />
</td>
<td width="423">
<br />
</td>
</tr>
<tr valign="BOTTOM">
<td height="24" width="181">
<span style="color: #333333;"><span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;">Hasta
sicil veya tahsis no: </span></span></span>
<br />
</td>
<td width="423">
<br />
</td>
</tr>
<tr valign="BOTTOM">
<td height="24" width="181">
<span style="color: #333333;"><span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;">Hasta
karne no:</span></span></span><br />
</td>
<td width="423">
<br />
</td>
</tr>
<tr valign="BOTTOM">
<td height="25" width="181">
<span style="color: #333333;"><span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;">(Bağ
-kur için yakınlık kodu):</span></span></span><br />
</td>
<td width="423">
<br />
</td>
</tr>
<tr valign="BOTTOM">
<td height="25" width="181">
<span style="color: #333333;"><span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;">Rapor
tarihi:</span></span></span><br />
</td>
<td width="423">
<br />
</td>
</tr>
<tr valign="BOTTOM">
<td height="23" width="181">
<span style="color: #333333;"><span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;">Rapor
no:</span></span></span><br />
</td>
<td width="423">
<br />
</td>
</tr>
<tr valign="BOTTOM">
<td height="23" width="181">
<span style="color: #333333;"><span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;">Hatanın
niteliği:</span></span></span><br />
</td>
<td width="423">
<br />
</td>
</tr>
</tbody></table>
<div align="CENTER" style="margin-bottom: 0.49cm; margin-top: 0.49cm;">
<br /><br />
</div>
<div align="JUSTIFY" style="margin-bottom: 0.49cm; margin-top: 0.49cm;">
<span style="color: #444444;"><span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;">Yapılan
hatanın düzeltilip hasta mağduriyetinin giderilmesini saygılarımla
arz ederim.</span></span></span></div>
<div align="JUSTIFY" style="margin-bottom: 0.49cm; margin-top: 0.49cm;">
<br /><br />
</div>
<div style="margin-bottom: 0.49cm; margin-top: 0.49cm;">
<span style="color: #444444;"><span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;"> ...../......./.......</span></span></span></div>
<div style="margin-bottom: 0.49cm; margin-top: 0.49cm;">
<span style="color: #444444;"><span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;">Adres:
Dilekçeyi verenin Ad ve Soyadı</span></span></span></div>
<div style="margin-bottom: 0.49cm; margin-top: 0.49cm;">
<br /><br />
</div>
<div style="margin-bottom: 0.49cm; margin-top: 0.49cm;">
<span style="color: #444444;"><span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;">Tel:
İmza</span></span></span></div>
<div align="CENTER" style="margin-bottom: 0.49cm; margin-top: 0.49cm;">
<br /><br />
</div>
<div align="CENTER" style="margin-bottom: 0.49cm; margin-top: 0.49cm;">
<br /><br />
</div>
<div align="CENTER" style="margin-bottom: 0.49cm; margin-top: 0.49cm;">
<br /><br />
</div>
<div align="CENTER" style="margin-bottom: 0.49cm; margin-top: 0.49cm;">
<span style="color: #444444;"><span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;"><b>Not</b></span></span></span><span style="color: #444444;"><span style="font-family: Verdana, sans-serif;"><span style="font-size: x-small;">:
Raporun aslı gibidir onayı yapılmış fotokopisi ,karne ön yüz
fotokopisini ve dilekçenin posta yolu ile gönderilmesi veya elden
teslim edilmesi gerekmektedir.</span></span></span></div>
<div align="CENTER" style="margin-bottom: 0.49cm; margin-top: 0.49cm;">
<strong><span style="color: #444444;">
</span></strong><br /><br />
</div>
.http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0tag:blogger.com,1999:blog-1741444599832658384.post-62333392326865849252012-10-08T09:12:00.000-07:002012-10-08T09:12:10.387-07:00Üstten Ders Alma Dilekçesi<br />
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: small;"><b>T.C.</b></span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-size: small;"><b>NECMETTİN
ERBAKAN ÜNİVERSİTESİ</b></span></div>
<div align="CENTER" style="margin-bottom: 0cm; margin-right: -0.59cm;">
<span style="font-size: small;"><b>AHMET
KELEŞOĞLU EĞİTİM FAKÜLTESİ DEKANLIĞINA</b></span></div>
<div align="CENTER" style="margin-bottom: 0cm; margin-right: -0.59cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm; margin-right: -0.59cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm; margin-right: -0.59cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm; margin-right: -0.59cm;">
<br />
</div>
<center>
<table border="1" bordercolor="#000000" cellpadding="5" cellspacing="0" style="width: 703px;">
<colgroup><col width="68"></col>
<col width="34"></col>
<col width="148"></col>
<col width="25"></col>
<col width="50"></col>
<col width="38"></col>
<col width="268"></col>
</colgroup><tbody>
<tr>
<td height="8" rowspan="5" width="68">
<div align="CENTER">
<span style="font-family: Garamond, serif;"><span style="font-size: x-small;">Öğrencinin</span></span></div>
</td>
<td colspan="2" width="192">
<span style="font-family: Garamond, serif;"><span style="font-size: x-small;">Adı
Soyadı</span></span><br />
</td>
<td colspan="4" valign="TOP" width="411">
<div align="CENTER">
<br />
</div>
</td>
</tr>
<tr>
<td colspan="2" width="192">
<span style="font-family: Garamond, serif;"><span style="font-size: x-small;">Numarası</span></span><br />
</td>
<td colspan="4" valign="TOP" width="411">
<div align="CENTER">
<br />
</div>
</td>
</tr>
<tr>
<td colspan="2" width="192">
<span style="font-family: Garamond, serif;"><span style="font-size: x-small;">Bölüm
/ Anabilim Dalı</span></span><br />
</td>
<td colspan="4" valign="TOP" width="411">
<div align="CENTER">
<br />
</div>
</td>
</tr>
<tr>
<td colspan="2" width="192">
<span style="font-family: Garamond, serif;"><span style="font-size: x-small;">Akademik
Not Ortalaması</span></span><br />
</td>
<td colspan="4" valign="TOP" width="411">
<div align="CENTER">
<br />
</div>
</td>
</tr>
<tr>
<td colspan="2" width="192">
<span style="font-family: Garamond, serif;"><span style="font-size: x-small;">Danışmanı
</span></span>
<br />
</td>
<td colspan="4" valign="TOP" width="411">
<div align="CENTER">
<br />
</div>
</td>
</tr>
<tr>
<td colspan="7" height="163" valign="TOP" width="691">
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Garamond, serif;">Aşağıda
belirttiğim dersleri almak istiyorum gereğini saygı ile arz
ederim.</span></div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Garamond, serif;"><span style="font-size: small;"><b>Telefon:</b></span></span><span style="font-family: Garamond, serif;">
</span><span style="font-family: Garamond, serif;"><span style="font-size: small;"><b>Tarih</b></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Garamond, serif;"><span style="font-size: small;"><b>Adres:</b></span></span></div>
<div style="margin-bottom: 0cm;">
<span style="font-family: Garamond, serif;"><span style="font-size: small;"><b>İmza</b></span></span></div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div style="margin-bottom: 0cm;">
<br />
</div>
<div align="JUSTIFY" style="margin-bottom: 0cm;">
<span style="font-family: Garamond, serif;"><span style="font-size: x-small;"><b>Not:
Süresi içinde yapılmayan başvurular dikkate alınmayacağından
başvuruların GÜZ/BAHAR dönemleri için Akademik Takvimde
belirtilen Ders Ekleme-Bırakma süresi sonuna kadar yapılması
gerekmektedir.</b></span></span></div>
<div align="JUSTIFY">
<br />
</div>
</td>
</tr>
<tr>
<td colspan="7" height="13" valign="TOP" width="691">
<div align="CENTER">
<span style="font-family: Garamond, serif;"><span style="font-size: x-small;"><b>Üstten
Almak İstediğim Dersler</b></span></span><span style="font-family: Garamond, serif;"><span style="font-size: x-small;"><b>
</b></span></span>
</div>
</td>
</tr>
<tr>
<td colspan="2" height="34" width="112">
<span style="font-family: Garamond, serif;"><span style="font-size: x-small;">Dersin
Kodu</span></span><br />
</td>
<td colspan="2" width="184">
<span style="font-family: Garamond, serif;"><span style="font-size: x-small;">Dersin
Adı</span></span><br />
</td>
<td width="50">
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-family: Garamond, serif;"><span style="font-size: xx-small;">Dönem</span></span></div>
<div align="CENTER">
<span style="font-family: Garamond, serif;"><span style="font-size: xx-small;">Güz/Bahar</span></span></div>
</td>
<td width="38">
<div align="CENTER">
<span style="font-family: Garamond, serif;"><span style="font-size: xx-small;">Dersin
Kredisi</span></span></div>
</td>
<td width="268">
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-family: Garamond, serif;"><span style="font-size: x-small;"><b>Açıklama</b></span></span></div>
<div align="CENTER">
<br />
</div>
</td>
</tr>
<tr valign="TOP">
<td colspan="2" height="40" width="112">
<br />
<br />
</td>
<td colspan="2" width="184">
<br />
<br />
</td>
<td width="50">
<div align="RIGHT">
<br />
</div>
</td>
<td width="38">
<div align="RIGHT">
<br />
</div>
</td>
<td width="268">
<div align="CENTER">
<br />
</div>
</td>
</tr>
<tr valign="TOP">
<td colspan="2" height="37" width="112">
<br />
<br />
</td>
<td colspan="2" width="184">
<br />
<br />
</td>
<td width="50">
<div align="RIGHT">
<br />
</div>
</td>
<td width="38">
<div align="RIGHT">
<br />
</div>
</td>
<td width="268">
<div align="RIGHT">
<br />
</div>
</td>
</tr>
<tr valign="TOP">
<td colspan="2" height="50" width="112">
<br />
<br />
</td>
<td colspan="2" width="184">
<br />
<br />
</td>
<td width="50">
<div align="RIGHT">
<br />
</div>
</td>
<td width="38">
<div align="RIGHT">
<br />
</div>
</td>
<td width="268">
<div align="RIGHT">
<br />
</div>
</td>
</tr>
<tr valign="TOP">
<td colspan="2" height="50" width="112">
<br />
<br />
</td>
<td colspan="2" width="184">
<br />
<br />
</td>
<td width="50">
<div align="RIGHT">
<br />
</div>
</td>
<td width="38">
<div align="RIGHT">
<br />
</div>
</td>
<td width="268">
<div align="RIGHT">
<br />
</div>
</td>
</tr>
<tr valign="TOP">
<td colspan="2" height="50" width="112">
<br />
<br />
</td>
<td colspan="2" width="184">
<br />
<br />
</td>
<td width="50">
<div align="RIGHT">
<br />
</div>
</td>
<td width="38">
<div align="RIGHT">
<br />
</div>
</td>
<td width="268">
<div align="RIGHT">
<br />
</div>
</td>
</tr>
<tr valign="TOP">
<td colspan="2" height="50" width="112">
<br />
<br />
</td>
<td colspan="2" width="184">
<br />
<br />
</td>
<td width="50">
<div align="RIGHT">
<br />
</div>
</td>
<td width="38">
<div align="RIGHT">
<br />
</div>
</td>
<td width="268">
<div align="RIGHT">
<br />
</div>
</td>
</tr>
<tr>
<td colspan="7" height="58" valign="TOP" width="691">
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-family: Garamond, serif;"><b>Danışman
Anabilim Dalı Başkanı</b></span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-family: Garamond, serif;">Adı
Soyadı
Adı Soyadı</span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<span style="font-family: Garamond, serif;">İmzası
İmzası</span></div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER" style="margin-bottom: 0cm;">
<br />
</div>
<div align="CENTER">
<br />
</div>
</td>
</tr>
</tbody></table>
</center>
<div style="margin-bottom: 0cm;">
<br />
</div>
.http://www.blogger.com/profile/00725884503979681550noreply@blogger.com0