ပုံစံ (၃)

ျမန္မာႏုိင္ငံသစ္လုပ္ငန္းရွင္မ်ားအသင္း

အမွတ္ (  )၊ ............................. လမ္း၊ ရန္ကုန္ၿမိဳ႕။

သင္းဖြဲ႕စည္းမ်ဥ္း အပုိဒ္ -၄၆ အရ ျပဌာန္းေသာ အမည္တင္သြင္းလႊာ

.................................... ခုႏွစ္

ဗဟုိအလုပ္အမႈေဆာင္အဖြဲ႕၀င္ လူႀကီးေရြးေကာက္ပြဲ အမည္တင္သြင္းလႊာ

    ေအာက္ေဖာ္ျပပါ ဇယားတြင္ ေဖာ္ျပပါရွိေသာ မဲဆႏၵရွင္မ်ား စာရင္း၀င္ အသင္းသား (          ) ဦးအမည္တုိ႔ကုိ ယခုႏွစ္ ဗဟုိအမႈေဆာင္
အဖြဲ႕၀င္ လူႀကီး ေရြးေကာက္ပြဲအတြက္ အဆုိတင္သြင္းပါေၾကာင္း။

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                အမည္            အသင္း၀င္/မွတ္ပုံတင္အမွတ္                    အမည္တင္သြင္းျခင္းခံရသူ၏

                                                                                           သေဘာတူညီခ်က္လက္မွတ္

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အဆုိရွင္အမည္ ..................................                                                                              မွတ္ပုံတင္အမွတ္၊    ..............................

                                                                                                                              အသင္း၀င္အမွတ္၊    ..............................................

    အထက္အမည္ပါ အဆုိတင္သြင္းခ်က္ကုိ ေထာက္ခံပါသည္။

    ေကာက္ခံသူအမည္၊        ..............................                                                                မွတ္ပုံတင္အမွတ္၊    ..............................

                                                                                                                              အသင္း၀င္္၊           ..............................

    ေန႔စြဲ။ ......................................

မွတ္ခ်က္။    မိမိလက္မွတ္မ်ားကုိ ဤအသင္းႀကီးမွ ထုတ္ေပးထားေသာ အသင္း၀င္လက္မွတ္ေရးထုိးထားသည့္ မိမိတုိ႔လက္မွတ္နမူနာမ်ားႏွင့္ ကုိက္ညီ

                ရန္ အထူးသတိျပဳပါ။

အၫႊန္း။      သင္းဖြဲ႕စည္းမ်ဥ္းမ်ားအပုိဒ္ - ၄၆အရ အမည္တင္သြင္းလႊာမ်ားတြင္ မဲဆႏၵရွင္မ်ားစာရင္းပါ အဆုိတင္သြင္းသူ/ေထာက္ခံသူ၏ လက္မွတ္ႏွင့္ ၎တုိ႔၏ အသင္း၀င္အမွတ္၊ အမ်ိဳးသားမွတ္ပုံတင္အမွတ္သာမက အမည္တင္သြင္းျခင္းခံရသူ၏ သေဘာတူညီခ်က္လက္မွတ္ႏွင့္ ၎တုိ႔၏ အသင္း၀င္ အမွတ္၊ အမ်ိဳးသားမွတ္ပုံတင္ အသီးသီးပါရွိေစရမည္။