˹ѧͺӹҨ                                     Դҡʵ 30 ҷ
                         (СͺͧպѵҢͧͼѴдѺѵ÷ͧ, ѵҢͧͼѴ кѵõ᷹ͧ͡Ѻ͹حҵ)
                                                                       (ó üӹҨŧ١ѹ 2 )
                                                                               ¹

                                                                              ѹ     ͹ ..
1. ˹ѧͩѺ ѷ ҧ ҹ 
2. ӹѡҹŢ                         Ҥ  
   ͡ /                         
   ǧ / Ӻ                        /
   ѧѴ                                                                ɳ
   Ѿ                                
3. ·  ҧҧ                          ʡ
     Ѻ    ҧҧ                           ʡ
    繡ѹӹҨзӡ㹹ͧѷ ҧ ҹ ֧ͺ
            
 ҧҧ                            ʡ
   ˹觡üѴ / Ѵ ͧѷ ҧ ҹ ҧ ӹҨзӡŧ١ѹ ѷ ҧ ҹ  ͡õҧ
   ǡѺšҡ÷ءԴ§
4. ѷ ҧ ҹ    ѭ׹ѹҺôҡԨ÷·ŷ
            
ҧҧ         ʡ
    з˵з㹹ѷ ҧ ҹ ͺӹҨؤ蹡з᷹
     ҧѷ ҧ ҹ   ԹѺԴͺ͡šҡ÷ءó
 
   ѡҹ觡ù ֧ŧͪ зѺҡӡѺͧ ѷ ҧ ҹ ˹Ҿҹҧ¹
                                                                                                               ѹ  ͹  ..

                                                                                                            ŧ ............................................................  (ͺӹҨ)
                                                                                                                    ( )
 
         зѺ ѷ ҧ ҹ                                                       ŧ ............................................................  (ͺӹҨ)                 

                    ()                                                                                      ( ) 
 

              ТѺͧ                                                                    ŧ ............................................................  (ѺͺӹҨ)

        繵һзѺ騴¹                                                           ()
 

           ѺзǧҳԪ                                                             ŧ ............................................................  (ҹ)

                                                                                                                    ( )
 

                                                                                                            ŧ ............................................................  (ҹ) 

                                                                                                                     ( )

˵ : ѺóաüӹҨŧ١ѹѷ 2 ͺӹҨ㴤˹ҷӺѵҢͧ
           
     ѴдѺѵ÷ͧ , ѵҢͧͼѴ кѵõ᷹ͧ͡Ѻ͹حҵ ѹṺҺѵûЪҪͧͺӹҨ,

                 ѺͺӹҨ оҹ 2 Ҵ·ء

                                                       

                                                                                    ͡ûСͺ˹ѧͺӹҨ