ÿþ<html dir="rtl"> <head> <p>ÔÑÔèÔ: ÔÞæÕèã ÔÙàÕ ÓÕÒÞÐ ÐÕäÙàÙê Ü×ÜçÙÝ ÔáØàÓèØÙÝ <br/>ÔÞçÕÑÜÙÝ ÜáÕÒ ÖÔ éÜ ×ÕÖÔ. ÔçÕÑâ ÔÕÐ Ô×ÕÖÔ ÔáäÙæÙäÙ <br/>éÑÙß ÔÞÙàÔÜ Ü×ÕÛè/ÙÖÝ ÕÔ×ÜØÕê ÞÕâæê ÞçèçâÙ ÙéèÐÜ.</p><meta content="microsoft office html filter 2.0" name="generator"/> <meta http-equiv="content-type" content="text/html; charset=windows-1255"/> <meta content="microsoft word 9" name="originator"/> <meta name="save" content="snapshot"/> <style> <!-- p.msonormal, li.msonormal, div.msonormal { margin:0cm; margin-bottom:.0001pt; text-align:right; direction:rtl; unicode-bidi:embed; font-size:11.0pt; font-family:david;} h1 { margin:0cm; margin-bottom:.0001pt; text-align:right; page-break-after:avoid; direction:rtl; unicode-bidi:embed; font-size:14.0pt; font-family:david;} h2 { margin:0cm; margin-bottom:.0001pt; text-align:right; page-break-after:avoid; direction:rtl; unicode-bidi:embed; font-size:12.0pt; font-family:david;} h3 { margin:0cm; margin-bottom:.0001pt; text-align:right; page-break-after:avoid; direction:rtl; unicode-bidi:embed; font-size:11.0pt; font-family:david;} h4 { margin-top:0cm; margin-right:338.8pt; margin-bottom:0cm; margin-left:0cm; margin-bottom:.0001pt; text-align:right; page-break-after:avoid; direction:rtl; unicode-bidi:embed; font-size:11.0pt; font-family:'times new roman';} h5 { margin:0cm; margin-bottom:.0001pt; text-align:center; direction:rtl; unicode-bidi:embed; font-size:11.david; font-family:arial;} h6 { margin-top:0cm; margin-right:6.0cm; margin-bottom:0cm; margin-left:0cm; margin-bottom:.0001pt; text-align:right; direction:rtl; unicode-bidi:embed; font-size:11.0pt; font-family:'times new roman'; font-weight:normal;} ol { margin-bottom:0cm; margin-top:0cm;} ul { margin-bottom:0cm; margin-top:0cm;} p { margin:0cm; margin-bottom:0cm; margin-top:0cm;} dd { margin-bottom:0cm; margin-top:0cm;} blockquote { margin-bottom:0cm; margin-top:0cm;} .savenetunim { behavior:url(#default#savesnapshot) } --></style> </head> <body lang="en-us"><table align="center"><thead style="display: table-header-group"><tr><td id="td"><table id="tbl" dir="rtl" align="center" style="width: 100%"><font face="David"><tbody><p><tr><td id="param1" align="right" style="width: 20%;TEXT-DECORATION: underline;FONT-SIZE: 9pt">ÓÕÒÞê ×ÕÖÔ ÜáÕÒ êÙç :</td><td id="Teur" align="right" style="width: 70%;TEXT-DECORATION: underline;FONT-SIZE: 9pt">ÞÔÕÕß</td><td id="param3" align="center" style="width: 10%;TEXT-DECORATION: underline;FONT-SIZE: 9pt"/></tr><br/></p></tbody></font></table></td></tr></thead><tfoot style="display: table-footer-group"><tr><td id="td" vAlign="bottom"><table id="tbl" dir="rtl" align="center" style="border-top: thin solid; width: 100%"><font face="Arial"><tbody><tr><td id="param1" align="right" style="width: 15%">×ÕÖÔ :225/11</td><td id="param2" align="center" style="width: 15%">êàÐÙÝ:206/10</td><td id="yp" align="center" style="width: 24%"/><td id="taayp" align="center" style="width: 1%"/><td id="time" align="center" style="width: 20%">ê.ÔäçÔ: 16:26:42</td><td id="date" align="center" style="width: 15%">12/12/2010</td><td id="misTik" align="left" style="width: 10%">ÑêÕçã</td></tr></tbody></font></table></td></tr></tfoot><tbody><tr><td vAlign="top"><div dir="rtl" class="section1"> <h4 dir="rtl"> <span style="font-family: david; font-weight: normal" lang="he">  Þá' ÔêÙç:     </span> <span style="font-family: david" lang="he">_________</span></h4> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">            </span> </p> <h4 dir="rtl"> <span style="font-family: david; font-weight: normal" lang="he">Þá' Ô×éÑÕß:  </span> <span style="font-family: david" lang="he">_________</span></h4> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <h1 dir="rtl"> <span style="font-family: david" lang="he">×ÕÖÔ ×ÛÙèÔ</span> </h1> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <h2 dir="rtl"> <span style="font-family: david" lang="he">(__________ ÑÞÑàÔ éÑÕ Üä×Õê éêÙ Ù×ÙÓÕê  ÞÔÕÕß)</span> </h2> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">éàâèÚ Õà×êÝ Ñ- __________________ ÑÙÕÝ ______________ Ü×ÕÓé __________________ éàê _________</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <h6 dir="rtl"> <span style="font-family: david" lang="he">ÑÙÕÝ ______________ Ü×ÕÓé __________________ éàê _________</span> </h6> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <h5 dir="rtl"> <span style="font-family: david" lang="he">Ñ Ù ß</span> </h5> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">ÞÙàÔÜ ÞçèçâÙ ÙéèÐÜ ÔÞàÔÜ Ðê çèçâÕê ÞÓÙàê ÙéèÐÜ / èéÕê ÔäÙêÕ× / çèß çÙÙÞê ÜÙéèÐÜ (éÙçèÐ ÜÔÜß "ÔÞ×ÛÙè"), éÛêÕÑêÕ ÜæÕèÚ ×ÕÖÔ ÖÔ: <b>_________________</b></span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p style="text-indent: 1cm; margin-right: 14cm" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">ÞæÓ Ð×Ó;</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <h5 dir="rtl"> <span style="font-family: david" lang="he">Ü Ñ Ù ß</span> </h5> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <b> <span style="font-family: david" lang="he"><table border="0" dir="rtl" style="FONT-FAMILY: david;font-size:11.0pt"><thead style="FONT-WEIGHT: bold"><tr valign="top"><td valign="baseline" align="right">_________________&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Þá' ÖÙÔÕÙ/êÐÒÙÓ _________&nbsp;&nbsp;&nbsp;&nbsp;&nbsp;Ô×Üç ÑàÛá: ___/___</td></tr></thead></table></span> </b> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">ÛÕÜÝ Ù×Ó ÕÛÜ Ð×Ó <font face="david">ÞÔÝ</font> Ü×ÕÓ (éÙçèÐÕ ÜÔÜß "Ô×ÕÛè"), éÛêÕÑêÕ ÜæÕèÚ ×ÕÖÔ ÖÔ ÔÙÐ: <b><span dir='rtl'>_________________</span> _________</b></span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p style="text-indent: 1cm; margin-right: 14cm" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">ÞæÓ éàÙ;</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <h5 dir="rtl"> <span style="font-family: david" lang="he">Þ Ñ Õ Ð</span> </h5> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">ÔÞÑÕÐ Ü×ÕÖÔ Ô×ÛÙèÔ ÞÔÕÕÔ ×Üç ÑÜêÙ àäèÓ ÞêàÐÙ Ô×ÛÙèÔ ÕÑÙ×Ó ÐÙêÝ ÞÔÕÕÔ Ðê ×ÕÖÔ Ô×ÛÙèÔ. êàÐÙ Ô×ÛÙèÔ Ôà"Ü äÕèáÞÕ ÑÙÜçÕØ äèáÕÞÙÝ Þá'  <strong>4818</strong> ÑÙÕÝ  <strong><span dir="ltr">04/11/1999</span></strong>.</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">Ô Õ Ð Ù Ü   ÕÞÓÙàê ÙéèÐÜ/èéÕê ÔäÙêÕ×/çèß çÙÙÞê ÜÙéèÐÜ ÔÙÐ ÔÑâÜÙÝ éÜ ÔÞçèçâÙß ÔÞäÕèØÙÝ ÜÔÜß ÑÞÑÕÐ ÖÔ (ÜÔÜß - "ÔÞÒèé");</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">Õ Ô Õ Ð Ù Ü   ÕâÜ ÔÞÒèé ÔÕçÝ, ÑÞéÚ ÔêçÕäÔ éçÓÞÔ ÜÙÕÝ ×êÙÞê ×ÕÖÔ ÖÔ, ÑàÙÙß éÑÕ Üä×Õê éêÙ Ù×ÙÓÕê (ÜÔÜß "ÔÞÑàÔ"), ÕÔÞÑàÔ àÙæÑ âÜ ÔÞÒèé ÑÙÕÝ ×êÙÞê ×ÕÖÔ ÖÔ;</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">Õ Ô Õ Ð Ù Ü   ÕÔ×ÕÛè:</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p style="text-indent: -1cm; margin-right: 1cm" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">1.         èÛé Ù×ÙÓÔ ÑÞÑàÔ ÑÔêÐÝ ÜÔáÛÝ ÑÙàÕ ÜÑÙß ×Ñèê <b>___________________</b> (ÜÔÜß "Ô×ÑèÔ ÔÙÕÖÞê") Ðéè ÑàêÔ Ðê ÔÞÑàÔ Õ/ÐÕ Ô×ÖÙçÔ ÐÕêÕ Õ/ÐÕ àÙÔÜÔ ÐÕêÕ, âÜ-äÙ ÔáÛÝ ÑÙàÔ ÜÑÙß ÔÞ×ÛÙè;</span> </p> <p style="text-indent: 1cm" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">ÐÕ -</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">2.         ÔÙÔ ÑâÜ ÖÛÕÙÕê ÛÜéÔß ÑÙ×ÙÓÔ ÔÞêÕÐèê ÜÔÜß âÕÑè Ü×êÙÞê ×ÕÖÔ ÖÔ, âÜ-äÙ ÔáÛÝ ÑÙàÕ ÜÑÙß ÔÞ×ÛÙè;</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">Õ Ô Õ Ð Ù Ü  ÕÔÞ×ÛÙè ÔáÛÙÝ ÜÔÙâàÕê ÜÑçéê Ô×ÕÛè ÕÜÔ×ÛÙè ÜÕ Ðê ÔÙ×ÙÓÔ éÑÞÑàÔ. ÔÙ×ÙÓÔ ÞêÕÐèê ÜÔÜß Ñ"èéÙÞÔ", ÕÖÐê ÑÙ×Ó âÝ ×Üç Ù×áÙ ÑèÛÕé ÔÞéÕêã ÛÐÞÕè ÜÔÜß Ñ"èéÙÞÔ" (ÜÔÜß - "ÔÙ×ÙÓÔ");</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">Õ Ô Õ Ð Ù Ü  ÕÔÕèÐÕê Ô×ÕÖÔ Ñçéè âÝ ÔÞÒèé Ù×ÕÜÕ, ÑÔêÐÝ ÜÔçéè ÔÓÑèÙÝ, âÜ ÔÞÒèé ÛÕÜÕ Õ/ÐÕ âÜ ×Üç Ù×áÙ ÑÜêÙ ÞáÕÙÙÝ Þß ÔÞÒèé, ÔÛÜÕÜ Ñ×ÜçÕ éÜ Ô×ÕÛè ÑèÛÕé ÔÞéÕêã Ôà"Ü (ÔÙ×ÙÓÔ ÑÙ×Ó âÝ Ô×Üç ÔÙ×áÙ ÑèÛÕé ÔÞéÕêã ÛÐÞÕè ÜâÙÜ êÙçèÐ Ñ×ÕÖÔ ÖÔ "ÔÞÕ×Ûè" Õ/ÐÕ "ÔÞ×ÕÑèÙÝ");</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">Õ Ô Õ Ð Ù Ü  ÕÔÞÙàÔÜ Þáè ÑêÐèÙÚ ê×ÙÜê êçÕäê Ô×ÛÙèÔ Ðê Ô×ÖçÔ ÑÞÕ×Ûè Ü×ÕÛè ÐÕ ÜÞÙ éÔÙÕ ÑâÜÙ ÖÛÕê ×ÛÙèÔ ÑÞÕ×Ûè ÜäàÙÕ;</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">Õ Ô Õ Ð Ù Ü  ÕÔ×ÕÛè ÞÐéè ÛÙ ÑÓç Ðê ÔÞÕ×Ûè ÕÞæÐ ÐÕêÕ ÞêÐÙÝ ÜæèÛÙÕ ÕÜÞØèÕêÙÕ ÜäÙ ×ÕÖÔ ÖÔ;</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">Õ Ô Õ Ð Ù Ü  ÕÔÞÕ×Ûè ÞÕ×Ûè Ü×ÕÛè ÜÞØèÔ, ÜÙÙâÕÓ ÕÜçÙÑÕÜê ÔÑàÙÔ ÛÞäÕèØ ÜÔÜß;</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">Õ Ô Õ Ð Ù Ü   ÕÔ×ÕÛè  ÞæÔÙè  ÑÖÔ ÛÙ ÜÐ ×ÜÔ  âÜÙÕ ÞÒÑÜÔ ÑÐéè  ÜÔêçéèÕêÕ âÝ ÔÞ×ÛÙè  Ñ×ÕÖÔ ÖÔ ÜäÙ ÔÕèÐÕê áâÙã 19(Ð)(3) éÜ êàÐÙ Ô×ÛÙèÔ éÜ ×ÕÖÔ ×ÛÙèÔ ÖÔ ÕÛÙ ÙÓÕâ ÜÕ éèç ÑêàÐÙ ÞÕçÓÝ ÕÙáÕÓÙ ÖÔ ÞÕÛß ÔÞ×ÛÙè ÜÔêçéè âÞÕ âÜ-äÙ ×ÕÖÔ ×ÛÙèÔ ÖÔ;</span> </p> <p dir="rtl" class="msonormal"> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">Õ Ô Õ Ð Ù Ü ÕÞéÞâÕê ÔÞÕà×ÙÝ éÑ×ÕÖÔ ÖÔ êÔÙÔ ÑÔêÐÝ ÜÐÞÕè ÜÔÜß ÑÞÑÕÐ ÖÔ, ÐÜÐ ÐÝ ÞÔçéè ÔÓÑèÙÝ Þê×ÙÙÑê ÞéÞâÕê Ð×èê âÜ-äÙ Ô×ÕÖÔ:</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">"ÔèéÙÞÔ": äèØÙÔÝ éÜ ÔÞÒèé ÕéÜ ÔÙ×ÙÓÔ ÑØÑÜÐÕê éÜÔÜß.</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">"ÔÞÒèé": ÔÞÒèé Õ/ÐÕ ÔÙ×ÙÓÔ ÔÞêÕÐèÙÝ ÑêèéÙÝ éæÕèã ÜÔáÛÝ ÑÙß Ô×ÕÛè ÜÑÙß Ô×ÑèÔ ÔÙÕÖÞê ÐÕ ÔÞÒèé ÔÞêÕÐè ÑêèéÙÝ ÔèæÕã ÑÖÔ éÔÕÛß â"Ù ÔÞ×ÛÙè ÕÐéè äèØÙÕ ÔÝ:</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p style="text-indent: 1cm" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">ÔÞçÕÝ: <b>_________            </b></span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p style="text-indent: 1cm" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">ÔÛêÕÑê:  <b><span dir='rtl'>______________________</span></b>          </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p style="text-indent: 1cm" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">ÔéØ× ÑÞ"è ÑâèÚ:</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p style="text-indent: 1cm" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">èéÕÝ ÑÜéÛê èÙéÕÝ ÔÞçèçâÙß Ñ -</span> </p> <p dir="rtl" class="msonormal"> </p> <p style="text-indent: 1cm" dir="rtl" class="msonormal"> <b> <span style="font-family: david" lang="he"><span dir='rtl'>ÒÕé/ÛèÚ:</span> <span dir='rtl'>_______</span>&nbsp;&nbsp;<span dir='rtl'>×ÜçÔ/Óã:</span> <span dir='rtl'>____</span></span> </b> </p> <p dir="rtl" class="msonormal"> </p> <p style="text-indent: 1cm" dir="rtl" class="msonormal"> <b> <span style="font-family: david" lang="he"><span dir='rtl'>ÞÒèé(ÙÝ)</span> <span dir='rtl'>Þá'</span> <span dir='rtl'>____</span> <span dir='rtl'>____</span> <span dir='rtl'>ÜäÙ</span> <span dir='rtl'>êÛàÙê</span> <span dir='rtl'>ÞäÕèØê</span>&nbsp;&nbsp;<span dir='rtl'>Þá'</span> <span dir='rtl'>________</span></span> </b> <span style="font-family: david" lang="he">               </span></p> <p dir="rtl" class="msonormal"> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">"ÔÙ×ÙÓÔ": ÔÙ×ÙÓÔ ÛÞêÕÐè ÑêèéÙÝ Ôà"Ü éÑÙß Ô×ÕÛè Ü×ÑèÔ ÔÙÕÖÞê ÛÞäÕèØ ÜÔÜß:</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p style="text-indent: 1cm; margin-right: 1cm" dir="rtl" class="msonormal"> <b> <span style="font-family: david" lang="he"><span dir='rtl'>ÒÕé/ÛèÚ:</span> <span dir='rtl'>_______</span>&nbsp;&nbsp;<span dir='rtl'>×ÜçÔ/Óã:</span> <span dir='rtl'>____</span>    ×Üçê ÞéàÔ: ___</span> </b> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p style="text-indent: 1cm; margin-right: 1cm" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">éØ× ÔèæäÔ:                         <b><span dir='rtl'>_________</span></b> Þ"è</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p style="text-indent: 1cm; margin-right: 1cm" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">Þáäè Ô×ÓèÙÝ ÑÙ×ÙÓÔ:        <b><span dir='rtl'>___</span></b></span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p style="text-indent: 1cm; margin-right: 1cm" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">Þáäè ÔÙ×ÙÓÔ ÑêéèÙØ:       <b>___</b></span> </p> <p dir="rtl" class="msonormal"> </p> <p style="text-indent: 1cm; margin-right: 1cm" dir="rtl" class="msonormal"> <b> <span style="font-family: david" lang="he">"æÞÙÓÕÙÕê":</span> </b> </p> <p dir="rtl" class="msonormal"> </p> <p style="text-indent: 1cm; margin-right: 2cm" dir="rtl" class="msonormal"> <b> <span style="font-family: david" lang="he">__________ ÑéØ× ________ Þ"è   </span> </b> <span style="font-family: david" lang="he">            </span></p> <p dir="rtl" class="msonormal"> </p> <p style="text-indent: 1cm; margin-right: 1cm" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">Þáäè Ô×ÜçÙÝ ÑèÛÕé ÔÞéÕêã ÔæÞÕÓÙÝ ÜÙ×ÙÓÔ:</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p style="text-indent: 1cm; margin-right: 1cm" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">Þáäè ÞéàÔ éÜ ÔèÛÕé ÔÞéÕêã:</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">"êçÕäê Ô×ÛÙèÔ": <b>___</b> éàÙÝ, Ô×Ü ÞêÐèÙÚ <b><span dir='rtl'>____/__/__</span></b> ÕÛÜÔ ÑêÐèÙÚ <b><span dir='rtl'>____/__/__</span>.</b></span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">"êçÕäê ×ÛÙèÔ àÕáäê": <b>___</b> éàÙÝ Ô×Ü ÞêÕÝ êçÕäê Ô×ÛÙèÔ.</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">"ÞØèê Ô×ÛÙèÔ": <b>______________________</b></span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">"ÔÙÙâÕÓ": <b><span dir='rtl'>__________________</span>.</b></span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">"çÙÑÕÜê ÔÑàÙÔ":</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">"ÓÞÙ ×ÛÙèÔ": <b>ÓÞÙ ×ÛÙèÔ ÞÔÕÕàÙÝ ÛÔÒÓèêÝ ÜÔÜß.</b></span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <b> <span style="font-family: david" lang="he"><span dir='rtl'>"ÓÞÙ</span> <span dir='rtl'>×ÛÙèÔ</span> <span dir='rtl'>ÞÔÕÕàÙÝ":</span> <span dir='rtl'>ÓÞÙ</span> <span dir='rtl'>×ÛÙèÔ</span> <span dir='rtl'>éàêÙÙÝ</span> <span dir='rtl'>ÜÛÜ</span> <span dir='rtl'>êçÕäê</span> <span dir='rtl'>Ô×ÛÙèÔ,</span> <span dir='rtl'>ÛéÔÝ</span> <span dir='rtl'>ÞÔÕÕàÙÝ</span> <span dir='rtl'>ÛÞçÕÑÜ</span> <span dir='rtl'>ÐæÜ</span> <span dir='rtl'>ÔÞ×ÛÙè</span> <span dir='rtl'>ÑáÚ</span> <span dir='rtl'>_________</span> <span dir='rtl'>é"×,</span> <span dir='rtl'>éÕÜÞÕ</span> <span dir='rtl'>ÜÞ×ÛÙè</span> <span dir='rtl'>ÞèÐé.</span></span> </b> </p> <p dir="rtl" class="msonormal"> </p> <p dir="rtl" class="msonormal"> <b> <span style="font-family: david" lang="he"></span> </b> </p> <p dir="rtl" class="msonormal"> </p> <p style="text-indent: 1cm; margin-right: 1cm" dir="rtl" class="msonormal"> <b> <span style="font-family: david" lang="he"></span> </b> </p> <p dir="rtl" class="msonormal"> </p> <p style="text-indent: 1cm; margin-right: 1cm" dir="rtl" class="msonormal"> <b> <span style="font-family: david" lang="he"></span> </b> </p> <p dir="rtl" class="msonormal"> </p> <p style="text-indent: 1cm; margin-right: 1cm" dir="rtl" class="msonormal"> <b> <span style="font-family: david" lang="he"></span> </b> </p> <p dir="rtl" class="msonormal"> </p> <p style="text-indent: 1cm; margin-right: 1cm" dir="rtl" class="msonormal"> <b> <span style="font-family: david" lang="he"></span> </b> </p> <p dir="rtl" class="msonormal"> </p> <p style="text-indent: 1cm; margin-right: 1cm" dir="rtl" class="msonormal"> <b> <span style="font-family: david" lang="he"></span> </b> </p> <p dir="rtl" class="msonormal"> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">"ÔâèÚ ÔÙáÕÓÙ éÜ ÔÞÒèé": áÚ ________________ é"× éÔÕÐ âèÛÕ éÜ ×Üç Ù×áÙ ÑÜêÙ ÞáÕÙÙÝ Þß ÔÞÒèé ÛäÙ éÔÕâèÚ âÜ-ÙÓÙ ÔéÞÐÙ ÔÞÞéÜêÙ Üê×ÙÜê êçÕäê Ô×ÛÙèÔ ÐÕ ÛäÙ éàçÑâ ÑÔà×ÙÕê ÞÕâæê ÞçèçâÙ ÙéèÐÜ ÛâèÚ ÔÞÒèé ÜæÕèÚ ×ÙéÕÑ ÓÞÙ ×ÛÙèÔ, ÛÐéè ÔÙ×á ÑÙß ÒÕÓÜ Ô×Üç ÔÙ×áÙ ÔÐÞÕè ÜÑÙß ÒÕÓÜ ÛÜ éØ× ÔÞÒèé éÕÕÔ ÜÙ×á éÑÙß Ô×Üç ÑèÛÕé ÔÞéÕêã éÜ ÔÑÙê, ÛÞéÞâÕ Ñ×Õç ÔÞçèçâÙß êéÛ"Ø-1969, ÔæÞÕÓ ÜÓÙèÔ ÜÑÙß ÛÜÜ ÔèÛÕé ÔÞéÕêã éÜ ÔÑÙê.</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <b> <span style="font-family: david" lang="he"></span> </b> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">"ÔÞÓÓ ÔÙáÕÓÙ": ÞÓÓ ÔÞ×ÙèÙÝ ÜæèÛß ÔÐ×èÕß éÔÙÔ ÙÓÕâ Ñê×ÙÜê êçÕäê Ô×ÛÙèÔ.</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">Õ Ô Õ Ð Ù Ü   ÕÑàÕáã ÜêàÐÙ Ô×ÛÙèÔ éÜÔÜß Ù×ÕÜÕ âÜ Ô×ÛÙèÔ ÜäÙ ×ÕÖÔ ÖÔ ÒÝ ÔêàÐÙÝ ÔÑÐÙÝ éÑÞÑÕÐ ÖÔ:</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p style="text-indent: -1cm; margin-right: 1cm" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">(Ð)       ÞÕáÛÝ ÑÖÔ ÑÞäÕèé ÛÙ ÛÜ âÕÓ ÜÐ àèéÝ ÔÞÑàÔ ÛÑÙê ÞéÕêã ÑÜéÛê èÙéÕÝ ÞçèçâÙß, ÜÐ ê×ÕÜ Ôê×ÙÙÑÕê ÔÞ×ÛÙè ÜäÙ áâÙã 2 éÜ êàÐÙ Ô×ÛÙèÔ éÜ ×ÕÖÔ ÖÔ Ñçéè ÜèÙéÕÝ Ô×ÛÙèÔ âÜ éÝ Ô×ÕÛè ÕÛÜ ×ÕÑÔ Ð×èê éÜ ÔÞ×ÛÙè ÜäÙ ×ÕÖÔ ÖÔ ÔÞéêÞâê ÞÞàÔ, ÕÙèÐÕ Ñ×ÕÖÔ Ôê×ÙÙÑÕê éÜ ÔÞ×ÛÙè ÜÔÑÙÐ ÜÙÓÙ Ô×Ûèê ÔÓÙèÔ ÑÔêÐÝ ÜêàÐÙ ×ÕÖÔ ÖÔ ÛéÔÙÐ àçÙÔ ÞÛÜ éâÑÕÓ ÐÕ Ôê×ÙÙÑÕê ÜéâÑÕÓ, ÞâÙçÕÜ ÕÞÛÜ ÖÛÕê éÜ æÓ éÜÙéÙ, ÜÞâØ éâÑÕÓ ÐÕ Ôê×ÙÙÑÕê ÜéâÑÕÓ Ü×ÕÑê Ô×ÕÛè, ÕÜäæÕê Ðê Ô×ÕÛè ÐÝ ÜÐ ÙêÞÜÐÕ Ôê×ÙÙÑÕÙÕê ÔÞ×ÛÙè ÛÐÞÕè, ÐÕÜÝ ÛÜ éÐè êàÐÙ ×ÕÖÔ ÖÔ Ù×ÕÜÕ Ô×Ü ÑêÐèÙÚ ê×ÙÜê Ô×ÛÙèÔ. ÔÔê×ÙÙÑÕê ÔÐÞÕèÔ ÞÕêàÙê ÑÞÙÜÕÙ ÔÕèÐÕê áâÙã 10 éÜ êàÐÙ Ô×ÛÙèÔ éÜ ×ÕÖÔ ÖÔ ÕÑêàÐÙ àÕáã éÜÞØèê èÙéÕÝ ×ÕÖÔ ×ÛÙèÔ ÖÔ ÙÞæÙÐ Ô×ÕÛè ÜÞ×ÛÙè ÜäàÙ ÔèÙéÕÝ ÐÙéÕè ÞÔ×ÑèÔ ÔÙÕÖÞê ÛÙ ÐÙß ÞæÙÓÔ ÞàÙâÔ ÜèÙéÕÝ ÑéÜ ÐÙ äèâÕß ÑÞÕâÓ éÜ ×ÕÑÕêÙÕ ÔÛáäÙÙÝ éÜ Ô×ÕÛè Ü×ÑèÔ, ÕÛß ÙéÜÝ Ô×ÕÛè ÜÞ×ÛÙè ÜäàÙ ÔèÙéÕÝ Ðê ÛÜ ÔêéÜÕÞÙÝ ÔÞÒÙâÙÝ ÜÕ ÜäÙ ×ÕÖÔ ÖÔ âÓ ÜÞÕâÓ ÔèÙéÕÝ.</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p style="margin-right: 1cm" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">Ôê×ÙÙÑÕê ÔÞ×ÛÙè ÜäæÕê Ðê Ô×ÕÛè ÛÐÞÕè ÜâÙÜ ÜÐ ê×ÕÜ âÜ ÔÞ×ÛÙè ÐÜÐ ÐÝ Ûß Ôê×ÙÙÑÔ Ô×ÑèÔ ÔÙÕÖÞê ÑÛêÑ, ÜäàÙ ×êÙÞê ×ÕÖÔ ÖÔ, ÜéäÕê Ðê ÔÞ×ÛÙè ÑáÛÕÝ ÔäÙæÕÙÙÝ ÐÝ ÕÛÐéè Ù×ÕÙÙÑ ÔÞ×ÛÙè ÑäÙæÕÙÙÝ ÛÐÞÕè ÜâÙÜ ÞáÙÑÕê éÐÙàß ÑéÜÙØêÕ ÔÑÜâÓÙê.</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p style="margin-right: 1cm" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">Ôê×ÙÙÑÕê ÔÞ×ÛÙè ÜäæÕê Ðê Ô×ÕÛè ÛÐÞÕè ÜâÙÜ ÜÐ ê×ÕÜ ÜÒÑÙ ×ÕÛè éÜ ÓÙèÔ éÔÕéÛèÔ ÐÕ ÔÕ×ÛèÔ ÜèÐéÕàÔ çÕÓÝ Ü- 2.2.75  êÐèÙÚ ê×ÙÜêÕ éÜ ×Õç ÔÞÛè (ÓÙèÕê) (ÔÑØ×ê ÔéçâÕê éÜ èÕÛéÙ ÓÙèÕê), êéÜ"Ô-1974.</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p style="text-indent: -1cm; margin-right: 1cm" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">(Ñ)        ÑàÕáã ÜÛÜ ÔÐÞÕè ÑáâÙã 10 ÜÔÜß, ÐÝ ÔÞÕ×Ûè ØèÝ àèéÝ ÜäÙ äèç Õ ' Ü×Õç ÔÞçèçâÙß êéÛ"Ø-1969,  êÔÙÔ ×ÕÑê èÙéÕÝ ÔÞÕ×Ûè ÛÐÞÕè âÜ Ô×ÕÛè ÐÕ âÜ Ô×ÑèÔ ÔÙÕÖÞê ÑÜÑÓ, ÕÛÜ ÔÔÕæÐÕê Ñçéè ÜèÙéÕÝ ÛÐÞÕè Ù×ÕÜÕ âÜ Ô×ÕÛè ÕÙéÕÜÞÕ âÜ-ÙÓÕ, ÕÔ×ÕÛè Þê×ÙÙÑ ÑÖÔ ÜÔ×ÖÙèÝ ÜÛÜ ÞÙ ééÙÜÞÝ ÑäÕâÜ ÑÞçÕÞÕ, ÞÙÓ âÝ çÑÜê ÓèÙéÔ ÜÛÚ ÞÞÙ ééÙÜÞÝ ÑÞçÕÞÕ ÐÕ ÞÔÞ×ÛÙè. ÞÕâÓ ÔèÙéÕÝ ÛÐÞÕè ÙÙçÑâ âÜ-äÙ éÙçÕÜ ÓâêÝ ÔÞÕ×ÜØ éÜ ÔÞ×ÛÙè ÐÕ éÜ Ô×ÑèÔ ÔÙÕÖÞê.</span> </p> <p style="text-indent: -1cm; margin-right: 1cm" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">          </span>  ÑàÕáã ÙÓÕâ Ü×ÕÛè ÛÙ âÓ ÜÔéÜÞê ÔÜÙÚ ÔèÙéÕÝ ÑÜéÛê èÙéÕÝ ÔÞçèçâÙß ÔÐ×èÙÕê ÜèÙéÕÝ âÙçÕÜÙÝ/ éâÑÕÓÙÝ, Þêß Ôê×ÙÙÑÕÙÕê ÜèÙéÕÝ ÞéÛàêÐ ÕØÙäÕÜ ÑÔâÑèê ÖÛÕÙÕê ÞÕØÜê âÜ ÔÞéÛß. <br/></p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p style="text-indent: -1cm; margin-right: 1cm" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">(Ò)        ÑàÕáã ÜÛÜ ÔÐÞÕè ÑáâÙã 13 ÜÔÜß, ê×ÕÜ âÜ Ô×ÕÛè ×ÕÑê ÔéêêäÕê ÑÔÕæÐÕê ÑÔêÐÝ ÜÐÞÕè ÑáâÙã 58 Ü×Õç ÔÞçèçâÙß êéÛ"Ø-1969.</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">Õ Ô Õ Ð Ù Ü   ÕÑàÕáã ÜêàÐÙ ×ÕÖÔ Ô×ÛÙèÔ éÜÔÜß Ù×ÕÜÕ ÔêàÐÙÝ ÔÞÙÕ×ÓÙÝ ÔÑÐÙÝ:</span> </p> <p dir="rtl" class="msonormal"> </p> <p dir="rtl" class="msonormal"> <strong><span dir='rtl'>_____________________________________________________________________________</span></strong> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">Õ Ô Õ Ð Ù Ü  ÕÑàÕáã ÜêàÐÙ ×ÕÖÔ Ô×ÛÙèÔ éäÕèáÞÕ ÛÐÞÕè ÜâÙÜ Ù×ÕÜÕ êàÐÙÝ ÞÙÕ×ÓÙÝ Õ/ÐÕ êÕáäê Ü×ÕÖÔ Ô×ÛÙèÔ Ñâê ÑÙæÕâ âáçê éÙàÕÙ àÙæÕÜ Õ/ÐÕ ÙâÕÓ Õ/ÐÕ äÙæÕÜ ÔÞäÕèØÙÝ ÕèæÕäÙÝ ÜÔÜß. ÞÕáÛÝ âÜ ÔæÓÓÙÝ ÛÙ ÔêèéÙÝ, ÔêàÐÙÝ ÔÞÙÕ×ÓÙÝ Õ/ÐÕ êÕáäê Ü×ÕÖÔ Ô×ÛÙèÔ Ûà"Ü ÞÔÕÕÙÝ ×Üç ÑÜêÙ àäèÓ éÜ ÔÞÑÕÐ ÕÔêàÐÙÝ éäÕèáÞÕ Ûà"Ü.</span> </p> <table> <thead style="display: table-header-group"> <tr> <td> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <h5 dir="rtl"> <span style="font-family: david" lang="he">ÕÜèÐÙÔ ÑÐÕ ÔæÓÓÙÝ âÜ Ô×êÕÝ:</span> </h5> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <div dir="ltr" align="right"> <table style="border-collapse: collapse" border="0" cellspacing="9" cellpadding="9"> <tbody> <tr> <td style="padding-bottom: 0cm; padding-left: 5.4pt; width: 132.75pt; padding-right: 5.4pt; padding-top: 0cm" valign="top" width="2841"> <p dir="rtl" class="msonormal"> </p> </td> <td style="padding-bottom: 0cm; padding-left: 5.4pt; width: 97.65pt; padding-right: 5.4pt; padding-top: 0cm" valign="top" width="2089"> <p dir="rtl" class="msonormal"> <b> <span style="font-family: david" lang="he">Ô×ÕÛè:</span> </b> </p> </td> <td style="padding-bottom: 0cm; padding-left: 5.4pt; width: 18pt; padding-right: 5.4pt; padding-top: 0cm" valign="top" width="393"> <p dir="rtl" class="msonormal"> </p> </td> <td style="padding-bottom: 0cm; padding-left: 5.4pt; width: 132.75pt; padding-right: 5.4pt; padding-top: 0cm" valign="top" width="2841"> <p dir="rtl" class="msonormal"> </p> </td> <td style="padding-bottom: 0cm; padding-left: 5.4pt; width: 96.3pt; padding-right: 5.4pt; padding-top: 0cm" valign="top" width="2057"> <p dir="rtl" class="msonormal"> <b> <span style="font-family: david" lang="he">ÔÞ×ÛÙè:</span> </b> </p> <p dir="rtl" class="msonormal"> </p> </td> </tr> <tr> <td style="padding-bottom: 0cm; padding-left: 5.4pt; width: 132.75pt; padding-right: 5.4pt; padding-top: 0cm" valign="top" width="2841"> <p style="line-height: 200%" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">______________________</span> </p> <p style="line-height: 200%" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">______________________</span> </p> <p style="line-height: 200%" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">______________________</span> </p> </td> <td style="padding-bottom: 0cm; padding-left: 5.4pt; width: 97.65pt; padding-right: 5.4pt; padding-top: 0cm" valign="top" width="2089"> <p style="line-height: 200%; text-indent: -18pt; margin-right: 18pt" dir="rtl" class="msonormal"> <span lang="he">1.   <span style="font: 7pt 'times new roman'">   </span></span> <span style="font-family: david" lang="he">éÝ</span></p> <p style="line-height: 200%; margin-right: 18pt" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">Þá' ÖÙÔÕÙ</span> </p> <p style="line-height: 200%; margin-right: 18pt" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">×êÙÞÔ</span> </p> </td> <td style="padding-bottom: 0cm; padding-left: 5.4pt; width: 18pt; padding-right: 5.4pt; padding-top: 0cm" valign="top" width="393"> <p style="line-height: 200%" dir="rtl" class="msonormal"> </p> </td> <td style="padding-bottom: 0cm; padding-left: 5.4pt; width: 132.75pt; padding-right: 5.4pt; padding-top: 0cm" valign="top" width="2841"> <p style="line-height: 200%" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">______________________</span> </p> <p style="line-height: 200%" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">______________________</span> </p> <p style="line-height: 200%" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">______________________</span> </p> </td> <td style="padding-bottom: 0cm; padding-left: 5.4pt; width: 96.3pt; padding-right: 5.4pt; padding-top: 0cm" valign="top" width="2057"> <p style="line-height: 200%; text-indent: -18pt; margin-right: 18pt" dir="rtl" class="msonormal"> <span lang="he">1.   <span style="font: 7pt 'times new roman'">  </span></span> <span style="font-family: david" lang="he">éÝ</span></p> <p style="line-height: 200%; margin-right: 18pt" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">êÕÐè ÔÞéèÔ</span> </p> <p style="line-height: 200%; margin-right: 18pt" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">×êÙÞÔ</span> </p> <p style="line-height: 200%; margin-right: 18pt" dir="rtl" class="msonormal"> </p> </td> </tr> <tr> <td style="padding-bottom: 0cm; padding-left: 5.4pt; width: 132.75pt; padding-right: 5.4pt; padding-top: 0cm" valign="top" width="2841"> <p style="line-height: 200%" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">______________________</span> </p> <p style="line-height: 200%" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">______________________</span> </p> <p style="line-height: 200%" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">______________________</span> </p> </td> <td style="padding-bottom: 0cm; padding-left: 5.4pt; width: 97.65pt; padding-right: 5.4pt; padding-top: 0cm" valign="top" width="2089"> <p style="line-height: 200%; text-indent: -18pt; margin-right: 18pt" dir="rtl" class="msonormal"> <span lang="he">2.   <span style="font: 7pt 'times new roman'">  </span></span> <span style="font-family: david" lang="he">éÝ</span></p> <p style="line-height: 200%; margin-right: 18pt" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">Þá' ÖÙÔÕÙ</span> </p> <p style="line-height: 200%; margin-right: 18pt" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">×êÙÞÔ</span> </p> </td> <td style="padding-bottom: 0cm; padding-left: 5.4pt; width: 18pt; padding-right: 5.4pt; padding-top: 0cm" valign="top" width="393"> <p dir="rtl" class="msonormal"> </p> </td> <td style="padding-bottom: 0cm; padding-left: 5.4pt; width: 132.75pt; padding-right: 5.4pt; padding-top: 0cm" valign="top" width="2841"> <p style="line-height: 200%" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">______________________</span> </p> <p style="line-height: 200%" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">______________________</span> </p> <p style="line-height: 200%" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">______________________</span> </p> </td> <td style="padding-bottom: 0cm; padding-left: 5.4pt; width: 96.3pt; padding-right: 5.4pt; padding-top: 0cm" valign="top" width="2057"> <p style="line-height: 200%; text-indent: -18pt; margin-right: 18pt" dir="rtl" class="msonormal"> <span lang="he">2.   <span style="font: 7pt 'times new roman'">   </span></span> <span style="font-family: david" lang="he">éÝ</span></p> <p style="line-height: 200%; margin-right: 18pt" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">êÕÐè ÔÞéèÔ</span> </p> <p style="line-height: 200%; margin-right: 18pt" dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">×êÙÞÔ</span> </p> </td> </tr> </tbody> </table> </div> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <b> <span style="font-family: david" lang="he">ÔÞÐéè :</span> </b> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">ÐàÙ Ô×êÕÝ ÞØÔ ÞÐéè ÛÙ ÖÙÔÙêÙ Ðê Ô×ÕÛè Ôà"Ü ÜäÙ ÞáÞÛÙ ÔÖÙÔÕÙ éÔÕæÒÕ ÑäàÙ ÕÛÙ Ô×ÕÛè ×êÝ  âÜ ×ÕÖÔ  ÖÔ ÑàÕÛ×ÕêÙ.</span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he"> </span> </p> <p dir="rtl" class="msonormal"> <span style="font-family: david" lang="he">éÝ  ____________________  êÕÐè ÔÞéèÔ  __________________  ×êÙÞê ÔÞÐéè __________________</span> </p> </td> </tr> </thead> </table> </div></td></tr></tbody></table></body></html>