İzahat

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                                (izahat verilən şəxsin vəzifəsi, xüsusi rütbəsi)

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 (adı və soyadı)

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 (izahat verənin doğulduğu gün, ay, il və yer)

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(vətəndaşlığı, təhsili)

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(iş yeri, məşğuliyyət növü və ya vəzifəsi)

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(faktiki yaşadığı və qeydiyyatda olduğu yer)

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___________________________________ tərəfindən

                                       (soyadı, adı və atasının adı)

İ Z A H A T

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(izahat verənin imzası)

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(izahat verənin imzası)

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İmza:                                       _____________________________________________

(izahat verənin adı və soyadı)

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(izahatın verildiyi tarix və yer)

İzahatı aldı:                              _____________________________________________

(izahatı alanın vəzifəsi, adı, soyadı və atasının adı)

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(izahatın alındığı tarix və yer)