for participation in the «Orley» project
To department of employment and social programs
(Full name (in case of its availability) the applicant)
living at ______________________________
(settlement, oblast) _________________________________________________________
(street, No. of the house and apartment, phone) document
identity certificate and (or) passport No. _______ ________________________________________________________
date of issue _________________________________
individual identification number ____________________________________________
bank name __________________________
bank account No. ___________________________
No. of a personal account _____________________________
I ask to accept me (my family) to the «Orley» project and to provide the caused monetary help on the basis of the social contract of activation of a family.
I consent to using the information on members of my family (including me) (the income, education, the residence, marital status) for assessment of competency of participation in the project, and also checking and updating the relevant information in public authorities.
I am informed that information provided by me is confidential and will be used only for implementation of social programs.
My family (including me) consists from _____ persons.
In case of changes of the data provided by me I promise to report on it within fifteen working days.
I am warned about responsibility for granting false information and doubtful (counterfeit) documents.
At the same time I ask to consider the possibility of granting according to the legislation of the Republic of Kazakhstan to me and terms of my family:
- social help according to the decision of local representative bodies.
«____»__________20__ year __________________
(date) (signature of applicant)
For office marks of department of employment and social programs.______________________________________________________________________________
((Full name and signature of the receiving person)
The statement with the enclosed documents is transferred to local Comission
Mark of the authoritative body on receipt of documents from the village akim «__»_________ 20__ year,
(Full name and signature of the receiving person)
_ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ __ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _ _
I am warned about responsibility for granting false information and
doubtful (counterfeit) documents.
The petition from citizen _________________________ with the enclosed documents (number), with registration number of family ________
accepted «____» _____________20__ year
(Full name and signature of the receiving person) ____________________________________