FORM 9

Edition Nov 2014

FORM 9

INYANDIKO ISABA IHEREREKANYA RY’UBURENGANZIRA KU BUTAKA RISHINGIYE KU IGURANA

Umwirondoro (w’impande zombi)

Uruhande rwa1:

Njyewe/Twebwe: .....…………………………………………………………………………………………………………………...........

Irangamimerere: …………………………….…………………………………………………………………..........................................

Indangamuntu/Pasiporo: …………………..………………………………………………………………………………………..........

Aderesi: Akarere ka…………………….…. Umurenge wa ……………………………Akagari ka…………………….............

Umudugudu wa ………………................Telefoni : ……………………………………E-mail: …………………………................

Cyangwa

Isosiyete/ONG/Ishyirahamwe ry’umwuga/Idini/Koperative/Ibindi…………………………………………….........

Njyewe (Uhagarariye mu buryo bwemewe n'amategeko):………………………………….............................................

Indangamuntu/Pasiporo: ……......………………………………………………………………………………………………………..

Aderesi: Akarere ka…………………….…. Umurenge wa ……………………………Akagari ka ……………………............

Umudugudu wa ………………................Telefoni : ……………………………………E-mail: …………………………................

Uruhande rwa kabiri

Njyewe/Twebwe: .....…………………………………………………………………………………………………………………...........

Irangamimerere: …………………………….…………………………………………………………………..........................................

Indangamuntu/Pasiporo: …………………..………………………………………………………………………………………..........

Aderesi: Akarere ka…………………….…. Umurenge wa ……………………………Akagari ka ……………………............

Umudugudu wa ………………................Telefoni : ……………………………………E-mail: …………………………................

Cyangwa

Isosiyete/ONG/Ishyirahamwe ry’umwuga/Idini/Koperative/Ibindi…………………………………………….........

Njyewe (Uhagarariye mu buryo bwemewe n'amategeko):………………………………….............................................

Indangamuntu/Pasiporo: ……......………………………………………………………………………………………………………..

Aderesi: Akarere ka…………………….…. Umurenge wa ……………………………Akagari ka ……………………............

Umudugudu wa ………………................Telefoni : ……………………………………E-mail: …………………………................

Turasaba ihererekanya ry’uburenganzira k’ubutaka rishingiye ku igurana Amakuru arebana n’ikibanza/isambu ya mbere y’uruhande rwa 1:

Nimero y'ikibanza/isambu (UPI): …………………………..................................

Umujyi wa Kigali/Intara: ………………………………………................

Akarere: …………………………………………………...

Umurenge: …………………………………….……………..

Akagari: …………………………………….……………..

gihinduranywa na

Amakuru arebana n’ikibanza/isambu ya Kabiri y’uruhande rwa 2:

Nimero y'ikibanza/isambu (UPI): …………………………..................................

Umujyi wa Kigali/Intara: ………………………………………................

Akarere: …………………………………………………...

Umurenge: …………………………………….……………..

Akagari: …………………………………….……………..

Impamvu yo gusaba guhererekanya uburenganzira ku butaka bishingiye ku ihinduranya ry’ubutaka

………………………………………………………………………………………………………………………………………………….

…………………………………………………………………………………………………………………………………………………

Ibyangombwa bisabwa

Amasezerano y’ihererekanya yashyizweho umukono n’impande zombi xxxxx xxxxx umukono wa Noteri mu bijyanye n’ubutaka mu gihe ibiguranwa ari ubutaka cyangwa Amasezerano

y’ihererekanya yashyizweho umukono n’impande zombi xxxxx xxxxx umukono wa Noteri mu bitajyanye n’ubutaka mu gihe ibiguranwa ari ubutaka n’ibindi bintu

Ibyangombwa by’ubutaka busabirwa igurana1

Inyandiko y’ubumvikane yakorewe imbere ya Noteri igaragaza imigabane buri muntu afite mu gihe mu bagomba kwandikwa ku butaka harimo abanyamahanga bafatanyije ubutaka n’Abanyarwanda cyangwa inyandiko yari isosiyete y’ubucuruzi, umuryango cyangwa ishyirahamwe bifite ubuzima

gatozi abanyamahanga bafitemo imigabane

…………………………….. ……………………………………………………………………………… Itariki y’ubusabe Imikono y’abasaba

Byakiriwe kandi bisuzumwa na: ……………………………….............................................................

Xxxxxxx Xxxxx

Umukono: …………………………………………………

1 Bitewe n’imitungire y’ubutaka, ibyangombwa by’ubutaka bishobora kuba kimwe muri ibi bikurikira:

• Amasezerano y’ubukode burambye, icyemezo cy’iyandikisha ry’ubukode bw’igihe kirekire n’ igishushanyo cyerekana ingano y’ubutaka

• Icyemezo cy’inkondabutaka

• Icyemezo cy’Iyandikisha ry’Impapurompamo ngenankomyi,

• Icyemezo cy’iyandikisha ry’ibice by’isangiramutungo ku nyubako