ࡱ> Nbjbj8**tL2 1111111$363131I1""""R 1" 1""r,T"m-p ev,0102,z(7(7m-m-8(7-T"3131_2(7*" L: T.C MERS0N VAL0L00 0l Mill Eitim Mdrl SAYI : 82418910-912.03-( ) 05/01/2017 KONU : Hizmet Damgal1 Pasaport Talep Formu EMN0YET MDRLNE 0LG0 :5682 say1l1 Pasaport Kanunu gerei a_a1da a1k kimlii, grev unvan1 ve kadro derecesi belirtilen grevli, e_ ve ocuklar1na hizmet damgal1 pasaport verilmesini arz/rica ederim. Yetkili Amir 0mzas1 FOTORAF (Kendisi) (Mutlaka Dolacak) (Mhr)FOTORAF (E_i) (Mhr)FOTORAF (ocuk) (Mhr)FOTORAF (ocuk) (Mhr)FOTORAF (ocuk) (Mhr) NFUS CZDANI/TRK0YE CUMHUR0YET0 K0ML0K KARTI B0LG0LER0 Hak Sahibi (Mutlaka Dolacak) Hak Sahibinin E_i (Alacaksa)ocuk (Alacaksa)ocuk (Alacaksa)ocuk (Alacaksa)T.C. Kimlik NoSoyad1Ad1Baba Ad1Ana Ad1Doum Tarihi (Gn-Ay-Y1l)CinsiyetiSeri NoGeerlilik TarihiVeren Makam PASAPORT ALACAK PERSONEL0N Kurum Sicil No Kamu Personelidir % Kamu Personeli deildir %Kadro DerecesiGrev Unvan1RakamlaYaz1ylaHak Sahibinin renim Durumu Yurtd1_1nda Grevlendirildii Tarih Ba_lang1 Biti_ & /& /& ( Gn/Ay/Y1l)  & /& /& ( Gn/Ay/Y1l)Yurtd1_1nda Grevlendirildii lke Hak sahibinin ikametgah adresi ve 0_/Ev Tel. No e- posta adresi  Hak sahibinin Formdaki bilgilerin ve dier hususlar1n  Ad1 Soyad1 doruluunu onaylar1m 0mzas1 Personel Birim Amiri Ad1 Soyad1 0mzas1 & & ../& ./. PASAPORT ALACAK RE^0T OCUK VARSA HAK SAH0B0 TARAFINDAN DOLDURULACAKTIR. 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"""$"&"p""of] $Ifgd, $Ifgdt!skd$$IfF, ) * t0644 lap ytb& 6$Ifgdb&$ $If^ a$gdb&""$"&""""""L#N#P#R##,.2N$(ƺwk_V_MAhQhs5mHsHh=5mHsHh5mHsHhQh+F5mHsHhQh,5mHsHhQhxg5mHsHhQhX5mHsHUhQh)mHsHh)hxgmHsHhXmHsHhb&h,mHsHhQh,\mHsHhb&hxgmHsHhQhxgmHsH h,@\hQht!\hQht!\mHsHhb&hXmHsH"""J#L#r 6$Ifgdb& 6$Ifgd,skdN$$IfF) * t0644 lap yt,L#N#P#R#,.(rrf^^$a$gdo*, $ ha$gdo*,$hL^h`La$gdo*,gd)gdXskd$$IfF) * t0644 lap ytxg GEREKL0 OLAN BELGELER 1-Nfus Czdan1/Trkiye Cumhuriyeti Kimlik Kart1 Asl1. 2-Pasaport alacak her ki_i iin iki adet Biometrik Fotoraf (Cepheden ekilmi_, arka fon rengi beyaz ve ICAO Standartlar1na uygun) 3-Pasaport czdan bedelinin yat1r1ld11na dair dekont. 4-Daha nce herhangi bir pasaport al1nm1_sa getirilmesi. 5-Re_it olmayan ocuklar iin kanuni mmessillerinin muvafakat namesi. 6-renim gren ocuklar iin renim belgesi. (renim belgesinin asl1 veya E-Devlet Kap1s1ndan al1nan renci belgesi) 7-Bedensel, zihinsel veya ruhsal engellerinden en az biri nedeniyle srekli bak1ma muhta durumda bulunan ocuklar iin resmi sal1k kurumlar1n1n dzenledii sal1k kurulu raporu ile velayet veya vasi kararlar1. D0ER HUSUSLAR Hizmet damgal1 pasaportlar, 5682 say1l1 Pasaport Kanununun 14/B-C maddesi hkmleri dorultusunda dzenlenmektedir. Hizmet damgal1 pasaportlar ilgilinin grev sresi dikkate al1narak dzenlenir. Hizmet damgal1 pasaport talep formu Dzenlendii tarihten itibaren Altm1_ (60) gn geerlidir. Hizmet damgal1 pasaport talep formu zerindeki bilgilerin eksik veya hatal1 olmas1 durumunda formu dzenleyen kurumun yetkilisi sorumludur. Hizmet damgal1 pasaport talep formunun n ve arka yz tek sayfada olmal1d1r. Merkez ve Ta_ra Te_kilat1nda grev yapan personel iin, hizmet damgal1 pasaport talep formunu imzalamaya yetkili k1l1nan ki_ilerin imza sirkleri, dei_iklik olmasa dahi birer y1ll1k dnemler halinde her y1l1n 1 Ocak tarihinde kurumun bulunduu 0l Emniyet Mdrlnde olacak _ekilde gndermeleri gerekmektedir. Hizmet damgal1 pasaport talep formunu imzalamaya yetkili ki_inin dei_mesi halinde yetkili k1l1nan ki_ilerin imza sirkleri kurumun bulunduu 0l Emniyet Mdrlne gnderilecektir. Hizmet damgal1 pasaport talep formu imzalamaya yetkili k1l1nan ki_ilerce 1slak imzal1 ve mhrl olmal1d1r. Hizmet damgal1 pasaport talep formunun n yzndeki kadro derece blm bo_ b1rak1lamayacakt1r. Hizmet damgal1 pasaport alm1_ al1_an personelin kadro derecesinin dei_mesi, ba_ka bir kuruma gemesi ve e_lerinden bo_anmalar1 durumunda kurum taraf1ndan pasaport ald1klar1 0l Emniyet Mdrlne bildirilecektir. Hizmet damgal1 pasaportun sresi olsa dahi, daha sonra farkl1 bir greve gidi_te hizmet damgal1 pasaport formu kurumca tanzim edilerek, sisteme kaydedilmek zere ilgili Emniyet Mdrlklerine gnderilmelidir. Form sisteme kaydedilmeden 1k1_ yap1lmazsa / yap1l1rsa _ah1s ve pasaportu kulland1ran kurum sorumlu olacakt1r. Adlar1na grev sresinden daha uzun sreli hizmet damgal1 pasaport dzenlenen grevli, e_ ve ocuklar1n1n grevle ilgili seyahatini tamamlamas1n1 takiben, geerlilii devam eden hizmet damgal1 pasaportlar birimlerinde muhafaza edilecektir. Hizmet damgal1 pasaportun zel seyahatlerde kullan1lmas1 halinde _ah1s ve pasaportu kulland1ran kurum sorumlu olacakt1r. Kurumlarca muhafaza alt1na al1nan sresi biten pasaportlar, pasaport mracaat1nda bulunulan 0l Emniyet Mdrlne gnderilecektir. Dier hususlar blmn okudum bilgi edindim. 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