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DEMANDE D'INSCRIPTION N° DU DOSSIER ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﻠ‬ ‫ﻒ‬ ‫ر‬ ‫ﻗ‬ ‫ﻢ‬ AE-201012-123684 ‫ا‬ ‫ﻟ‬ ‫ﺘ‬ ‫ﺴ‬ ‫ﺠ‬ ‫ﻴ‬ ‫ﻞ‬ ‫ا‬ ‫ﺳ‬ ‫ﺘ‬ ‫ﻤ‬ ‫ﺎ‬ ‫ر‬ ‫ة‬ PARTIE A — RENSEIGNEMENTS SUR LE DEMANDEUR ‫ا‬ ‫ﻟ‬ ‫ﻄ‬ ‫ﻠ‬ ‫ﺐ‬ ‫ﺻ‬ ‫ﺎ‬ ‫ﺣ‬ ‫ﺐ‬ ‫ﺣ‬ ‫ﻮ‬ ‫ل‬ ‫ﻣ‬ ‫ﻌ‬ ‫ﻠ‬ ‫ﻮ‬ ‫ﻣ‬ ‫ﺎ‬ ‫ت‬ — ‫أ‬ ‫ا‬ ‫ﻟ‬ ‫ﺠ‬ ‫ﺰ‬ ‫ء‬ A1 — IDENTITÉ DU DEMANDEUR ‫ا‬ ‫ﻟ‬ ‫ﻄ‬ ‫ﻠ‬ ‫ﺐ‬ ‫ﺻ‬ ‫ﺎ‬ ‫ﺣ‬ ‫ﺐ‬ ‫ﻫ‬ ‫ﻮ‬ ‫ﻳ‬ ‫ﺔ‬ — 1‫أ‬ Prénom(s) ‫ﻣ‬ ‫ﺤ‬ ‫ﻤ‬ ‫ﺪ‬ ‫ا‬ ‫ﻟ‬ ‫ﺸ‬ ‫ﺨ‬ ‫ﺼ‬ ‫ﻲ‬ ‫ا‬ ‫ﻻ‬ ‫ﺳ‬ ‫ﻢ‬ ‫ﻣ‬ ‫ﺤ‬ ‫ﻤ‬ ‫ﺪ‬ Nom ‫ا‬ ‫ﻟ‬ ‫ﻌ‬ ‫ﻠ‬ ‫ﻮ‬ ‫ي‬ ‫ا‬ ‫ﻟ‬ ‫ﻌ‬ ‫ﺎ‬ ‫ﺋ‬ ‫ﻠ‬ ‫ﻲ‬ ‫ا‬ ‫ﻻ‬ ‫ﺳ‬ ‫ﻢ‬ ‫ا‬ ‫ﻟ‬ ‫ﻌ‬ ‫ﻠ‬ ‫ﻮ‬ ‫ي‬ ‫ا‬ ‫ﻟ‬ ‫ﻨ‬ ‫ﻘ‬ ‫ﺎ‬ ‫ل‬ ‫ا‬ ‫ﻟ‬ ‫ﻬ‬ ‫ﺎ‬ ‫ﺗ‬ ‫ﻒ‬ Tél Mobile 0616-77-35-96 ‫ا‬ ‫ﻟ‬ ‫ﺜ‬ ‫ﺎ‬ ‫ﺑ‬ ‫ﺖ‬ ‫ا‬ ‫ﻟ‬ ‫ﻬ‬ ‫ﺎ‬ ‫ﺗ‬ ‫ﻒ‬ Tél Fixe E-mail ‫ا‬ ‫ﻹ‬ ‫ﻟ‬ ‫ﻜ‬ ‫ﺘ‬ ‫ﺮ‬ ‫و‬ ‫ﻧ‬ ‫ﻲ‬ ‫ا‬ ‫ﻟ‬ ‫ﺒ‬ ‫ﺮ‬ ‫ﻳ‬ ‫ﺪ‬ simolmnawar8@gmail.com ‫ا‬ ‫ﻟ‬ ‫ﺠ‬ ‫ﻨ‬ ‫ﺲ‬ Sexe ‫ذ‬ ‫ﻛ‬ ‫ﺮ‬ ‫ا‬ ‫ﻟ‬ ‫ﺠ‬ ‫ﻨ‬ ‫ﺴ‬ ‫ﻴ‬ ‫ﺔ‬ Nationalité Maroc Date et lieu de naissance ‫ا‬ ‫ﻻ‬ ‫ز‬ ‫د‬ ‫ﻳ‬ ‫ﺎ‬ ‫د‬ ‫و‬ ‫ﻣ‬ ‫ﻜ‬ ‫ﺎ‬ ‫ن‬ ‫ﺗ‬ ‫ﺎ‬ ‫ر‬ ‫ﻳ‬ ‫ﺦ‬ 15-05-1987 ‫ا‬ ‫ﻟ‬ ‫ﺨ‬ ‫ﻤ‬ ‫ﺴ‬ ‫ﺎ‬ ‫ت‬ ‫ا‬ ‫ﻹ‬ ‫ﻟ‬ ‫ﻜ‬ ‫ﺘ‬ ‫ﺮ‬ ‫و‬ ‫ﻧ‬ ‫ﻴ‬ ‫ﺔ‬ ‫ﻟ‬ ‫ﻠ‬ ‫ﺘ‬ ‫ﻌ‬ ‫ﺮ‬ ‫ﻳ‬ ‫ﻒ‬ ‫ا‬ ‫ﻟ‬ ‫ﻮ‬ ‫ﻃ‬ ‫ﻨ‬ ‫ﻴ‬ ‫ﺔ‬ ‫ا‬ ‫ﻟ‬ ‫ﺒ‬ ‫ﻄ‬ ‫ﺎ‬ ‫ﻗ‬ ‫ﺔ‬ ‫ر‬ ‫ﻗ‬ ‫ﻢ‬ N° de CNIE X295041 ‫ا‬ ‫ﻹ‬ ‫ﻗ‬ ‫ﺎ‬ ‫ﻣ‬ ‫ﺔ‬ ‫ﺑ‬ ‫ﻄ‬ ‫ﺎ‬ ‫ﻗ‬ ‫ﺔ‬ ‫ر‬ ‫ﻗ‬ ‫ﻢ‬ N° Carte de séjour ‫ﻓ‬ ‫ﻲ‬ ‫ﺳ‬ ‫ﻠ‬ ‫ﻤ‬ ‫ﺖ‬ Délivrée le ‫ﻏ‬ ‫ﺎ‬ ‫ﻳ‬ ‫ﺔ‬ ‫إ‬ ‫ﻟ‬ ‫ﻰ‬ ‫ﺻ‬ ‫ﺎ‬ ‫ﻟ‬ ‫ﺤ‬ ‫ﺔ‬ Valide jusqu'au 29-10-2027 A2 — ADRESSE DE LA RÉSIDENCE PRINCIPALE DU DEMANDEUR ‫ا‬ ‫ﻟ‬ ‫ﻄ‬ ‫ﻠ‬ ‫ﺐ‬ ‫ﻟ‬ ‫ﺼ‬ ‫ﺎ‬ ‫ﺣ‬ ‫ﺐ‬ ‫ا‬ ‫ﻟ‬ ‫ﺮ‬ ‫ﺋ‬ ‫ﻴ‬ ‫ﺴ‬ ‫ﻲ‬ ‫ا‬ ‫ﻟ‬ ‫ﺴ‬ ‫ﻜ‬ ‫ﻦ‬ ‫ﻋ‬ ‫ﻨ‬ ‫ﻮ‬ ‫ا‬ ‫ن‬ — 2‫أ‬ Adresse de la résidence principale ‫ا‬ ‫ﻟ‬ ‫ﺮ‬ ‫ﺋ‬ ‫ﻴ‬ ‫ﺴ‬ ‫ﻲ‬ ‫ا‬ ‫ﻟ‬ ‫ﺴ‬ ‫ﻜ‬ ‫ﻦ‬ ‫ﻋ‬ ‫ﻨ‬ ‫ﻮ‬ ‫ا‬ ‫ن‬ 5 ‫ا‬ ‫ﻟ‬ ‫ﻘ‬ ‫ﻨ‬ ‫ﻴ‬ ‫ﻄ‬ ‫ﺮ‬ ‫ة‬ ‫ا‬ ‫ﻟ‬ ‫ﺨ‬ ‫ﻄ‬ ‫ﺎ‬ ‫ﺑ‬ ‫ﻲ‬ ‫ﻋ‬ ‫ﻤ‬ ‫ﺮ‬ ‫إ‬ ‫ﻗ‬ ‫ﺎ‬ ‫ﻣ‬ ‫ﺔ‬ 1 ‫ا‬ ‫ﻟ‬ ‫ﺸ‬ ‫ﻘ‬ ‫ﺔ‬ ‫إ‬ ‫ﺷ‬ ‫ﺒ‬ ‫ﻴ‬ ‫ﻠ‬ ‫ﻴ‬ ‫ﺔ‬ ‫ز‬ ‫ﻧ‬ ‫ﻘ‬ ‫ﺔ‬ ‫ا‬ ‫ﻟ‬ ‫ﺒ‬ ‫ﺮ‬ ‫ﻳ‬ ‫ﺪ‬ ‫ي‬ ‫ا‬ ‫ﻟ‬ ‫ﺮ‬ ‫ﻣ‬ ‫ﺰ‬ Code postal 14020 Commune/Ville ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﺪ‬ ‫ﻳ‬ ‫ﻨ‬ ‫ﺔ‬ / ‫ا‬ ‫ﻟ‬ ‫ﺠ‬ ‫ﻤ‬ ‫ﺎ‬ ‫ﻋ‬ ‫ﺔ‬ KENITRA Province/Préfecture ‫ا‬ ‫ﻹ‬ ‫ﻗ‬ ‫ﻠ‬ ‫ﻴ‬ ‫ﻢ‬ / ‫ا‬ ‫ﻟ‬ ‫ﻌ‬ ‫ﻤ‬ ‫ﺎ‬ ‫ﻟ‬ ‫ﺔ‬ KENITRA Région ‫ا‬ ‫ﻟ‬ ‫ﺠ‬ ‫ﻬ‬ ‫ﺔ‬ Rabat-Salé-Kénitra Document généré le 20-10-2020 19:10 Page-1/3
PARTIE B — RENSEIGNEMENTS SUR L'ACTIVITE ‫ا‬ ‫ﻟ‬ ‫ﻨ‬ ‫ﺸ‬ ‫ﺎ‬ ‫ط‬ ‫ﺣ‬ ‫ﻮ‬ ‫ل‬ ‫ﻣ‬ ‫ﻌ‬ ‫ﻠ‬ ‫ﻮ‬ ‫ﻣ‬ ‫ﺎ‬ ‫ت‬ — ‫ب‬ ‫ا‬ ‫ﻟ‬ ‫ﺠ‬ ‫ﺰ‬ ‫ء‬ B1 — ACTIVITÉ EXERCÉE (1) (1) ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﺰ‬ ‫ا‬ ‫و‬ ‫ل‬ ‫ا‬ ‫ﻟ‬ ‫ﻨ‬ ‫ﺸ‬ ‫ﺎ‬ ‫ط‬ — 1‫ب‬ Secteur d'activité ‫ا‬ ‫ﻟ‬ ‫ﻨ‬ ‫ﺸ‬ ‫ﺎ‬ ‫ط‬ ‫ﻗ‬ ‫ﻄ‬ ‫ﺎ‬ ‫ع‬ SERVICES Branche d'activité ‫ا‬ ‫ﻟ‬ ‫ﻨ‬ ‫ﺸ‬ ‫ﺎ‬ ‫ط‬ ‫ﻓ‬ ‫ﺮ‬ ‫ع‬ PRESTATIONS DE SERVICES Activité ‫ا‬ ‫ﻟ‬ ‫ﻨ‬ ‫ﺸ‬ ‫ﺎ‬ ‫ط‬ Musicien interprète Lieu d'exercice ‫ا‬ ‫ﻟ‬ ‫ﻨ‬ ‫ﺸ‬ ‫ﺎ‬ ‫ط‬ ‫ﻣ‬ ‫ﺰ‬ ‫ا‬ ‫و‬ ‫ﻟ‬ ‫ﺔ‬ ‫ﻣ‬ ‫ﻘ‬ ‫ﺮ‬ Autre Périodicité de l'activité ‫ا‬ ‫ﻟ‬ ‫ﻨ‬ ‫ﺸ‬ ‫ﺎ‬ ‫ط‬ ‫ﻣ‬ ‫ﺰ‬ ‫ا‬ ‫و‬ ‫ﻟ‬ ‫ﺔ‬ ‫د‬ ‫و‬ ‫ر‬ ‫ﻳ‬ ‫ﺔ‬ [X] Permanente [ ] Saisonnière N° d'identification fiscale (si existant) ‫ﺗ‬ ‫ﻮ‬ ‫ا‬ ‫ﺟ‬ ‫ﺪ‬ ‫ه‬ ‫ﺣ‬ ‫ﺎ‬ ‫ﻟ‬ ‫ﺔ‬ ‫ﻓ‬ ‫ﻲ‬ - ‫ا‬ ‫ﻟ‬ ‫ﻀ‬ ‫ﺮ‬ ‫ﻳ‬ ‫ﺒ‬ ‫ﻲ‬ ‫ا‬ ‫ﻟ‬ ‫ﺘ‬ ‫ﻌ‬ ‫ﺮ‬ ‫ﻳ‬ ‫ﻒ‬ ‫ر‬ ‫ﻗ‬ ‫ﻢ‬ Numéro d'identification à la taxe professionnelle (si existant) ‫ﺗ‬ ‫ﻮ‬ ‫ا‬ ‫ﺟ‬ ‫ﺪ‬ ‫ه‬ ‫ﺣ‬ ‫ﺎ‬ ‫ﻟ‬ ‫ﺔ‬ ‫ﻓ‬ ‫ﻲ‬ - ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﻬ‬ ‫ﻨ‬ ‫ﻲ‬ ‫ﺑ‬ ‫ﺎ‬ ‫ﻟ‬ ‫ﺮ‬ ‫ﺳ‬ ‫ﻢ‬ ‫ا‬ ‫ﻟ‬ ‫ﺘ‬ ‫ﻌ‬ ‫ﺮ‬ ‫ﻳ‬ ‫ﻒ‬ ‫ر‬ ‫ﻗ‬ ‫ﻢ‬ B2 — DOMICILE FISCAL ‫ا‬ ‫ﻟ‬ ‫ﻀ‬ ‫ﺮ‬ ‫ﻳ‬ ‫ﺒ‬ ‫ﻲ‬ ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﻮ‬ ‫ﻃ‬ ‫ﻦ‬ ‫ﻣ‬ ‫ﻘ‬ ‫ﺮ‬ — 2‫ب‬ Adresse du lieu de travail (si existant) ‫ﺗ‬ ‫ﻮ‬ ‫ا‬ ‫ﺟ‬ ‫ﺪ‬ ‫ه‬ ‫ﺣ‬ ‫ﺎ‬ ‫ﻟ‬ ‫ﺔ‬ ‫ﻓ‬ ‫ﻲ‬ - ‫ا‬ ‫ﻟ‬ ‫ﻌ‬ ‫ﻤ‬ ‫ﻞ‬ ‫ﻣ‬ ‫ﻘ‬ ‫ﺮ‬ ‫ﻋ‬ ‫ﻨ‬ ‫ﻮ‬ ‫ا‬ ‫ن‬ 5 ‫ا‬ ‫ﻟ‬ ‫ﻘ‬ ‫ﻨ‬ ‫ﻴ‬ ‫ﻄ‬ ‫ﺮ‬ ‫ة‬ ‫ا‬ ‫ﻟ‬ ‫ﺨ‬ ‫ﻄ‬ ‫ﺎ‬ ‫ﺑ‬ ‫ﻲ‬ ‫ﻋ‬ ‫ﻤ‬ ‫ﺮ‬ ‫إ‬ ‫ﻗ‬ ‫ﺎ‬ ‫ﻣ‬ ‫ﺔ‬ 1 ‫ا‬ ‫ﻟ‬ ‫ﺸ‬ ‫ﻘ‬ ‫ﺔ‬ ‫إ‬ ‫ﺷ‬ ‫ﺒ‬ ‫ﻴ‬ ‫ﻠ‬ ‫ﻴ‬ ‫ﺔ‬ ‫ز‬ ‫ﻧ‬ ‫ﻘ‬ ‫ﺔ‬ ‫ا‬ ‫ﻟ‬ ‫ﺒ‬ ‫ﺮ‬ ‫ﻳ‬ ‫ﺪ‬ ‫ي‬ ‫ا‬ ‫ﻟ‬ ‫ﺮ‬ ‫ﻣ‬ ‫ﺰ‬ Code postal 14020 Commune/Ville ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﺪ‬ ‫ﻳ‬ ‫ﻨ‬ ‫ﺔ‬ / ‫ا‬ ‫ﻟ‬ ‫ﺠ‬ ‫ﻤ‬ ‫ﺎ‬ ‫ﻋ‬ ‫ﺔ‬ KENITRA Province/Préfecture ‫ا‬ ‫ﻹ‬ ‫ﻗ‬ ‫ﻠ‬ ‫ﻴ‬ ‫ﻢ‬ / ‫ا‬ ‫ﻟ‬ ‫ﻌ‬ ‫ﻤ‬ ‫ﺎ‬ ‫ﻟ‬ ‫ﺔ‬ KENITRA Région ‫ا‬ ‫ﻟ‬ ‫ﺠ‬ ‫ﻬ‬ ‫ﺔ‬ Rabat-Salé-Kénitra Document généré le 20-10-2020 19:10 Page-2/3
Le soussigné, certifie exactes les indications consignées sur la présente demande. ‫ا‬ ‫ﻟ‬ ‫ﻄ‬ ‫ﻠ‬ ‫ﺐ‬ ‫ﻫ‬ ‫ﺬ‬ ‫ا‬ ‫ﻓ‬ ‫ﻲ‬ ‫ا‬ ‫ﻟ‬ ‫ﻮ‬ ‫ا‬ ‫ر‬ ‫د‬ ‫ة‬ ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﻌ‬ ‫ﻠ‬ ‫ﻮ‬ ‫ﻣ‬ ‫ﺎ‬ ‫ت‬ ‫ﺑ‬ ‫ﺼ‬ ‫ﺤ‬ ‫ﺔ‬ ‫أ‬ ‫ﻗ‬ ‫ﺮ‬ ، ‫أ‬ ‫ﺳ‬ ‫ﻔ‬ ‫ﻠ‬ ‫ﻪ‬ ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﻮ‬ ‫ﻗ‬ ‫ﻊ‬ ‫أ‬ ‫ﻧ‬ ‫ﺎ‬ En date du : 20-10-2020 ‫ﺑ‬ ‫ﺘ‬ ‫ﺎ‬ ‫ر‬ ‫ﻳ‬ ‫ﺦ‬ A KENITRA ‫ﻓ‬ ‫ﻲ‬ Article 7 de la Loi n° 114-13 relative au statut de l'auto- entrepreneur L'auto-entrepreneur doit remplir les conditions requises pour l'exercice de ses activités conformément aux dispositions législatives et réglementaires en vigueur. En outre, il est soumis dans l'exercice desdites activités aux mesures de protection du consommateur, aux règles d'hygiène et de sécurité publique conformément aux textes législatifs et réglementaires en vigueur. SIGNATURE ‫ا‬ ‫ﻟ‬ ‫ﺬ‬ ‫ا‬ ‫ﺗ‬ ‫ﻲ‬ ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﻘ‬ ‫ﺎ‬ ‫و‬ ‫ل‬ ‫ﺑ‬ ‫ﻨ‬ ‫ﻈ‬ ‫ﺎ‬ ‫م‬ ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﺘ‬ ‫ﻌ‬ ‫ﻠ‬ ‫ﻖ‬ 114.13 ‫ر‬ ‫ﻗ‬ ‫ﻢ‬ ‫ﻗ‬ ‫ﺎ‬ ‫ﻧ‬ ‫ﻮ‬ ‫ن‬ ‫ﻣ‬ ‫ﻦ‬ 7 ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﺎ‬ ‫د‬ ‫ة‬ ، ‫ﻧ‬ ‫ﺸ‬ ‫ﺎ‬ ‫ﻃ‬ ‫ﻪ‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﻤ‬ ‫ﺎ‬ ‫ر‬ ‫ﺳ‬ ‫ﺔ‬ ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﻄ‬ ‫ﻠ‬ ‫ﻮ‬ ‫ﺑ‬ ‫ﺔ‬ ‫ا‬ ‫ﻟ‬ ‫ﺸ‬ ‫ﺮ‬ ‫و‬ ‫ط‬ ‫ﻋ‬ ‫ﻠ‬ ‫ﻰ‬ ‫ﻳ‬ ‫ﺘ‬ ‫ﻮ‬ ‫ﻓ‬ ‫ﺮ‬ ‫أ‬ ‫ن‬ ‫ا‬ ‫ﻟ‬ ‫ﺬ‬ ‫ا‬ ‫ﺗ‬ ‫ﻲ‬ ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﻘ‬ ‫ﺎ‬ ‫و‬ ‫ل‬ ‫ﻋ‬ ‫ﻠ‬ ‫ﻰ‬ ‫ﻳ‬ ‫ﺠ‬ ‫ﺐ‬ ‫ا‬ ‫ﻟ‬ ‫ﻌ‬ ‫ﻤ‬ ‫ﻞ‬ ‫ﺑ‬ ‫ﻬ‬ ‫ﺎ‬ ‫ا‬ ‫ﻟ‬ ‫ﺠ‬ ‫ﺎ‬ ‫ر‬ ‫ي‬ ‫و‬ ‫ا‬ ‫ﻟ‬ ‫ﺘ‬ ‫ﻨ‬ ‫ﻈ‬ ‫ﻴ‬ ‫ﻤ‬ ‫ﻴ‬ ‫ﺔ‬ ‫ا‬ ‫ﻟ‬ ‫ﺘ‬ ‫ﺸ‬ ‫ﺮ‬ ‫ﻳ‬ ‫ﻌ‬ ‫ﻴ‬ ‫ﺔ‬ ‫ﻟ‬ ‫ﻠ‬ ‫ﻨ‬ ‫ﺼ‬ ‫ﻮ‬ ‫ص‬ ‫ﻃ‬ ‫ﺒ‬ ‫ﻘ‬ ‫ﺎ‬ ‫ا‬ ‫ﻟ‬ ‫ﺨ‬ ‫ﺎ‬ ‫ﺻ‬ ‫ﺔ‬ ‫ﺑ‬ ‫ﺎ‬ ‫ﻟ‬ ‫ﺘ‬ ‫ﺪ‬ ‫ا‬ ‫ﺑ‬ ‫ﻴ‬ ‫ﺮ‬ ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﺬ‬ ‫ﻛ‬ ‫ﻮ‬ ‫ر‬ ‫ة‬ ‫ﻟ‬ ‫ﻸ‬ ‫ﻧ‬ ‫ﺸ‬ ‫ﻄ‬ ‫ﺔ‬ ‫ﻣ‬ ‫ﺰ‬ ‫ا‬ ‫و‬ ‫ﻟ‬ ‫ﺘ‬ ‫ﻪ‬ ‫ﻓ‬ ‫ﻲ‬ ‫ﻳ‬ ‫ﺘ‬ ‫ﻘ‬ ‫ﻴ‬ ‫ﺪ‬ ‫أ‬ ‫ن‬ ‫أ‬ ‫ﻳ‬ ‫ﻀ‬ ‫ﺎ‬ ‫ﻋ‬ ‫ﻠ‬ ‫ﻴ‬ ‫ﻪ‬ ‫و‬ ‫ﻳ‬ ‫ﺠ‬ ‫ﺐ‬ ‫و‬ ‫ا‬ ‫ﻟ‬ ‫ﺘ‬ ‫ﻨ‬ ‫ﻈ‬ ‫ﻴ‬ ‫ﻢ‬ ‫ﻟ‬ ‫ﻠ‬ ‫ﺘ‬ ‫ﺸ‬ ‫ﺮ‬ ‫ﻳ‬ ‫ﻊ‬ ‫ﻃ‬ ‫ﺒ‬ ‫ﻘ‬ ‫ﺎ‬ ، ‫ا‬ ‫ﻟ‬ ‫ﻌ‬ ‫ﺎ‬ ‫ﻣ‬ ‫ﺔ‬ ‫و‬ ‫ا‬ ‫ﻟ‬ ‫ﺴ‬ ‫ﻼ‬ ‫ﻣ‬ ‫ﺔ‬ ‫ا‬ ‫ﻟ‬ ‫ﺼ‬ ‫ﺤ‬ ‫ﺔ‬ ‫و‬ ‫ﻗ‬ ‫ﻮ‬ ‫ا‬ ‫ﻋ‬ ‫ﺪ‬ ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﺴ‬ ‫ﺘ‬ ‫ﻬ‬ ‫ﻠ‬ ‫ﻚ‬ ‫ﺑ‬ ‫ﺤ‬ ‫ﻤ‬ ‫ﺎ‬ ‫ﻳ‬ ‫ﺔ‬ ‫ا‬ ‫ﻟ‬ ‫ﻌ‬ ‫ﻤ‬ ‫ﻞ‬ ‫ﺑ‬ ‫ﻬ‬ ‫ﻤ‬ ‫ﺎ‬ ‫ا‬ ‫ﻟ‬ ‫ﺠ‬ ‫ﺎ‬ ‫ر‬ ‫ي‬ CADRE RESERVE A L'ADMINISTRATION ‫ﺑ‬ ‫ﺎ‬ ‫ﻻ‬ ‫د‬ ‫ا‬ ‫ر‬ ‫ة‬ ‫ﺧ‬ ‫ﺎ‬ ‫ص‬ ‫إ‬ ‫ﻃ‬ ‫ﺎ‬ ‫ر‬ Date de dépôt : ‫ا‬ ‫ﻹ‬ ‫ﻳ‬ ‫ﺪ‬ ‫ا‬ ‫ع‬ ‫ﺗ‬ ‫ﺎ‬ ‫ر‬ ‫ﻳ‬ ‫ﺦ‬ N° de dépôt : ‫ا‬ ‫ﻹ‬ ‫ﻳ‬ ‫ﺪ‬ ‫ا‬ ‫ع‬ ‫ر‬ ‫ﻗ‬ ‫ﻢ‬ AE-201012-123684 RECEPISSE DE DEPOT DE LA DEMANDE D'INSCRIPTION AU REGISTRE DES AUTO-ENTREPRENEURS ‫ا‬ ‫ﻟ‬ ‫ﺬ‬ ‫ا‬ ‫ﺗ‬ ‫ﻲ‬ ‫ﻟ‬ ‫ﻠ‬ ‫ﻤ‬ ‫ﻘ‬ ‫ﺎ‬ ‫و‬ ‫ل‬ ‫ا‬ ‫ﻟ‬ ‫ﻮ‬ ‫ﻃ‬ ‫ﻨ‬ ‫ﻲ‬ ‫ا‬ ‫ﻟ‬ ‫ﺴ‬ ‫ﺠ‬ ‫ﻞ‬ ‫ﻓ‬ ‫ﻲ‬ ‫ا‬ ‫ﻟ‬ ‫ﺘ‬ ‫ﺴ‬ ‫ﺠ‬ ‫ﻴ‬ ‫ﻞ‬ ‫ﻃ‬ ‫ﻠ‬ ‫ﺐ‬ ‫ﺑ‬ ‫ﺈ‬ ‫ﻳ‬ ‫ﺪ‬ ‫ا‬ ‫ع‬ ‫ا‬ ‫ﻳ‬ ‫ﺼ‬ ‫ﺎ‬ ‫ل‬ Nom et Prénom(s) : ‫و‬ ‫ا‬ ‫ﻟ‬ ‫ﺸ‬ ‫ﺨ‬ ‫ﺼ‬ ‫ﻲ‬ ‫ا‬ ‫ﻟ‬ ‫ﻌ‬ ‫ﺎ‬ ‫ﺋ‬ ‫ﻠ‬ ‫ﻲ‬ ‫ا‬ ‫ﻻ‬ ‫ﺳ‬ ‫ﻢ‬ ‫ﻣ‬ ‫ﺤ‬ ‫ﻤ‬ ‫ﺪ‬ ‫ا‬ ‫ﻟ‬ ‫ﻌ‬ ‫ﻠ‬ ‫ﻮ‬ ‫ي‬ N° de CNIE ou Carte de séjour : ‫ﻟ‬ ‫ﻠ‬ ‫ﺘ‬ ‫ﻌ‬ ‫ﺮ‬ ‫ﻳ‬ ‫ﻒ‬ ‫ا‬ ‫ﻟ‬ ‫ﻮ‬ ‫ﻃ‬ ‫ﻨ‬ ‫ﻴ‬ ‫ﺔ‬ ‫ا‬ ‫ﻟ‬ ‫ﺒ‬ ‫ﻄ‬ ‫ﺎ‬ ‫ﻗ‬ ‫ﺔ‬ ‫ر‬ ‫ﻗ‬ ‫ﻢ‬ ‫ا‬ ‫ﻻ‬ ‫ﻗ‬ ‫ﺎ‬ ‫ﻣ‬ ‫ﺔ‬ ‫ﺑ‬ ‫ﻄ‬ ‫ﺎ‬ ‫ﻗ‬ ‫ﺔ‬ ‫أ‬ ‫و‬ ‫ا‬ ‫ﻻ‬ ‫ﻟ‬ ‫ﻜ‬ ‫ﺘ‬ ‫ﺮ‬ ‫و‬ ‫ﻧ‬ ‫ﻴ‬ ‫ﺔ‬ X295041 Date de dépôt : ‫ا‬ ‫ﻹ‬ ‫ﻳ‬ ‫ﺪ‬ ‫ا‬ ‫ع‬ ‫ﺗ‬ ‫ﺎ‬ ‫ر‬ ‫ﻳ‬ ‫ﺦ‬ N° de dépôt : ‫ا‬ ‫ﻹ‬ ‫ﻳ‬ ‫ﺪ‬ ‫ا‬ ‫ع‬ ‫ر‬ ‫ﻗ‬ ‫ﻢ‬ AE-201012-123684 Document généré le 20-10-2020 19:10 Page-3/3

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  • 1. DEMANDE D'INSCRIPTION N° DU DOSSIER ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﻠ‬ ‫ﻒ‬ ‫ر‬ ‫ﻗ‬ ‫ﻢ‬ AE-201012-123684 ‫ا‬ ‫ﻟ‬ ‫ﺘ‬ ‫ﺴ‬ ‫ﺠ‬ ‫ﻴ‬ ‫ﻞ‬ ‫ا‬ ‫ﺳ‬ ‫ﺘ‬ ‫ﻤ‬ ‫ﺎ‬ ‫ر‬ ‫ة‬ PARTIE A — RENSEIGNEMENTS SUR LE DEMANDEUR ‫ا‬ ‫ﻟ‬ ‫ﻄ‬ ‫ﻠ‬ ‫ﺐ‬ ‫ﺻ‬ ‫ﺎ‬ ‫ﺣ‬ ‫ﺐ‬ ‫ﺣ‬ ‫ﻮ‬ ‫ل‬ ‫ﻣ‬ ‫ﻌ‬ ‫ﻠ‬ ‫ﻮ‬ ‫ﻣ‬ ‫ﺎ‬ ‫ت‬ — ‫أ‬ ‫ا‬ ‫ﻟ‬ ‫ﺠ‬ ‫ﺰ‬ ‫ء‬ A1 — IDENTITÉ DU DEMANDEUR ‫ا‬ ‫ﻟ‬ ‫ﻄ‬ ‫ﻠ‬ ‫ﺐ‬ ‫ﺻ‬ ‫ﺎ‬ ‫ﺣ‬ ‫ﺐ‬ ‫ﻫ‬ ‫ﻮ‬ ‫ﻳ‬ ‫ﺔ‬ — 1‫أ‬ Prénom(s) ‫ﻣ‬ ‫ﺤ‬ ‫ﻤ‬ ‫ﺪ‬ ‫ا‬ ‫ﻟ‬ ‫ﺸ‬ ‫ﺨ‬ ‫ﺼ‬ ‫ﻲ‬ ‫ا‬ ‫ﻻ‬ ‫ﺳ‬ ‫ﻢ‬ ‫ﻣ‬ ‫ﺤ‬ ‫ﻤ‬ ‫ﺪ‬ Nom ‫ا‬ ‫ﻟ‬ ‫ﻌ‬ ‫ﻠ‬ ‫ﻮ‬ ‫ي‬ ‫ا‬ ‫ﻟ‬ ‫ﻌ‬ ‫ﺎ‬ ‫ﺋ‬ ‫ﻠ‬ ‫ﻲ‬ ‫ا‬ ‫ﻻ‬ ‫ﺳ‬ ‫ﻢ‬ ‫ا‬ ‫ﻟ‬ ‫ﻌ‬ ‫ﻠ‬ ‫ﻮ‬ ‫ي‬ ‫ا‬ ‫ﻟ‬ ‫ﻨ‬ ‫ﻘ‬ ‫ﺎ‬ ‫ل‬ ‫ا‬ ‫ﻟ‬ ‫ﻬ‬ ‫ﺎ‬ ‫ﺗ‬ ‫ﻒ‬ Tél Mobile 0616-77-35-96 ‫ا‬ ‫ﻟ‬ ‫ﺜ‬ ‫ﺎ‬ ‫ﺑ‬ ‫ﺖ‬ ‫ا‬ ‫ﻟ‬ ‫ﻬ‬ ‫ﺎ‬ ‫ﺗ‬ ‫ﻒ‬ Tél Fixe E-mail ‫ا‬ ‫ﻹ‬ ‫ﻟ‬ ‫ﻜ‬ ‫ﺘ‬ ‫ﺮ‬ ‫و‬ ‫ﻧ‬ ‫ﻲ‬ ‫ا‬ ‫ﻟ‬ ‫ﺒ‬ ‫ﺮ‬ ‫ﻳ‬ ‫ﺪ‬ simolmnawar8@gmail.com ‫ا‬ ‫ﻟ‬ ‫ﺠ‬ ‫ﻨ‬ ‫ﺲ‬ Sexe ‫ذ‬ ‫ﻛ‬ ‫ﺮ‬ ‫ا‬ ‫ﻟ‬ ‫ﺠ‬ ‫ﻨ‬ ‫ﺴ‬ ‫ﻴ‬ ‫ﺔ‬ Nationalité Maroc Date et lieu de naissance ‫ا‬ ‫ﻻ‬ ‫ز‬ ‫د‬ ‫ﻳ‬ ‫ﺎ‬ ‫د‬ ‫و‬ ‫ﻣ‬ ‫ﻜ‬ ‫ﺎ‬ ‫ن‬ ‫ﺗ‬ ‫ﺎ‬ ‫ر‬ ‫ﻳ‬ ‫ﺦ‬ 15-05-1987 ‫ا‬ ‫ﻟ‬ ‫ﺨ‬ ‫ﻤ‬ ‫ﺴ‬ ‫ﺎ‬ ‫ت‬ ‫ا‬ ‫ﻹ‬ ‫ﻟ‬ ‫ﻜ‬ ‫ﺘ‬ ‫ﺮ‬ ‫و‬ ‫ﻧ‬ ‫ﻴ‬ ‫ﺔ‬ ‫ﻟ‬ ‫ﻠ‬ ‫ﺘ‬ ‫ﻌ‬ ‫ﺮ‬ ‫ﻳ‬ ‫ﻒ‬ ‫ا‬ ‫ﻟ‬ ‫ﻮ‬ ‫ﻃ‬ ‫ﻨ‬ ‫ﻴ‬ ‫ﺔ‬ ‫ا‬ ‫ﻟ‬ ‫ﺒ‬ ‫ﻄ‬ ‫ﺎ‬ ‫ﻗ‬ ‫ﺔ‬ ‫ر‬ ‫ﻗ‬ ‫ﻢ‬ N° de CNIE X295041 ‫ا‬ ‫ﻹ‬ ‫ﻗ‬ ‫ﺎ‬ ‫ﻣ‬ ‫ﺔ‬ ‫ﺑ‬ ‫ﻄ‬ ‫ﺎ‬ ‫ﻗ‬ ‫ﺔ‬ ‫ر‬ ‫ﻗ‬ ‫ﻢ‬ N° Carte de séjour ‫ﻓ‬ ‫ﻲ‬ ‫ﺳ‬ ‫ﻠ‬ ‫ﻤ‬ ‫ﺖ‬ Délivrée le ‫ﻏ‬ ‫ﺎ‬ ‫ﻳ‬ ‫ﺔ‬ ‫إ‬ ‫ﻟ‬ ‫ﻰ‬ ‫ﺻ‬ ‫ﺎ‬ ‫ﻟ‬ ‫ﺤ‬ ‫ﺔ‬ Valide jusqu'au 29-10-2027 A2 — ADRESSE DE LA RÉSIDENCE PRINCIPALE DU DEMANDEUR ‫ا‬ ‫ﻟ‬ ‫ﻄ‬ ‫ﻠ‬ ‫ﺐ‬ ‫ﻟ‬ ‫ﺼ‬ ‫ﺎ‬ ‫ﺣ‬ ‫ﺐ‬ ‫ا‬ ‫ﻟ‬ ‫ﺮ‬ ‫ﺋ‬ ‫ﻴ‬ ‫ﺴ‬ ‫ﻲ‬ ‫ا‬ ‫ﻟ‬ ‫ﺴ‬ ‫ﻜ‬ ‫ﻦ‬ ‫ﻋ‬ ‫ﻨ‬ ‫ﻮ‬ ‫ا‬ ‫ن‬ — 2‫أ‬ Adresse de la résidence principale ‫ا‬ ‫ﻟ‬ ‫ﺮ‬ ‫ﺋ‬ ‫ﻴ‬ ‫ﺴ‬ ‫ﻲ‬ ‫ا‬ ‫ﻟ‬ ‫ﺴ‬ ‫ﻜ‬ ‫ﻦ‬ ‫ﻋ‬ ‫ﻨ‬ ‫ﻮ‬ ‫ا‬ ‫ن‬ 5 ‫ا‬ ‫ﻟ‬ ‫ﻘ‬ ‫ﻨ‬ ‫ﻴ‬ ‫ﻄ‬ ‫ﺮ‬ ‫ة‬ ‫ا‬ ‫ﻟ‬ ‫ﺨ‬ ‫ﻄ‬ ‫ﺎ‬ ‫ﺑ‬ ‫ﻲ‬ ‫ﻋ‬ ‫ﻤ‬ ‫ﺮ‬ ‫إ‬ ‫ﻗ‬ ‫ﺎ‬ ‫ﻣ‬ ‫ﺔ‬ 1 ‫ا‬ ‫ﻟ‬ ‫ﺸ‬ ‫ﻘ‬ ‫ﺔ‬ ‫إ‬ ‫ﺷ‬ ‫ﺒ‬ ‫ﻴ‬ ‫ﻠ‬ ‫ﻴ‬ ‫ﺔ‬ ‫ز‬ ‫ﻧ‬ ‫ﻘ‬ ‫ﺔ‬ ‫ا‬ ‫ﻟ‬ ‫ﺒ‬ ‫ﺮ‬ ‫ﻳ‬ ‫ﺪ‬ ‫ي‬ ‫ا‬ ‫ﻟ‬ ‫ﺮ‬ ‫ﻣ‬ ‫ﺰ‬ Code postal 14020 Commune/Ville ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﺪ‬ ‫ﻳ‬ ‫ﻨ‬ ‫ﺔ‬ / ‫ا‬ ‫ﻟ‬ ‫ﺠ‬ ‫ﻤ‬ ‫ﺎ‬ ‫ﻋ‬ ‫ﺔ‬ KENITRA Province/Préfecture ‫ا‬ ‫ﻹ‬ ‫ﻗ‬ ‫ﻠ‬ ‫ﻴ‬ ‫ﻢ‬ / ‫ا‬ ‫ﻟ‬ ‫ﻌ‬ ‫ﻤ‬ ‫ﺎ‬ ‫ﻟ‬ ‫ﺔ‬ KENITRA Région ‫ا‬ ‫ﻟ‬ ‫ﺠ‬ ‫ﻬ‬ ‫ﺔ‬ Rabat-Salé-Kénitra Document généré le 20-10-2020 19:10 Page-1/3
  • 2. PARTIE B — RENSEIGNEMENTS SUR L'ACTIVITE ‫ا‬ ‫ﻟ‬ ‫ﻨ‬ ‫ﺸ‬ ‫ﺎ‬ ‫ط‬ ‫ﺣ‬ ‫ﻮ‬ ‫ل‬ ‫ﻣ‬ ‫ﻌ‬ ‫ﻠ‬ ‫ﻮ‬ ‫ﻣ‬ ‫ﺎ‬ ‫ت‬ — ‫ب‬ ‫ا‬ ‫ﻟ‬ ‫ﺠ‬ ‫ﺰ‬ ‫ء‬ B1 — ACTIVITÉ EXERCÉE (1) (1) ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﺰ‬ ‫ا‬ ‫و‬ ‫ل‬ ‫ا‬ ‫ﻟ‬ ‫ﻨ‬ ‫ﺸ‬ ‫ﺎ‬ ‫ط‬ — 1‫ب‬ Secteur d'activité ‫ا‬ ‫ﻟ‬ ‫ﻨ‬ ‫ﺸ‬ ‫ﺎ‬ ‫ط‬ ‫ﻗ‬ ‫ﻄ‬ ‫ﺎ‬ ‫ع‬ SERVICES Branche d'activité ‫ا‬ ‫ﻟ‬ ‫ﻨ‬ ‫ﺸ‬ ‫ﺎ‬ ‫ط‬ ‫ﻓ‬ ‫ﺮ‬ ‫ع‬ PRESTATIONS DE SERVICES Activité ‫ا‬ ‫ﻟ‬ ‫ﻨ‬ ‫ﺸ‬ ‫ﺎ‬ ‫ط‬ Musicien interprète Lieu d'exercice ‫ا‬ ‫ﻟ‬ ‫ﻨ‬ ‫ﺸ‬ ‫ﺎ‬ ‫ط‬ ‫ﻣ‬ ‫ﺰ‬ ‫ا‬ ‫و‬ ‫ﻟ‬ ‫ﺔ‬ ‫ﻣ‬ ‫ﻘ‬ ‫ﺮ‬ Autre Périodicité de l'activité ‫ا‬ ‫ﻟ‬ ‫ﻨ‬ ‫ﺸ‬ ‫ﺎ‬ ‫ط‬ ‫ﻣ‬ ‫ﺰ‬ ‫ا‬ ‫و‬ ‫ﻟ‬ ‫ﺔ‬ ‫د‬ ‫و‬ ‫ر‬ ‫ﻳ‬ ‫ﺔ‬ [X] Permanente [ ] Saisonnière N° d'identification fiscale (si existant) ‫ﺗ‬ ‫ﻮ‬ ‫ا‬ ‫ﺟ‬ ‫ﺪ‬ ‫ه‬ ‫ﺣ‬ ‫ﺎ‬ ‫ﻟ‬ ‫ﺔ‬ ‫ﻓ‬ ‫ﻲ‬ - ‫ا‬ ‫ﻟ‬ ‫ﻀ‬ ‫ﺮ‬ ‫ﻳ‬ ‫ﺒ‬ ‫ﻲ‬ ‫ا‬ ‫ﻟ‬ ‫ﺘ‬ ‫ﻌ‬ ‫ﺮ‬ ‫ﻳ‬ ‫ﻒ‬ ‫ر‬ ‫ﻗ‬ ‫ﻢ‬ Numéro d'identification à la taxe professionnelle (si existant) ‫ﺗ‬ ‫ﻮ‬ ‫ا‬ ‫ﺟ‬ ‫ﺪ‬ ‫ه‬ ‫ﺣ‬ ‫ﺎ‬ ‫ﻟ‬ ‫ﺔ‬ ‫ﻓ‬ ‫ﻲ‬ - ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﻬ‬ ‫ﻨ‬ ‫ﻲ‬ ‫ﺑ‬ ‫ﺎ‬ ‫ﻟ‬ ‫ﺮ‬ ‫ﺳ‬ ‫ﻢ‬ ‫ا‬ ‫ﻟ‬ ‫ﺘ‬ ‫ﻌ‬ ‫ﺮ‬ ‫ﻳ‬ ‫ﻒ‬ ‫ر‬ ‫ﻗ‬ ‫ﻢ‬ B2 — DOMICILE FISCAL ‫ا‬ ‫ﻟ‬ ‫ﻀ‬ ‫ﺮ‬ ‫ﻳ‬ ‫ﺒ‬ ‫ﻲ‬ ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﻮ‬ ‫ﻃ‬ ‫ﻦ‬ ‫ﻣ‬ ‫ﻘ‬ ‫ﺮ‬ — 2‫ب‬ Adresse du lieu de travail (si existant) ‫ﺗ‬ ‫ﻮ‬ ‫ا‬ ‫ﺟ‬ ‫ﺪ‬ ‫ه‬ ‫ﺣ‬ ‫ﺎ‬ ‫ﻟ‬ ‫ﺔ‬ ‫ﻓ‬ ‫ﻲ‬ - ‫ا‬ ‫ﻟ‬ ‫ﻌ‬ ‫ﻤ‬ ‫ﻞ‬ ‫ﻣ‬ ‫ﻘ‬ ‫ﺮ‬ ‫ﻋ‬ ‫ﻨ‬ ‫ﻮ‬ ‫ا‬ ‫ن‬ 5 ‫ا‬ ‫ﻟ‬ ‫ﻘ‬ ‫ﻨ‬ ‫ﻴ‬ ‫ﻄ‬ ‫ﺮ‬ ‫ة‬ ‫ا‬ ‫ﻟ‬ ‫ﺨ‬ ‫ﻄ‬ ‫ﺎ‬ ‫ﺑ‬ ‫ﻲ‬ ‫ﻋ‬ ‫ﻤ‬ ‫ﺮ‬ ‫إ‬ ‫ﻗ‬ ‫ﺎ‬ ‫ﻣ‬ ‫ﺔ‬ 1 ‫ا‬ ‫ﻟ‬ ‫ﺸ‬ ‫ﻘ‬ ‫ﺔ‬ ‫إ‬ ‫ﺷ‬ ‫ﺒ‬ ‫ﻴ‬ ‫ﻠ‬ ‫ﻴ‬ ‫ﺔ‬ ‫ز‬ ‫ﻧ‬ ‫ﻘ‬ ‫ﺔ‬ ‫ا‬ ‫ﻟ‬ ‫ﺒ‬ ‫ﺮ‬ ‫ﻳ‬ ‫ﺪ‬ ‫ي‬ ‫ا‬ ‫ﻟ‬ ‫ﺮ‬ ‫ﻣ‬ ‫ﺰ‬ Code postal 14020 Commune/Ville ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﺪ‬ ‫ﻳ‬ ‫ﻨ‬ ‫ﺔ‬ / ‫ا‬ ‫ﻟ‬ ‫ﺠ‬ ‫ﻤ‬ ‫ﺎ‬ ‫ﻋ‬ ‫ﺔ‬ KENITRA Province/Préfecture ‫ا‬ ‫ﻹ‬ ‫ﻗ‬ ‫ﻠ‬ ‫ﻴ‬ ‫ﻢ‬ / ‫ا‬ ‫ﻟ‬ ‫ﻌ‬ ‫ﻤ‬ ‫ﺎ‬ ‫ﻟ‬ ‫ﺔ‬ KENITRA Région ‫ا‬ ‫ﻟ‬ ‫ﺠ‬ ‫ﻬ‬ ‫ﺔ‬ Rabat-Salé-Kénitra Document généré le 20-10-2020 19:10 Page-2/3
  • 3. Le soussigné, certifie exactes les indications consignées sur la présente demande. ‫ا‬ ‫ﻟ‬ ‫ﻄ‬ ‫ﻠ‬ ‫ﺐ‬ ‫ﻫ‬ ‫ﺬ‬ ‫ا‬ ‫ﻓ‬ ‫ﻲ‬ ‫ا‬ ‫ﻟ‬ ‫ﻮ‬ ‫ا‬ ‫ر‬ ‫د‬ ‫ة‬ ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﻌ‬ ‫ﻠ‬ ‫ﻮ‬ ‫ﻣ‬ ‫ﺎ‬ ‫ت‬ ‫ﺑ‬ ‫ﺼ‬ ‫ﺤ‬ ‫ﺔ‬ ‫أ‬ ‫ﻗ‬ ‫ﺮ‬ ، ‫أ‬ ‫ﺳ‬ ‫ﻔ‬ ‫ﻠ‬ ‫ﻪ‬ ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﻮ‬ ‫ﻗ‬ ‫ﻊ‬ ‫أ‬ ‫ﻧ‬ ‫ﺎ‬ En date du : 20-10-2020 ‫ﺑ‬ ‫ﺘ‬ ‫ﺎ‬ ‫ر‬ ‫ﻳ‬ ‫ﺦ‬ A KENITRA ‫ﻓ‬ ‫ﻲ‬ Article 7 de la Loi n° 114-13 relative au statut de l'auto- entrepreneur L'auto-entrepreneur doit remplir les conditions requises pour l'exercice de ses activités conformément aux dispositions législatives et réglementaires en vigueur. En outre, il est soumis dans l'exercice desdites activités aux mesures de protection du consommateur, aux règles d'hygiène et de sécurité publique conformément aux textes législatifs et réglementaires en vigueur. SIGNATURE ‫ا‬ ‫ﻟ‬ ‫ﺬ‬ ‫ا‬ ‫ﺗ‬ ‫ﻲ‬ ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﻘ‬ ‫ﺎ‬ ‫و‬ ‫ل‬ ‫ﺑ‬ ‫ﻨ‬ ‫ﻈ‬ ‫ﺎ‬ ‫م‬ ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﺘ‬ ‫ﻌ‬ ‫ﻠ‬ ‫ﻖ‬ 114.13 ‫ر‬ ‫ﻗ‬ ‫ﻢ‬ ‫ﻗ‬ ‫ﺎ‬ ‫ﻧ‬ ‫ﻮ‬ ‫ن‬ ‫ﻣ‬ ‫ﻦ‬ 7 ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﺎ‬ ‫د‬ ‫ة‬ ، ‫ﻧ‬ ‫ﺸ‬ ‫ﺎ‬ ‫ﻃ‬ ‫ﻪ‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﻤ‬ ‫ﺎ‬ ‫ر‬ ‫ﺳ‬ ‫ﺔ‬ ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﻄ‬ ‫ﻠ‬ ‫ﻮ‬ ‫ﺑ‬ ‫ﺔ‬ ‫ا‬ ‫ﻟ‬ ‫ﺸ‬ ‫ﺮ‬ ‫و‬ ‫ط‬ ‫ﻋ‬ ‫ﻠ‬ ‫ﻰ‬ ‫ﻳ‬ ‫ﺘ‬ ‫ﻮ‬ ‫ﻓ‬ ‫ﺮ‬ ‫أ‬ ‫ن‬ ‫ا‬ ‫ﻟ‬ ‫ﺬ‬ ‫ا‬ ‫ﺗ‬ ‫ﻲ‬ ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﻘ‬ ‫ﺎ‬ ‫و‬ ‫ل‬ ‫ﻋ‬ ‫ﻠ‬ ‫ﻰ‬ ‫ﻳ‬ ‫ﺠ‬ ‫ﺐ‬ ‫ا‬ ‫ﻟ‬ ‫ﻌ‬ ‫ﻤ‬ ‫ﻞ‬ ‫ﺑ‬ ‫ﻬ‬ ‫ﺎ‬ ‫ا‬ ‫ﻟ‬ ‫ﺠ‬ ‫ﺎ‬ ‫ر‬ ‫ي‬ ‫و‬ ‫ا‬ ‫ﻟ‬ ‫ﺘ‬ ‫ﻨ‬ ‫ﻈ‬ ‫ﻴ‬ ‫ﻤ‬ ‫ﻴ‬ ‫ﺔ‬ ‫ا‬ ‫ﻟ‬ ‫ﺘ‬ ‫ﺸ‬ ‫ﺮ‬ ‫ﻳ‬ ‫ﻌ‬ ‫ﻴ‬ ‫ﺔ‬ ‫ﻟ‬ ‫ﻠ‬ ‫ﻨ‬ ‫ﺼ‬ ‫ﻮ‬ ‫ص‬ ‫ﻃ‬ ‫ﺒ‬ ‫ﻘ‬ ‫ﺎ‬ ‫ا‬ ‫ﻟ‬ ‫ﺨ‬ ‫ﺎ‬ ‫ﺻ‬ ‫ﺔ‬ ‫ﺑ‬ ‫ﺎ‬ ‫ﻟ‬ ‫ﺘ‬ ‫ﺪ‬ ‫ا‬ ‫ﺑ‬ ‫ﻴ‬ ‫ﺮ‬ ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﺬ‬ ‫ﻛ‬ ‫ﻮ‬ ‫ر‬ ‫ة‬ ‫ﻟ‬ ‫ﻸ‬ ‫ﻧ‬ ‫ﺸ‬ ‫ﻄ‬ ‫ﺔ‬ ‫ﻣ‬ ‫ﺰ‬ ‫ا‬ ‫و‬ ‫ﻟ‬ ‫ﺘ‬ ‫ﻪ‬ ‫ﻓ‬ ‫ﻲ‬ ‫ﻳ‬ ‫ﺘ‬ ‫ﻘ‬ ‫ﻴ‬ ‫ﺪ‬ ‫أ‬ ‫ن‬ ‫أ‬ ‫ﻳ‬ ‫ﻀ‬ ‫ﺎ‬ ‫ﻋ‬ ‫ﻠ‬ ‫ﻴ‬ ‫ﻪ‬ ‫و‬ ‫ﻳ‬ ‫ﺠ‬ ‫ﺐ‬ ‫و‬ ‫ا‬ ‫ﻟ‬ ‫ﺘ‬ ‫ﻨ‬ ‫ﻈ‬ ‫ﻴ‬ ‫ﻢ‬ ‫ﻟ‬ ‫ﻠ‬ ‫ﺘ‬ ‫ﺸ‬ ‫ﺮ‬ ‫ﻳ‬ ‫ﻊ‬ ‫ﻃ‬ ‫ﺒ‬ ‫ﻘ‬ ‫ﺎ‬ ، ‫ا‬ ‫ﻟ‬ ‫ﻌ‬ ‫ﺎ‬ ‫ﻣ‬ ‫ﺔ‬ ‫و‬ ‫ا‬ ‫ﻟ‬ ‫ﺴ‬ ‫ﻼ‬ ‫ﻣ‬ ‫ﺔ‬ ‫ا‬ ‫ﻟ‬ ‫ﺼ‬ ‫ﺤ‬ ‫ﺔ‬ ‫و‬ ‫ﻗ‬ ‫ﻮ‬ ‫ا‬ ‫ﻋ‬ ‫ﺪ‬ ‫ا‬ ‫ﻟ‬ ‫ﻤ‬ ‫ﺴ‬ ‫ﺘ‬ ‫ﻬ‬ ‫ﻠ‬ ‫ﻚ‬ ‫ﺑ‬ ‫ﺤ‬ ‫ﻤ‬ ‫ﺎ‬ ‫ﻳ‬ ‫ﺔ‬ ‫ا‬ ‫ﻟ‬ ‫ﻌ‬ ‫ﻤ‬ ‫ﻞ‬ ‫ﺑ‬ ‫ﻬ‬ ‫ﻤ‬ ‫ﺎ‬ ‫ا‬ ‫ﻟ‬ ‫ﺠ‬ ‫ﺎ‬ ‫ر‬ ‫ي‬ CADRE RESERVE A L'ADMINISTRATION ‫ﺑ‬ ‫ﺎ‬ ‫ﻻ‬ ‫د‬ ‫ا‬ ‫ر‬ ‫ة‬ ‫ﺧ‬ ‫ﺎ‬ ‫ص‬ ‫إ‬ ‫ﻃ‬ ‫ﺎ‬ ‫ر‬ Date de dépôt : ‫ا‬ ‫ﻹ‬ ‫ﻳ‬ ‫ﺪ‬ ‫ا‬ ‫ع‬ ‫ﺗ‬ ‫ﺎ‬ ‫ر‬ ‫ﻳ‬ ‫ﺦ‬ N° de dépôt : ‫ا‬ ‫ﻹ‬ ‫ﻳ‬ ‫ﺪ‬ ‫ا‬ ‫ع‬ ‫ر‬ ‫ﻗ‬ ‫ﻢ‬ AE-201012-123684 RECEPISSE DE DEPOT DE LA DEMANDE D'INSCRIPTION AU REGISTRE DES AUTO-ENTREPRENEURS ‫ا‬ ‫ﻟ‬ ‫ﺬ‬ ‫ا‬ ‫ﺗ‬ ‫ﻲ‬ ‫ﻟ‬ ‫ﻠ‬ ‫ﻤ‬ ‫ﻘ‬ ‫ﺎ‬ ‫و‬ ‫ل‬ ‫ا‬ ‫ﻟ‬ ‫ﻮ‬ ‫ﻃ‬ ‫ﻨ‬ ‫ﻲ‬ ‫ا‬ ‫ﻟ‬ ‫ﺴ‬ ‫ﺠ‬ ‫ﻞ‬ ‫ﻓ‬ ‫ﻲ‬ ‫ا‬ ‫ﻟ‬ ‫ﺘ‬ ‫ﺴ‬ ‫ﺠ‬ ‫ﻴ‬ ‫ﻞ‬ ‫ﻃ‬ ‫ﻠ‬ ‫ﺐ‬ ‫ﺑ‬ ‫ﺈ‬ ‫ﻳ‬ ‫ﺪ‬ ‫ا‬ ‫ع‬ ‫ا‬ ‫ﻳ‬ ‫ﺼ‬ ‫ﺎ‬ ‫ل‬ Nom et Prénom(s) : ‫و‬ ‫ا‬ ‫ﻟ‬ ‫ﺸ‬ ‫ﺨ‬ ‫ﺼ‬ ‫ﻲ‬ ‫ا‬ ‫ﻟ‬ ‫ﻌ‬ ‫ﺎ‬ ‫ﺋ‬ ‫ﻠ‬ ‫ﻲ‬ ‫ا‬ ‫ﻻ‬ ‫ﺳ‬ ‫ﻢ‬ ‫ﻣ‬ ‫ﺤ‬ ‫ﻤ‬ ‫ﺪ‬ ‫ا‬ ‫ﻟ‬ ‫ﻌ‬ ‫ﻠ‬ ‫ﻮ‬ ‫ي‬ N° de CNIE ou Carte de séjour : ‫ﻟ‬ ‫ﻠ‬ ‫ﺘ‬ ‫ﻌ‬ ‫ﺮ‬ ‫ﻳ‬ ‫ﻒ‬ ‫ا‬ ‫ﻟ‬ ‫ﻮ‬ ‫ﻃ‬ ‫ﻨ‬ ‫ﻴ‬ ‫ﺔ‬ ‫ا‬ ‫ﻟ‬ ‫ﺒ‬ ‫ﻄ‬ ‫ﺎ‬ ‫ﻗ‬ ‫ﺔ‬ ‫ر‬ ‫ﻗ‬ ‫ﻢ‬ ‫ا‬ ‫ﻻ‬ ‫ﻗ‬ ‫ﺎ‬ ‫ﻣ‬ ‫ﺔ‬ ‫ﺑ‬ ‫ﻄ‬ ‫ﺎ‬ ‫ﻗ‬ ‫ﺔ‬ ‫أ‬ ‫و‬ ‫ا‬ ‫ﻻ‬ ‫ﻟ‬ ‫ﻜ‬ ‫ﺘ‬ ‫ﺮ‬ ‫و‬ ‫ﻧ‬ ‫ﻴ‬ ‫ﺔ‬ X295041 Date de dépôt : ‫ا‬ ‫ﻹ‬ ‫ﻳ‬ ‫ﺪ‬ ‫ا‬ ‫ع‬ ‫ﺗ‬ ‫ﺎ‬ ‫ر‬ ‫ﻳ‬ ‫ﺦ‬ N° de dépôt : ‫ا‬ ‫ﻹ‬ ‫ﻳ‬ ‫ﺪ‬ ‫ا‬ ‫ع‬ ‫ر‬ ‫ﻗ‬ ‫ﻢ‬ AE-201012-123684 Document généré le 20-10-2020 19:10 Page-3/3