Republika e Kosovs

Republika Kosova Republic of Kosovo

Oda e Mjekve t Kosovs
KOMISIONI QENDROR I ZGJEDHJEVE

FLETAPLIKACION PR KANDIDIM
PR KRYETAR T ODS S MJEKVE T KOSOVS

N pajtim me dispozitat e Nenit 9, paragrafin 2 t Rregullores pr Procedurn e Kandidimit dhe

Mnyrn e Zgjedhjes t Antarve t Organeve t Ods s Mjekve t Kosovs:
Afati i aplikimit sht nga data _______________ deri m________________

Shnimet pr kandidatin (plotsohet nga kandidati):

1. Emri dhe Mbiemri _____ __________________________ 2. Data e lindjes:_______________________
3. Numri personal _______________________________ 4. Numri i licencs____________________
5. Zgjedhur nga Njsia zgjedhore ___________________

Kandidimi mbshtetet nga kta 20 antar t Kuvendit t Ods s Mjekve t Kosovs:

DEKLARAT E MBSHTETSIT T KANDIDATIT: Deklaroj se me vullnetin tim t lir e jap kt
mbshtetje pr kandidim t kandidatit pr Kryetarin e Ods s Mjekve t Kosovs. Po ashtu
konfirmoj nn prgjegjsin time civile dhe penale se t dhnat personale t poshtshnuara jan t
vrteta dhe se me dhnien e mbshtetjes kam hequr dor nga e drejta pr tu zgjedhur n procesin
zgjedhor pr Kryetar t OMK-s. T drejtn pr dhnien e mbshtetjes pr kandidatin nuk do ta
keqprdori duke e dhn mbshtetjen edhe nj kandidati tjetr.
Emri dhe Mbiemri Numri Personal Numri i Licencs Data e nnshkrimit Nnshkrimi
1._______________________ ___________________ _____________ ______________ ______________
2._______________________ ___________________ _____________ ______________ ______________
3._______________________ ___________________ _____________ ______________ ______________
4._______________________ ___________________ _____________ ______________ ______________
5._______________________ ___________________ _____________ ______________ ______________
6._______________________ ___________________ _____________ ______________ ______________
7._______________________ ___________________ _____________ ______________ ______________
8._______________________ ___________________ _____________ ______________ ______________
9._______________________ ___________________ _____________ ______________ ______________
10.______________________ ___________________ _____________ ______________ ______________
11.______________________ ___________________ _____________ ______________ ______________
12.______________________ ___________________ _____________ ______________ ______________
13.______________________ ___________________ _____________ ______________ ______________
14.______________________ ___________________ _____________ ______________ ______________
15._______________________ ___________________ _____________ ______________ ______________
16.______________________ ___________________ _____________ ______________ ______________
17.______________________ ___________________ _____________ ______________ ______________
18.______________________ ___________________ _____________ ______________ ______________
19.______________________ ___________________ _____________ ______________ ______________
20.______________________ ___________________ _____________ ______________ ______________
Kandidatura i dorzohet Komisionit Qendror t Zgjedhjeve
Data dhe Vendi________________________ Nnshkrimi i Kandidatit________________________
Sekretariati i KQZ-s ________________________