N.

BOLETIM DE INSCRIO ARBITRO 2013

N. FOTOS
2

NOME COMPLETO: ________________________________________________________________________________

____________________________________________________________________________________________________
MORADA: __________________________________________________________________________________________
CDIGO POSTAL: ______________________________LOCALIDADE: ______________________________________
TELEFONE: _____________________ TELEMVEL: ______________________ NIF _________________________
NIB: ________________________________________________________________________________________________
E-MAIL: _____________________________ ______________________________________________________________
FILIAO: PAI ______________________________________________________________________________________
ME _______________________________________________________________________________________
NATURAL DA FREGUESIA DE: ________________________ CONCELHO DE: ______________________________
NASCIDO A: _____/ _____ / _____ N. B.I. ______________________

ARQUIVO DE: _________________________

ESTADO CIVIL: ______________________________ PROFISSO: __________________________________________

HABILITAES LITERRIAS: _______________________________________________________________________
____________________________________________________________________________________________________
____________________________________________________________________________________________________

REGISTO DE CURSOS

curso

DATA

/
/
/
/
/

O ARBITRO
________________________

curso

/
/
/
/
/

DATA DE ENTRADA
_____/ _____ / _____

DATA

/
/
/
/
/

/
/
/
/
/

A DIRECO DA FPKM
_________________________
(ASSINATURA/CARIMBO)