![](data:image/png;base64,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)
T.C.
……………….. Valiliği/Kaymakamlığı
SEYAHAT İZİN BELGESİ
Beyan Sahibinin
Adı Soyadı
İmza
Valiliğimizce/Kaymakamlığımızca düzenlenen “Seyahat İzin Belgesi” yukarıda belirtilen
şahıs ve ulaşım aracı için ………………………………………… tarihleri arasında …………………….. gün
süresince geçerlidir. İzin belgesi düzenlenen 65 yaş ve üzeri olanlar ile kronik hastalığı bulunan
vatandaşlarımız, her türü koruyucu tedbirleri alarak, kullanmakta oldukları ilaçları ile maske ve
koruyucu eldivenleri gerektiğinde kullanmak üzere, yanlarında bulundurmaları tavsiye
edilmektedir.
Valiliğimiz/Kaymakamlığımız hayırlı yolculuklar diler.
Tarih
İzin Veren
Valilik/Kaymakamlık
Şuan Bulunduğu/Kaldığı Adres
Gideceği Yerdeki Hane Halkından En Az Birinin
TC Kimlik Numarası, Adı-Soyadı, Cep Telefonu
Seyahat Vasıtası (Uçak, Otobüs, Deniz aracı,
Kendi Vasıtası vb)
Araç Plakası (Özel Taşıt İse) / Seyahat Firması
: ………………………………………………..
: ………………………………………………..
Beraberindekilerin TC No ve İsimleri
: 1) ………………………………………………………………………..
2) ………………………………………………………………………..
3) ………………………………………………………………………..
4) ………………………………………………………………………..
5) ………………………………………………………………………..