Ilanngussaq:

KALAALLIT NUNAANNI NANNUTAQ:
KALAALLIT NUNAANNI PISSATAQ:

(NAQINNERIT ANGISUUT ATORNEQASSAPPUT)

ATEQ:                                                                                             CPR.NR.:

NUNAQARFIK/ILLOQARFIK:

ULLOQ PISAQARFIK:

PISAQARFIK Imaluunniit:

SUMIIFFIK: allorn. sanim. avann._________ gr. min.                        allorn. kimmukaartut _________ gr. min.

SUIAASSUSIA:                              ANGUTIVIAQ:                                     ARNAVIAQ: Arnaviaappat, piaraqarpa ?     Naamik          Aap                 Utoqq.:______________

UTOQQAASSUSIA: 1-mik ukiulik         2-nik ukiulik ,                                     inuusukaaq            inerluarsimasoq          qanganisaq

IMMERSUISUP AQQA: ULLOQ:____________

NANOQ NALUNAAQUTAQARPA ? AAP:             Nr.______        NAAMIK: RADIOMIK AALLAKAATITSISSUTEQARPA ? AAP:                  Nr._______                                                                                      NAAMIK: Taamaattoqarpat nalunaarusiamut ilanngullugu tunniunneqassaaq.

IMMERSUISUP AQQA                                                                        ULLOQ:

ALLANIK PINIAQATAASOQARPAT AQQI CPR.NORMUILU:

Pisaqareernermi immersugassaq immersorlugu kommunip allaffianut tunniunneqassaaq. Immersugassat tiguneqartut kommunip Aalisarnermut, Piniarnermut Nunalerinermullu Pisortaqarfimmut nassiutissavai pisat pillugit nalunaarusiap tiguneraniit qaammat ataaseq qaangiutsinnagu.