[Translator’s notes appear in square brackets]

[Personal information has been redacted.]


Islamic Republic of Iran

Form A (52-4) 32 National Administration and Employment Organization

1- Ministry of Education

2- Employment number: [redacted]

3- Name: Mr. Rajab-Ali

4- Surname: Haeri

5- Father’s name: Mohammad Hashem

6- Identification number and place of issue: Birth certificate Number: [redacted], Village -----, District -----, County Fasa, Province/Governor: Fars

7- Place of birth: [redacted]

8- Date of birth: Day 21, Month 4, Year [redacted] [12 July [redacted]]

9- Highest qualification and course of study: Associated Diploma, Language Literature

10- Position: High School Teacher

11- Field:  Educational and Cultural, High School Teacher, Classification: 3

12- Group: 7

13- Level: 9

14- Organization: Department of Education, Area 1, Shiraz

15- Place of employment: Village -----, District -----, County: Shiraz, Province: Fars

16- Licence -----, Date -----, Number -----

17- Type of Order: Expulsion from employment

18 – Details of the verdict: In accordance with Section 14 of the Employment Act, as you are not an adherent of any of the officially recognized religions of the country, your employment is terminated effective as of the date of this Order. In addition, Order number 18436 [date] 27 Khordad 1359 [17 June 1980] is amended by this Order. Soltani Middle School

19- Salary, benefits and bonuses

A- Salary, Level, Group ----- rial

B- Difference in salary adjustment ----- rial

C- Total of ongoing benefits and one-time benefits, bonuses ----- rial

D- Difference in bonuses adjustment ----- rial

E- Bonus for working abroad ----- rial

F- Bonus for inclement weather ----- rial

G- Bonus for deprivation of life privilages ----- rial

H- Extras for place of employment ----- rial

I- Other benefits ----- rial

Total ----- rial

20- Salaries, benefits and bonuses detailed in this Order in the sum of  ----- rial after deduction from  ----- section ----- permitted by law is payable from -----

21- Date of enforcement of the Order: 27 Khordad 1359 [17 June 1980]

22- Date of Order and Number: Date: 15 Tir 1359 [6 July 1980], Number 1083

23- Name and surname of Supervisor: Abol-Ahrari

Title: General Manager of Education, Islamic Revolution of Iran: – Fars

Signature: [Signature]

14 Tir 1359 [5 July 1980]

Copy: Employee