[Translator’s notes appear in square brackets]

[Personal information has been redacted.]



Islamic Republic of Iran

Decision of the Office of Personnel

Form (52-4) 32-A Department of State for Administrative Affairs and Employment


1- Ministry/ Department of Agriculture and Rural Development

2- Employee number: [redacted]

3- Given Name: Mr Khosrow

4- Surname: Forouzan

5- Name of father: Ebrahim

6- Birth certificate number and place of issuance

  • Birth certificate number: [redacted]
  • Issued in: [redacted]
  • City: [redacted]
  • Province: [redacted]

7- Place of birth: [redacted]

8- Date of birth: Day: 26, Month: Shahrivar, Year: [redacted][17 September]

9- Highest degree and field of study

Highest degree: Third grade middle school

10- Title of Permanent Government Position:  In charge of artificial insemination 463


  • Agriculture, Responsibility: Assistant technician of animal husbandry
  • Group: Two

12- [Employment] Category:  3

13- [Employment] Level: Seven

14- Government Unit: Agriculture Head Office – Mazandaran Province

15- Place of service:

  • Town: Qaemshahr
  • Province/Governorate: Mazandaran

16-Permit: Date: 7 Mordad 1360 [29 July 1981] Number: K/16460

17- Type of Ruling: Termination of Employment

18- Description of Ruling:

Following directive number 630/17664/19378 dated 17 Mordad 1360 [8 August 1981] and in accordance with that administrative order and Clause S of Article 14 of The Public Services Employment Act, you are hereby dismissed from employment. .

19- Salary, benefits and bonuses ………..

20- Salary, benefits and bonuses specified in this ruling amounting to a total of (spelled out) ……….. are payable after deductions ……….

21- Date of the ruling’s execution: 17 Mordad 1360[8 August 1981]

22- Date of issuance and ruling number

  • Date: 25 Mordad 1360 [16 August 1981],
  • Number: 18930/630-[stamp:] 21426

23- Name and surname of the official in charge:

Title of permanent organizational position [of the official in charge]: On behalf of the Minister of the Agriculture and Rural Development

Signature: [illegible]

Copy: Employee