BAa HIEM XA. HQI VIET NAMBAa HIEM xA HQI TP. HO CHi MINH

CQNG HOA XA HQI cuD NGHiA Vl¢T NAMDQc l~p - TV do - H~oh phuc

S6: ~~t /QD-BHXH Tp. H6 Chi Minh, ngay 2J thcing02niirn 2013

QUYETD!NHV~ vi~c si'ra dAiquy trioh ti~p oh~n h6 SO' va tni k~t qua

theo CO' ch~ mQt ci'ra cua BHXH TP.HCM

GIAM DOC BAo HIEM xA H(H THANH PHO HO CHi MINHCan Cll Quy~t dinh s6 4857/BHXH-TCCB ngay 21/10/2008 cua T6ng giarn d6c

BHXH Vi~t Narn quy dinh ChllCnang, nhi~rn V\l, quy~n h~n va cO'cau t6 ChllCcua BHXHdia phuang;

Can Cll Quy~t dinh s6 884/QD-BHXH ngay 25/8/2011 cua T6ng giarn d6c BHXHVi~t Narn v~ vi~c ban hanh Quy dinh ti~p nh~n h6 sa va tra k~t qua giai quy~t cac thu !\Ichanh chinh v~ BHXH, BHYT;

Can CllQuy~t dinh s6 777/QD-BHXH ngay 17/5/2010 cua T6ng giarn d6c BHXH Vi~tNam v~ vi~c ban hanh quy dinh v~ h6 sa va quy trinh giai quy~t hUOngcac ch~ d<)BHXH;

Can Cll Quy~t dinh s6 1111/QD-BHXH ngay 25/10/2011 cua T6ng giarn d6cBHXH Vi~t Narn v~ vi~c ban hanh Quy dinh quan ly thu BHXH, BHYT; quan ly s6BHXH,BHYT;

Can Cll Cong van s6 555/BHXH- THU ngay 17/02/20 12 v~ vi~c hu6ng d~n thlJchi~n quy dinh quan ly thu BHXH, BHYT va cap s6 BHXH, the BHYT thea Quy~t dinh s61111/QD-BHXH cua T6ng giarn d6c BHXH Vi~t Narn;

Can Cll Quy~t dinh s6 2103/QD-BHXH ngay 6/6/2012 cua Giam d6c Baa hiern xlih<)iThanh ph6 H6 Chi Minh v~ vi~c ban hanh Quy dinh ti~p nh~n h6 sa va tra k~t quathea cO'ch~ rn<)tcua t~i Baa hi~rn xli h<)iThanh ph6 H6 Chi Minh;

Can Cll Quy~t dinh s6 4294/QD-BHXH ngay 15/10/2012 v~ vi~c di~u chinh Ph~nIV Quy dinh Ti~p nh~n h6 sa va tra k~t qua thea cO' ch~ rn<)t cua t~i Baa hiern xli h<)iThanh ph6 H6 Chi Minh dinh kern Quy€t dinh s6 2103/QD-BHXH ngay 6/6/2012 cuaGiarn d6c Baa hi~rn xli h<)iThanh ph6 H6 Chi Minh;

Can Cll Cong van s6 481/BHXH-CSXH ngay 29/01/2013 cua Baa hiern xli h<)iVi~tNarn v~ vi~c hu6ng d~n thlJc hi~n chinh sach Baa hi~rn xli h<)i;

Xet d~ nghi cua TruOng phong Ch€ d<)Baa hi~rn xii h<)iva TruOng phong T6 ChllC-Can b<),

QUYETD!NH:Di~u 1. Sua d6i Quy trinh ti~p nh~n h6 sa va tra k€t qua t~i Quy trinh s6 35 "Quy

trinh gild quyit chi il(J huu tri", Ph~n III cua Quy€t dinh s6 2103/QD-BHXH ngay6/6/2012 cua Giarn d6c Baa hi~rn xii h<)iThanh ph6 H6 Chi Minh va 11 Phi~u giaa nh~nh6 sa.

1. Sua d6i Quy trinh giai quy~t ch€ d<)huu tri (Dinh kern Ph~ l~c 01);

2. Sua d6i Phi~u giaa nh~n h6 sa: (Dinh kern Ph~ l~c 02)

a) Phi~u giao nh~n h6 sa 601;

b) Phi~u giao nh~n h6 sa 602;

c) Phi~u giao nh~n h6 sa 604;

d) Phi~u giao nh~n h6 sa 605;

e) Phi~u giao nh~n h6 sa 606;

f) Phi~u giao nh~n h6 sa 607;

g) Phi~u giao nh~n h6 sa 612;

h) Phi~u giao nh~n h6 sa 613;

i) Phi~u giao nh~n h6 sa 614;

j) Phi~u giao nh~n h6 sa 615;

k) Phi~u giao nh~n h6 sa 621.

Di~u 2. Quy~t dinh mly co hi~u k~ tir ngay 11/3/2013. MQi quy dinh tru6c day tniiv6i Quy~t dinh nay d~u bi huy bo.

Di~u 3. Tru6ng phong T6 chuc - Can b(>,Tru6ng cac phong nghi~~ ~/a Giamd6c BilO hi~m xii h(>iQu~n, Huy~n co trach nhi~m thi hanh Quy~t dinh nay./ ~

Noi nh~n: ~-' AM DOC" ~A ,_

- Nhu dl'e~u3', Pi?\::' ,.'----,':0"" '/!J . <:•./' •...'" Ao '- BGB BHXH TP.HCM; .~( " HIE;""- Trang web BHXH TP.HCM; /10 tH .XA H(h- LUll: VT, TCCB(02b). 1'A \\4\ .,·"ANHPHO'

/:' '?~\raCHi:?-- \ ' MINH

'-.,* "'"

Cao Van Sang

Ph\lI\lC 01: Quy trinh giai quy~t ch~ dQ huu tri(Dinh kern Quy€t t/;nh s61 Ai- IQD- BHXH ngay 2% 1212013

cua Giarn t/6c BHXH Thanh ph6 H6 Chi Minh)

Quy trinh giai quy~t ch~ dQhuu tri (Phi~u giao nh~n hB SO' 606,02 ban).

1. D6i vOi hB SO' nQp t\li BHXH Thanh ph6:

1.1. Quy trinh tom tit:

- M\lc dich: dung d€ ghli quy~t ch~ d(>huu tri cho nguai lao d(>ng n(>p h6 So' t~iBHXH Thanh ph6.

- Tho; h\ln tra k~t qua: 15 ngay lam vi~c.

- SO' dB:

KhachI

Ph6ng I 85 • Ph6nghang CST CflBHXH

B1 84 IBe>ph~n B2 Ph6ng B3

~TNHS CflBHXH ~ Thu

B6- Di~n giai quy trinh:

+ BuO'c 1: Phong TNHS. Thai h~n 01 ngay.

+ BuO'c2: Phong Ch~ d(>BHXH. Thai h~n 04 ngay.

+ BuO'c 3: Phong Thu. Thai h~n 02 ngay.

+ BuO'c4: Phong cap 56, the. Thai h~n 02 ngay.

+ BuO'c 5: Phong Ch~ d(>BHXH. Thai h~n 05 ngay.

+ BuO'c 6: Phong TNHS. Thai h~n 01 ngay.

1.2. Quy trinh chi ti~t:

Bmyc 1: Phong TNHS. Thai h~n 01 ngay lam vi~c.

- Ti~p nh~n h6 So' theo quy dinh: Ti~p nh~n va ki€m tra h6 So' v~ 56 IUQ11gva tinh hqpphap cua h6 So'; Ki€m tra tinh hinh n(>pBHXH cua dan vi sir dVng lao d(>ngd~n thai di€mn(>ph6 So' co nQ'BHXH hay khong?

- Sau khi ki€m tra h6 So' can b(>TNHS nh~p thong tin vao ph~n m~m TNHS.

- Chuy€n h6 So' cho Phong Ch~ d(>BHXH.

Bmyc 2: Phong Ch~ dQBHXH. Thai h~n 04 ngay lam vi~c.

- Ti~p nh~n, ki€m tra h6 So' theo quy dinh. Xac nh~n vi~c giao nh~n h6 So' tren ph~nm~m TNHS.

- Ki€m tra: Thai h~n nang luang xem co dung nien h~n hay khong; Vi~c x~p luangcua dan vi co dung nganh ngh~ hay khong; Phv cap chuc vv, phv cap tham nien vuqt

1

khung ... co dung khong?; Chuc danh cong vi~c co n~m trong danh m\lC ngfmh ngh~ di)ch~i hay khong? Vi~c ni)p BHXH co du so vai thai gian tham gia BHXH dil duqc xac nh~ntrong s6 BHXH hay khong?

- H6 so chua du di~u ki~n giai quySt thi l~p PhiSu bao tra h6 so, ghi ra ly do chuagiai quySt, nhung vfin d~ ho~c gifiy to' d.n don vi b6 sung va trinh lilnh d~o phong ky vatra ngay cho Phong TN&QLHS.

- Nhfrng h6 so chua du thu t\lC, du di~u ki~n hu6ng luong huu thi in Ban qua trinh d~chuy~n Phong cfip s6, the in to' bia, to' rO'iva to' 07/SBH (nhfrng h6 so co qua trinh dongBHXH chua dung quy dinh: nang luong sam, hu6ng PCCV chua dung, sai tham nien vuqtkhung ... thi vdn in ban qua trinh nhung phai dung theo quy dinh).

- Xac nh~n vi~c giao nh~n h6 so tren phfrn m~m TNHS truac khi chuy~n Ban quatrinh kern toan bi) h6 so huu tri cho Phong thu.

Bmrc 3: Phong Thu. Thai h~ 02 ngay lam vi~c.

- TiSp nh~n h6 so tir Phong ChS di) BHXH, xac nh~n giao nh~n tren phfrn m~mTNHS.

- Can cu thai di~m nghi huu tren quySt dinh cua don vi, di~n biSn ti~n luong dongBHXH th~ hi~n tren s6 BHXH, Ban qua trinh do phong ChS di) BHXH l~p d~ df>ichiSu vaiSMS.

+ NSu du li~u trimg kh6'p: Chuy~n toan bi) h6 so huu tri cho Phong cfip s6, the in to'rO'iva to' 07/SBH th~ hi~n toan bi) qua trinh dong BHXH, BHTN.

+ NSu du li~u khong trung kh6'p (k~ ca truO'ng hqp don vi dil b6 sung D02- TS co di~uchinh luong ngay tir luc ni)p h6 so huu trf): NSu sai do co quan BHXH thi can bi) PhongThu ki~m tra h6 so va l~p PhiSu giai quySt cong vi~c trinh lilnh d~o ky duy~t d~ di~u chinhdu li~u. NSu sai du li~u do don vi thi thong bao cho don vi biSt va ghi ni)i dung giai quyStvao PhiSu di~u chinh (mdu C02- TS).

Bmrc 4: Phong cip sA, the. Thai h~n 02 ngay lam vi~c.

- In to' bia, to' rm, to' 07/SBH va chuy~n tra tOM bi) h6 so huu tn cho Phong Ch€ di)BHXH.

- Xac nh~n vi~c giao nh~n h6 so tren phfrn m~m TNHS.

Bmrc 5: Phong Ch~ dQBHXH. Thai h~n 05 ngay lam vi~c.

- L~p quySt dinh huang chS di) huu tri.

- Trinh lanh d~o k)', dong dfiu. Tach ghep h6 so. Dong dfiu dil hu6ng chS di) hUll tri trentrang li~n k~ trang co th~ hi~n qua trinh dong BHXH cua s6 BHXH va tren to' bia s6 BHXH.

- D\lc 16s6 BHXH.

- Ban giao h6 so huu tri (khong bao g6m s6 BHXH) dil hoan chinh cho PhongTN&QLHS. Nhung h6 so chua du can cu giai quySt cfrn b6 sung them cac gifiy to', thu t\lCthi l~p phiSu bao kern h6 so tra cho Phong TN&QLHS.

- Xac nh~n vi~c giao nh~n h6 so tren phfrn m~m TNHS.

Bmrc 6: Phong TN&QLHS. Thai h~n 01 ngay lam vi~c.

+ BQph~n TNHS.

- Xac nh~n giao nh~n h6 sa khi nh~n him giao h6 sa tir Phong Ch€ dQBHXH.

- Tni h6 sa theo Phi€u giao nh~n h6 sa.

+ BQ ph~n k~ toan: Chi ti~n cho khach himg theo gifry gi6'i thi~u va quy€t dinh hUlltrf (n€u co).

2. :OBiVOl h6 sO" nQp t~i BHXH qu~n, huy~n:

2.1. Quy trinh tom t~t:

- M1}c dich: dung d€ giiii quy€t ch€ dQ hUll tri cho nguai lao dQng nQP h6 sa t~iBHXH qu~n, huy~n.

- Tho; h~n tra k~t qua: 20 ngay lam vi~c.

- SO" dA:

So ph~n -CST

B4

Khach Bo ph~n B5hang Thu

B1 B3

B2Bo ph~n Bo ph~n +--- B6 P. CflTNHS - CflBHXH BHXH TP~ B8

- Di~n giai quy trinh:

+ Bu6'c 1: BQ ph~n TNHS. Thai h~n 01 ngay.

+ Bu6'c 2: BQ ph~n Ch€ dQBHXH. Thai h~n 03 ngay.

+ Bu6'c 3: BQ ph~n thu. Thai h~n 02 ngay.

+ Bu6'c 4: BQ ph~n cfrp sf>,the. Thai h~n 02 ngay.

+ Bu6'c 5: BQ ph~n Ch€ dQBHXH. Thai h~n 01 ngay.

+ Bu6'c 6: Phong Ch€ dQBHXH Thanh ph5. Thai h~n 09 ngay.

+ Bu6'c 7: BQ ph~n Ch€ dQBHXH. Thai h~n 01 ngay.

+ Bu6'c 8: BQ ph~n TN&QLHS. Thai h~n 01 ngay.

2.2. Quy trinh chi ti~t:

Bmyc 1: BQ ph~n TNHS. Thai h~n 01 ngay lam vi~c.

- Ti€p nh~n h6 sa theo quy dinh: Ti€p nh~n va ki€m tra h6 sa v~ s5 lUQ'llgva tinh hqpphap cua h6 sa; Ki€m tra tinh hinh nQPBHXH cua dan vi sir dVng lao dQng d€n thai di€mnQp h6 sa co nQ'BHXH hay khong?

- Sau khi ki€m tra h6 sa can bQTNHS nh~p thong tin vila phfrn m~m TNHS.

- Chuy€n h6 sa cho BQ ph~n Ch~ dQBHXH.

BuO'c 2: BQ ph~n Ch~ dQ BHXH. ThO'ih~n 03 ngay lam vi~c.

- Ti~p nh~n, ki€m tra h6 sa theo quy dinh. Xac nh~n vi~c giao nh~n h6 sa tren phfrnm~m TNHS.

- Ki€m tra: ThO'i h~n nang luang xem co dung nien h~n hay khong; Vi~c x~p luO'ngcua dan vi co dung nganh ngh~ hay khong; Ph\l cap chuc V\l, ph\l cap tham nien vuqtkhung ... co dung khong?; Chuc danh cong vi~c co n~m trong danh m\lC nganh ngh~ dQch~i hay khong? Vi~c nQP BHXH co du so v6i thO'igian tham gia BHXH da duQ'cxac nh~ntrong s6 BHXH hay khong?

- H6 sa chua du di~u ki~n ghii quy~t thi l~p Phi~u bao tni h6 sO',ghi ra ly do chuagiai quy~t, nhfmg van d~ ho~c giay to' cfrn dan vi b6 sung va trinh lanh d~o BHXH qu~n,huy~n ky va tni ngay cho bQph~n TNHS.

- Nhfrng h6 sa du thu t\lC, du di~u ki~n hu6ng luang huu thi chuy€n BQph~n Thu.

- Xac nh~n vi~c giao nh~n h6 sa tren phfrn m~m TNHS tru6c khi chuy€n ban quatrinh kern toan bQ h6 sa huu tri cho BQph~n cap s6, the.

BuO'c 3: BQ ph~n thu. ThO'ih~n 02 ngay lam vi~c.

- Ti~p nh~n h6 sa tit BQ ph~n Ch~ dQ BHXH, xac nh~n giao nh~n tren phfrn m~mTNHS.

- Can cu thO'i di€m nghi huu tren quy~t dinh cua dan vi, di~n bi~n ti~n luang dongBHXH th€ hi~n tren s6 BHXH, Ban qua trinh do BQph~ Ch~ dQBHXH l~p d€ d6i chi~u v6iSMS.

+ N~u dfr li~u trung kh6p: Chuy€n toan bQ h6 sa huu tri cho BQ ph~n Cap s6, the into' rO'iva to' 07/SBH th€ hi~n toan bQ qua trinh dong BHXH, BHTN.

+ N~u dfr li~u khong trung kh6p (k€ ca truO'ng hqp dan vi da b6 sung D02- TS co di~uchinh luang ngay tit luc nQp h6 sa huu tri): N~u sai do cO'quan BHXH thi can bQBQ ph~nThu ki€m tra h6 sa va l~p Phi~u giai quy~t cong vi~c trinh lanh d~o ky duy~t d€ di~u chinhdfr li~u. N~u sai dfr li~u do dan vi thi thong bao cho dan vi bi~t va ghi nQi dung giai quy~tvao Phi~u di~u chinh (m~u C02- TS).

BuO'c 4: BQ ph~n c§p sA, the. ThO'ih~n 02 ngay lam vi~c.

- In to' bia, to' rm, to' 07/SBH va chuy€n tra toan bQ h6 sa huu tri cho BQ ph~n Ch~ dQBHXH.

- Xac nh~n vi~c giao nh~n h6 sa tren phfrn m~m TNHS.

BuO'c 5: BQ ph~n Ch~ dQ BHXH. ThO'ih~n 01 ngay lam vi~c.

- Xac nh~n vi~c giao nh~n h6 sa tren phfrn m~m TNHS;

- Chuy€n toan bQh6 sa huu tri cho Phong Ch~ dQBHXH.

BuO'c 6: Phong Ch~ dQ BHXH. ThO'ih~n 09 ngay lam vi~c.

- ThlJc hi~n cong vi~c tuang tlJ Bu6c 5, phfrn 1 cua quy trinh nay ..--/J.-

~

- Ban giao h6 sa huu tri (kh6ng bao g6m s6 BHXH) da hofm chinh cho B<)ph~nchinh sach. Nhfrng h6 sa chua du din Cll'giai quy~t d.n b6 sung them cac gitiy to', thu t\lCthi l~p Phi~u bao kern h6 sa tni cho can b<)qu~n huy~n.

BU'O'c7: BQ ph~n Ch~ dQ BHXH. Thai h1;ln01 ngay lam vi~c.

- S~p x~p va giao h6 sa cho B<)ph~n TNHS.

- Xac nh~ giao nh~n tren phfin m~m TNHS.

BU'O'c8: BQ ph~n TNHS va BQ ph~n k~ toano Thai h1;ln01 ngay lam vi~c.

+ BQ ph~n TNHS.- Xac nh~ tren phfin m~m TNHS sau khi nh~ ban giao quy~t toan ill B<)ph~ ch~ d<)

BHXH.

- Tra h6 sa kern s6 BHXH cho khach hang theo Phi~u giao nh~n h6 sa.

+ BQph~n k~ toan: Chi ti~ cho khach hang theo gifrygi6i thi~u va Quy~t dinh huu tri (n~u

Luu y:- Truilng hQ'ph6 sO'huu tri chuyin tinh ma co tre/ cdp 01 l{m thi huang ddn nguili lao

Gf}ngnhl).ntiJn t(li B(5phl).n ki toan.

- Nhfmg truilng hQ'ph6 sO'sai sot hoijc phai tliJu chinh, b6 sung thi can b(5giai quyith6 sO'phai ghi ro nhi1ng n(5idung hoijc cac lO(lih6 sO'thiiu c6n b6 sung va chuyin tra l(licho B(5phl).n TNHS. Khong tluQ'cyeu c6u b6 sung qua 02ldn.

- Nhi1ng truilng h()'JJco thili tliim biit tl6u huang luO'ng huu trong thili gian huangtrQ'cdp thdt nghi¢p thi thong bao cho B(5phl).n thdt nghi¢p biit tli thong bao chdm duthuang tre/ cdp thdt nghi¢p.

- Niu nguili lao tl(5ngco nhu c6u nhl).n luO'nghuu qua the ATM thi tlJ nghi cung cdps6 tai khoan the, ghi ro ten chi nhanh Ngan hang nO'ima the tli ti¢n cho vi¢c chuyin tiJn.Niu nguili lao tl(5ng chua co tai khoan ma co tlJ nghi thi B(5phl).n TNHS co thi cung cdpdanh sach cac ngan hang co lien kit vai cO'quan BHXH tli nguili lao tl(5ng tl! ch(m nganhang tli tluQ'ch6 trQ'thit tl:lCma the.

- Niu co tliJu chinh nhan than hoijc/va chuc danh nghJ thi n(5ph6 sO'theo thit tl:lCva quytlinh t(li Phiiu giao nhl).nh6 sO'614 hoijc 6~

Ph\! ~\!C02: rhi~u giao nh~n hB SO'(Dinh kern Quyet ajnh so ~~4 IQD-BHXH ngay ~ 1212013

cua Gicitn a6c BHXH Thanh ph6 H6 Chi Minh)

Bao g6rn 11 Phi€u giao nh~n h6 sa:

a) Phi€u giao nh~n h6 sa 601;

b) Phi€u giao nh~n h6 sa 602;

c) Phi€u giao nh~n h6 sa 604;

d) Phi€u giao nh~n h6 sa 605;

e) Phi€u giao nh~n h6 sa 606;

f) Phi€u giao nh~n h6 sa 607;

g) Phi€u giao nh~n h6 sa 612;

h) Phi€u giao nh~n h6 sa 613;

i) Phi€u giao nh~n h6 sa 614;

j) Phi€u giao nh~ h6 sa 615;

k) Phi€u giao nh~n h6 sa 621.

Phiiu giao nhgn h6 sa nay ap d1!ngki fir ngiIy 1113/2013

86 H6 sO': 6011 .ICDBHXH CONG HOA XA HOI CUlT NGHiA VIET NAM. . .DQc l~p - TV do - H~nh phuc

PHIEU GIAO NHAN HO sa.Lo~i h6 sO": HU'o-ng trQ' cAp am dau

(ThOi ht\n giai quy~t lot\i h6 sO' nay: 15 ngay lam vi~c)

1. Ten dan vi: , , Mil dan vi: '" '" .

2. Di~n tho~i: Email: .

86hrQ'Dg

I.I.

H&sO'yeu cAu chung:File du Ii¢u: Gui qua Email DIMS D Chuy~n b&ngilia D Chuy~n b&ngUSB D- Danh sach nguaj lao dQng d~ nghj hui'mg ch~ dQ6m dau theo m~u C66a-HD (03 ban chinh).

·····~···\i~·n···"i)~n····x~c·'·n·h~n···di~ii···ki'e·n····i·~m···~i~c···'n·~ng···nh·Qc':···d~·c··'h~i·:·'·n·gu·y···hI~·m':····3···'ca····~,·~··~····k~·m···hi·~·~···i562·~·T·S···d~····n'gh·!·'··di~'uchinh chuc danh cong vi~c.N~u c1iSutrj b~nh trong nU"cYc,ngoai nhiing h&sO'tl}i phAn I, ba sung:Ban thiin nguai Ian dQng 6m:B~nh ngan ngay:

............................................................,···················· ..·..····· ·· ············l······ .

- Truang hqp dieu trj nQitru: Giay ra vi~n (Ban chinh)~pi~~tiL~i?~Lt.i4:9j~y?h~i~h~~~ih(yj~?F~~~~B~E~~~¢~~~Bt?(~~~~~i~~)- Trui'mg hqp bj tai nlilnrui ro phai c6 ban tUO'ngtrinh cua nguai laDdQng(ban chinh)D6i vai b~nh dai ngay:- TruO'nghqp di~u tri nQitru: Gifty ra vi~n (Ban chinh) .

....•••.•...•...••.•••.,; .•...••..•.....................•........•....•••..••.•••...••..•.•....•••...•...•••.•••...••••.•......................•.••••..•...•.•.•., ..••...•••...•.•••.•.•.•.•........•...•..........................•...•...•..•••...•.•.•...•...•.•........•, , , , ,.......................•...., ,....•...•....,....•..........•.....•.........•....•....................., , , ,·····,···,···,··· ····r'··..··..··,···,····,···,..·

- Dieu trj ngolilitru: Bien ban hQi chiin cua b¢nh vi~n (Ban chinh ho,c ban sao co chu-ng th.,c) va giiiy xacnh~n dgt di~u trj (ban chin h) n~u Bien ban hQichdn kh6ng th~ hi~n thai gian di~u tri ngolilitru.:·02D~~h~i~hb~~·gi~~i~~d~~gth~~·bi€~D02=TSm

.....~g~i !~.?~8.~()11.81!1: , ._TruO'nghqp dieu tri nQitru: Giiiy ra vi~n (Ban chinh)=Di~~t~j~g~~it~(;~S6yb~h~i~Gi§:y~hfr~g~h~~~ghi~i~~h~~gBHXH~§..~C65=HD(bi~~hi~h)=(jifiy~~cnh~n~enghi~i~cd€ch~n~6ccon6~c&angu&is&d\l;.;glaod¢ngnaingu&Cjaod~ng;.;gl1 i~i~ctruac d6 (cha hoi[lcml() da hui'mg h~t thai gian then quy djnh then m~u 5B-HSB (ban chinh)N~u c1iSutrj b~nh i1 nwc ngoai, ngoai nhiing h8 sO'tl}i phAn I, ba sung:Ban djch ti~ng Vi¢t (dugc cong chung) gifty kham, chua b~nh do co sa y t~ nuac ngoai cftp

II.1.

III.1.

Ngay tnl k€t qua: ./ ./ (Qua hl;ln tra h6 sa 30 ngay, don vi chua d€n nh~n, CO'

quan BHXH se chuy~n h6 sa nay van kho luu trii)

............... , ngay thang nam .Can bQti~p nh~n h6 sO'

(Ky, ghi h(J ten)NglfOi nQp h6 sO'

(Ky, ghi h(J ten)

Phiiu giao nlujn h6 sa nay ap dl,mgki tit ngay 1113/2013

86 H6 sO': 602/ .ICDBHXH CQNG HOA XA HQI CHU NGHiA VI~T NAMDQcl~p - T1}' do - H~nh phuc

PHIEU GIAO NH~N HO SOLo~i h6 so-: Htr01ig trv cAp thai san

(ThOi h~n giai quy~t lo~i h6 sO' nay: 15 ngay lam vi~c)

Ad' M- d .1. Ten an Vl: a an Vl: .

2. I)i~n tho~i: Email: .

2,

II.

86hrQ11g

D6i vOi ngum dang dong BHXHH6 sO'yeu cAu:- Danh sach nguO'ilao d¢ng d~ nghi hu6'ng ch~ d¢ thai san theo mfiu67a-HD (03 ban chinh)~-V~~b~~x~c-~h-~~-djf;:;-kj~~-jil;n~j~cn~~g~hQc;d6ch?i:~g;:;yhj~;n:3ca:::k~;nbi€uD62~Tsd~~ghTdjf;:;chinh chuc danh cong vi~c,TruO'nghQ'PnguO'i lao d¢ng Kham thai: So kham thai ho1i-cGiay kham thai ho1i-cgiay chung nh~n nghi vi~chu6'ng bao hi~m xii hQiC65-HD (Ban chinh)T~~!1:gh2P_~_~p!.~\_!~?__~9.~g_~L~~y._!.h~\l_~5l?~_h~!._!.h~i_?!.~~L~~~t!l!lJ,!.~v~h!_~~~!~~ph~P!~~~b_t~~i.:- Giay ra vi~n (ban chinh) ho,c=Gjfiy~h&-~g~h~~~ghi-~i~ch~6;{g-BHXH-th~~;n~;:;C65=HD-('bi;~hi;h'jT.~C!!lg~2P~gl!.C!\}~?~9!lg_~i~h~_?!l:__- Giftykhai sinh ho1i-cchung sinh cua con (Ban sao co chfrng thy'c, 01 ban/con)

·····=···N·~;:;·~·~~·chetphiij··c6··th~;ngi;{y··chfr~gtfr(·Bi;···~hi~h··h~·~~···bi;~;~···~6··~h~:~g··th~c, 01 ban/con)+T~u&nghgp-conch~tngaysa;:;khjsjnh;nikh6;:;gdugcapGjdych(fngtfrthjthayb~ngB~~hK;:; (Ban sao cochUng thl}'c), ho(lc-+-Gi;{y··~~~i~~···ci;a···;;gu&i··;;:;~-(Ba:;-~-hi~hh~~~·bii~~·;~-~6~h~g-th·l}'c).TruO'nghQ'Plao d¢ng netbi t~mt~t: Gifty chung nh~n ty I~thuong t~t 21% tra len (01 Ban sao co chU'ng thy'c)Nh~n nuoi con nuoi du6i 4 thang tu6i: Quy~t dinh cong nh~n vi~c nuoi con nu6i (01 Ban sao co chfrng thy'c)TruO'nghQ'Psau khi sinh con my chet:

·····~···Gifiy~h&~gtfr··c~~;;:;~(Oi··Bi~···~;~~6··~h~~gth;f~)······~···D~···c~-~··~g~&i···ch~··h~~~~g~&i···i~v~···ti~p·~;:;6id~~g··c~~···th~·~···;nI;:;···i··iA~H·SB··(bi·~··~hi~'h)'File det Ii~u: Gui qua Email DIMS D Chuy~n b~ng d'ia D Chuy~n b~ng USB DD6i vOingum lao dQng dli nghi vi~c, sinh con ho,c nh,n nuoi con nuoi duOi 04 thang tulli:

....~?J'3}~.~.II_;.~.~~~...~?I?J!~~I'I_~.c.~~!~l:I~~t<:t...~<:ti;~()~c.t<:t~ll:l..s~)..'1~..~.~.~...t~,lI1~.t<:t.r<:ti.,~.(\~l:..(.~~..~....~.~.ill~.).TO'rO'i:TO' bla s6:s6 BHXH (mau cii):

Don theo mfiu IIB-HSB (ban chinh)- Tru6'ng hQ'Psinh con: Gifty khai sinh ho(lc Gifty chung sinh cua con (Ban sao co chfrng thy'c, 01 b3n/con)

····~-T;';:;:&ng··hgp·nh~nc;:;~~~6idu&j··04··thingt;:;6i·~Q;:;y~i·dj;:;h··c6ng~h~~···~i~cn;:;6i·~o;:;··~;:;6i···(o·i···Bi~···~~~"'~6"~h'~'Dgthy'c)

Ngay tfl:lk~t qua: ./ ./ (Qua h~n tra h6 sO'30 ngay, don vi ho~c ca nhan chuad~n nh~n, cO'quan BHXH se chuy€n h6 sO'nay van kho luu trfr)

............... , ngay thang naro .Can bQti~p nh~n h6 sO'

(Ky, ghi hr; ten)NguOi nQp h6 sO'

(Ky, ghi hr; ten)

Phiiu giao nh{in h6 sa nay lip dl,lng k€ tit ngiIy 11/3/2013

sA H6 sO': 604/ .ICDBHXH CQNG HOA XA HQI CHU NGHiA VI~T NAMDQcl~p - Tv do - H,nh phuc

PHIEU GIAO NHAN HO saLo,i h6 sO': Giai qny~t ch~ dQtai n,n l~o dQng - b~nh ngh~ nghi~p

(ThO; h,n giai qny~t lo,i h6 sO' nay: 15 ngay lam vi~c)

1. Ten dan vi: ., , Mil dan vi:··· .

2. Di~n tho<;ti: Email: '"

STT Lo,i gidy to', bi~n ll: sAman lU'Q'ngI. Tai n~m lao elC)ng(TNLD)1. Tai n\ln lao elC)ngt\li noi laID vi~c:

~~~I:i?\}::l;~?~l?~~~li~liy.~l?~l?t~ll!'S!C:1~<:i;~?~':.!<:~Ill~()y.~':.~l?t.~(l!'g!~TC:1i,g~!'l:(':\~~<:~i~~)

1.1. TO'rO'i:TO' bia s6:S6 BHXH (mau eii):

1.2. Van bi'm de nghj giai quyet TNLD eua nguO'i SI! dl,lng lao d¢ng theo mau 5A-HSB (ban chinh)- D(ji vOi trU'011g hQ'P bj tai n\ln lao elC)ng:Bien ban dieu tra tai n~n lao d¢ng (Ban chinh)

1.3. - NSu tai n\ln lao elQng do tai n\ln giao thOng: Bien ban kham nghi~m hi~n tflIemg, Sa dd hi~n tflIong VI,I tain~n giao thong eua Cong an giao thong ho~e Bien ban tai n~n giao thong (ban chinh hoiJc Ban sao co chUngthU'c- NSu eli~u trj nC)itni: Gi~y ra vi~n (Ban chinh hoiJc ban sao co chUng thl,rC)

1.4. ···················1············ ...···········...·•·· ...·········x·····························································r········································ ..•..........................................•...•........................... .,.. ........................•.•..•............................. y......... ....

- Neu khOng elieu trj nQi tru: Giay chung nh~n thuong tieh, don thuoe, cae giay to' kham, dieu tri co lien quan(Ban chinh hoiJc ban sao co chUng th •••.c)

1.5. Bien ban giam djnh mue suy giam kha nang lao d¢ng eua H¢i dong giam djnh y khoa ttr 5% tr6' len. (Banchinh)

2. Hi.'>khau thuemg tru ho~e giay dang ky t~m tru (Ban sao co chUng th •••.c) neu TNLD do tai nl,m giao thongII. Bfnh ngh~ nghi~p:

~?~li~li;~()~?~?~J.::I:~liy.~?~?tr.~llgt.?r.~i;~()~?t.~lJI::l~?y.~?~?t.~(lllgt.c'1rc'1i,g?f!l:(~~(l<:~i(l~)

1To rO'i:TO' bia s6:S6 BHXH (mau eii):

2 Van ban d~ nghj giai quy~t b~nh ngh~ nghi~p eua nguO'i SI! dl,lng lao d¢ng theo mau 5A-HSB (ban chinh)3 Bien ban do d~e moi tflIemg (ban chinh hoiJc ban sao co chUng th •••.c)4 Phi~u kham b~nh ngh~ nghi~p ho~e phi~u hQi eh~n (ban chinh hoiJc ban sao co chUng th •••.c)5 B~nh an b~nh ngh~ nghi~p (ban chinh hoiJc ban sao co chli'ng th •••.c)

6Bien ban giam djnh mue suy giam kha nang lao dQng elm HQi dong giam djnh y khoa ttr 5% tr6' len. (Banchinh)

Lull, Y: _ . . _ .- Neu suy giam kha nang laD a(mg < 31% thi moi lor;dgiay tit, bieu mau l(lp 02 bim. (trir so BHXH)- Niu suy giam kha nang laD a(mg ~ 31% thi m6i lor;tigidy tit, biiu mdu l(lp 03 ban. (trir s6 BHXH)

Ngay tra k~t qua: ./ ./ (Qua h~n tra h6 sO'30 ngay, dan vi chua d~n nh~n, cO'quan BHXH se chuy~n h6 sO'nay vao kho hru tm)

............... , ngay thang...... nam .Can bQti~p nh~n h6 sO'

(Ky, ghi h9 ten)NgU'o; nQp h6 sO'

(Ky, ghi h9 ten)

Phiiu giao nhgn h6 sa nay lip dl,mg k€ tit ngay 11/3/2013

s6 H6 sO': 605/ •••••••••••••• .ICDBHXH CQNG HOA XA HQI CHU NGHIA VI~T NAMDQcI~p - T" do - H~nh phiic

PHIEU GIAO NHAN HO saLo~i h6 sO': Giii quy~t ch~ dQtai n~n lao d~ng - b~nh ngh~ nghi~p bli phat

ho{ic tai n~n lao dQng - b~nh ngh~ nghi~p tAng hW(ThOi h~n giii quy~t lo~i h6 sO' nay: 15 ngay lam vi~c)

1. Ten dan vi: , '" ., , Mil dan vi: .. · '" .

2. Di~n thoe;ti:.. , '" Email: '" , .

Lo~i giiy to', bi~u miuTai n~m laG dQng (TNLD), b~nh nghS nghi~p tong hQ1l(bi tai n~m laG dQng nhiSu IAn, bi nhiSu b~nh nghSne:hiep hoac vil'a bi tai nan lao dQne:vira bi benh ne:hSne:hiep):~?~~!?S!.I;~?~~~?~!i?S!iy~?~~~~~Il~t~E?i;~?~~~?lJi~~?y~~~?tE'~Il~t?~?i.~?I11:(~~Ilc.~ •.Il~)

Tarai:Tobia s6:S6 BHXH (m~u cii):

Van bim d~nghi giai quy~tTNLD, BNN CllanguOiSlrd\lng lao dQngtheo m~u 5A-HSB (Ban chinh)- Doi vai truang hqp bi tai n~n lao dQng: Bien ban dieu tra tai n~n lao dQng(Ban chin h)- N~u tai n~n lao dQng do tai n~n giao thong: Bien ban kham nghi~m hi~n truang. Sa d6 hi~n truang VI,!tai n~ngiao thong cua Cong an giao thong hoilicBien ban tai n~n giao thong (ban chinh ho~c Ban saG co chUng thl}'c).................... 1." ); , ,. ............• , , ,'.

- Doi vai truang hQ'pbi b~nh nghe nghi~p: Bien ban do d~c moi truang co yeu to dQc h~i (Ban saG co chungth,!c). N8u co nhi~u nguai bi BNN thi h6 sa m6i nguai phai trich sao bien ban,- N€u diSu tri nQi tru: Gidy ra vi~n (Ban chinh ho~c ban saG co chUng th,!c)~~~~~~~~g~i~~~a~9{~i.~~':::m'm+ Neu bi tai n~n lao dQng: Giay chung nh~n thuang tich. dan thuoc, cac giay to kham, dieu tri co lien quan (Banchinh ho~c ban saG co chii'ng th,!c)+N~;;b!b~~h~gh~~ghi~p:Gi&ykhimb~~h~gh~~ghi~pho~cphi~;;h~jch&~b~~h~gh~~ghi~p(B~~ctii~tiho~c ban saG co chiine; thl}'c)Bien ban giam dinh muc suy giam kha nang lao dQngcua HQid6ng Giam dinh Y khoa tu 5% tra len (Ban chinh)Ho sa huang trQ'cap tai n~n lao dQng ho(lc Ho sa huang trQ'cap b~nh nghe nghi~p cua nhfrng Ian bi tai n~n laodQng,b~nh ngh~ nghi~p truac do (Ban saG co chUng th,!c)HQkhdu thuang tru hoilicgidy dang ky t~m tru (Ban saGco chUng th,!c) n~u TNLD do tai n~n giao thongTai n~mlaGdQng tai phat ho~c b~nh nghS nghi~p tai phat:

...~.6..~J-\)\.tI; ..I1(l~c...~?.~II?<:II...y~..c..~c...t~llI1~..t('y..r(!i;..~.(l~C.t??ill..S?.V.~.?ac...trlll1.~..t?.r?.i.•..i:?tllll:.(]Jan...c~.il1h).Tarai:To bia s5:S6 BHXH (m~u cii):

- N~u dieu tri nQi tru: Giay ra vi~n (Ban chinh ho~c ban saG co chii'ng thl}'c) sau khi da:dieu trj on djnh tain~n lao d¢ng hoilicb~nh ngh~ nghi~p tai philt=NS~kh8~gdi~~t;i~~it;~;GiIyt&kh~m:di~~t~ith~a~gt~tt~iph~th~~cb~~ht~tt~iph~t(Bi~chi~hh~~cban saG co chUng th,!c)Bien ban giam dinh muc suy giilm khli nang lao dQngdo tai phat cua HQid6ng Giam djnh Y khoa (Ban chinh)H6 SCYhuc'mgtrQ'cap tai n~n lao dQng hoilicb~nh ngh~ nghi~p truac do (Ban saG co chUng thl}'c)

Ltr'f Y: _ ,,_ .,- Neu suy giam kha niing lao d{jng < 31% thi m6i IO(li giay tir, bieu mau Igp 02 ban. (trit so BHXH)- Niu suy giam kha niing lao d{jng ~ 31% thi m6i IO(ligidy ta, bi€u mdu Igp 03 ban. (trit s6 BHXH)- TNLD, BNN tal ph at:+ Niu dang huang tr(Y clip hang thang thi n{jp h6 sa cho BHXH qugn, huy~n nai dang chi tra tr(Y ct1p.+ Niu dil huang tr(Y clip 01 tdn thi n{jp h6 sa cho BHXH qugn, huy~n nai dang cu tm.Ngay tni k~t qua: ./ ./ (Qua h~n tni h6 sO'30 ngay, don vi chua d~n nh~n, cO'quan BHXH se chuy€n h6 sO'nay vao kho lUll trii')

............... , ngay thang nam .Can bQti~p nh~n h6 sO'

(Ky, ghi h9 ten)NglfOi nQp h6 sO'

(Ky, ghi h9 ten)

Phdu giao nlujn hb sa nlly ap d1,lng kd tit ngay 1113/2013

s6 H3 sO': 606/ .ICDBHXH CQNG HOA XA HQI CHU NGHiA VI"E:TNAMDQc I~p - TV do - H~nh phuc

PHIEU GIAO NHAN HO SOLo~i h3 sO': Giii quy~t ch~ dQ huu tri

(rhO; h~n giii quy~t lo~i h3 SO' nay: 15 ngay lam vi~ d6i v(ri cApBHXH Thanh ph6;20 ngay lam vi~ d6i v(ri clp BHXH qu~n, huy~n)

1. Ten dan vi: Mil dan vi: '" .2. Di~n tho~i: Email: .

STT Lo~ti giiiy to', bi~u mAuSo

IU'Qnl!:I. Ha sO' hU1l tri d6i vai ngU"m dang lam vi~c:

~<?~l:I.~!:!;h<:J~'?§()~!:I~l:I.y~c.~'?!r.t1I:tg!~r.~i;h<:J~c.!~~ia.~()'I~c.~c.t~a.Tlgt~I:~i·g~)l11:(~~II~~ill~)

1. Tarai:. ······Tc1blas;r ..

·················S6·BHXH·(~!~···cii)······ •.......................... ..

2. Quyet dinh nghi vi~c hui'mg ch~ dQ huu tri theo m§.u do BQ LDTB&XH guy dinh (03 Ban chinh).3. QuyH dinh chuyen nganh va cac guyet dinh phong guan ham - neu co (Ban sao co chu'ng thlfC)

4.Bien ban gilim dinh muc suy giam kha nang laD dQng tu 61 % tr6 len cua HQi dong giam dinh y khoa neu co (03 Banchinh)

5. Giay chung nMn bi nhiem H1V/AlDS do rui ro b~nh nghe nghi~p - neu co (02 Ban chinh ho,c ban sao co chungthlfC)

6.Danh sach nguai lao dQng nghi huu truac tuoi duqc cap co tham guyen phe duy~t theo guy dinh (sti' dl,mg chung choh6 sa cua mQt dqt gifli guy~t) (02 Ban sao co chUng thlfC)

7.Thong bao cua ca guan BHXH dong y cho dan vi dong truac tien BHXH, BHYT, BHTN cua doi tugng lam ho sahuu tri (n~u co). 01 ban chinh

8. Cong van giai trinh vi~c nQp ho sa hUll tri ch~m so vai thai diem hu6ng luang huu (01 ban chin h)9. Phieu cung cap thong tin so tai khoan do nguai hui'mg luang huu de nghj (01 ban chinh) (neu co nhu diu)

10.Cac giay to' khac co lien guan (neu co)...............................................................................................................................................

II. Ho SO' hU1l tri doi vai ngU"m co tham gia BHXH tlf nguy~n, ngU"m bao lUll thO'i gian dong BHXH bat bUQc ho,cn2U"m dli co quy~t dinh chO' hU1l:~<?~':!~tI;~<:J~'?~()~!:!~I:!y~~~'?!Et~Tlgt~ES!i;~<:J~c.!~~itl~()y~c.4~t~a.Tlgt~I·~i.g()l11:(~~1I5~ill~)

I. Tarai:..."'T~bjas6:"

S6 BHXH (m§.u cu):.........

2.- Dan de nghj hui'mg che dQ huu tri theo m§.u 12-HSB (01 ban chinh), ho~c

..:Gi~ych&~g;;h~;;ch&hu~d6f~6ingu&ilaod~~g~ghi~i~cch&d~df~ui(j~;;~rtu6i dai (Ban chin h).

3. Doi vai nguai chap hanh xong hinh ph~t tu khong dugc huang an treo thi phai co them Giay chung nh~n chap hanhxong hinh ph~t tu (02 Ban sao co chUng thlfC)

4. Quyet djnh tro ve nuac dinh cu hqp phap - neu cO (02 Ban sao co chUng thlfC,)5. Quyet dinh cua Toa an tuyen bo mat tich tro ve - neu co (02 Ban sao co chUng thlfC)

6.Bien ban giam djnh muc suy gitim kha nang lao dQng tu 61 % tr6 len cua HQi dong giam djnh y khoa neu co (02 Banchinh)

7. Van ban xac nh~n dieu ki~n lam vi~c co yeu to n~mg nhQc, dQc h:,'ticua nguai si'r d"mg laD dQng (Ban chinh theo mau)8. Van ban giai trinh vi~c nQp hi'>sa huu tri ch~m so vai thai diem huang !uang huu (01 ban chin h)9. Phieu cung cap thong tin so tai khofm do nguai huang luang huu de nghi (01 ban chinh) (neu co nhu cau)

10.Cac giay to' khac co lien guan (neu co).............................................................................................................................................

Luuy:- Nguifi co quydt t/inh chi! huu cua BHXH Tp.HCM. kh6ng n(Jp s6 BHXH vi ca quan BHXH dang giii'.- Sau khi giai quydt huu tri, s6 BHXH se 1uu giii' tgi ca quan BHXH, khOng tra cho nguifi 1ao d(Jng- N€u sui lfch nhan than (h(J, ten afm, ten, ngity, thang, nom sinh) giii'a sa BHXH va CMND, Hp KHiiu thi a€ nghj iJi€u chinh saBHXH trtruc khi giiii quy€t h6 sO'huu tri. CO'quan BHXH khOng iJi€u chinh l(li nhii'ng sui sot tren sau khi ail lfjp QD huu tri.Ngay tra k€t qua: ./ ../. (Qua h~n tra h6 so 30 ngay, don vi chua d€n nh~n, coquan BHXH se chuy€n h6 so nay vao kho luu trfr)

............... , ngay thang nam .Can bQ ti~p nh~n h3 sO'

(Ky, ghi h9 ten)NguOi nQp h3 sO'

(Ky, ghi h9 ten)

Phidu giao nhgn hb sa nay ap d1,lngM tit ngay 11/3/2013

s6 H6 sO': 607/ .••.•.••••...• .ICDBHXH CONG HOA XA HOI CHi) NGHiA VIET NAM. . .DQcl~p - TV do - H~nh phuc

PHIEU GIAO NHAN HO SO.Lo~i h8 sO': Hmyng chi dQ tfr tuit

(ThOi h~n giai quy~t lo~i h6 sO' nay: 15 ngay lam vifC)

1. Ten dan vi: Mil dan vi: .

2. Di~n thofili: Email: .

s6IUO'Dg

HB sO'du diSu ki~n blfCmgtudt 01 lin:86 BHXH; ho?c 86 BH.~l:f va c.~c.t~angt(yE(yi;ho~c.t(y~ias.?v~c.~c.tr<lI1~~(yr(yi.~?fIl:(lJallc~il1h)

To roi:Ta bia s6:86 BHXH (miu cil):

Giiiy chUng tu, Giiiy bao tu ho?c Quyet djnh cua Toa an tuyen bo nguai lao d(\ng dii chet (ban chinh ho~c bansao co cbUn2 tbl!c)!=?()\y~~'!g~'!i~~g1.~~y~~<::<::h~~4{)!~i'!I;lI1I~{)~9I1g(~~<::a.c:h~tt.r.{)11g!h9tgi<ll1~i~lItr.tl~I1~~1I),p()sllng:- Bien bim di~u tra tai nlilnlaDd(\ng (Ban cbinh)

·····=GiAy~~·~i~~·(bi~····~hi~h···h~~~~ibi~····~~·~····~6·~h~g··th~~);··N€~·di·e·~····t~i····~·g~~i····t~~·~····giAy····~·h(;~g····~·h·~~····thuangtich, gilly to kham, di~u trj co lien quan (ban chinh ho~c/va ban sao co chu'ng th\l'c)=N€~t~j~~~giaoth6~gduq~;icd!~hi~t~i~~~j~od~~gthib6s~~g~Bis~b~~khi~nghi~m hi~n truang, sad6 hi~n trtrang VI,I tai nlilngiao thong cua Cong an giao thong ho?c Bien ban tai nlilngiao thong (Ban chinhho~c/va ban sao co chUn2 thl!c)

....!=?o.iy~i...'!g~'!i ..~.~gla.~ ..y.~~c:<::h~~4{)p~l1.h...I1.gh.~...l1.gh.i~p..(.~.~...c:a..<::h~!.tr{)l1g..th'!i..gi<lrl...~i.~.lI..trj..1~n...diill),..b().sung:- Bien bim do dlilCmoi trtrang (ban chinh bo~c/va ban sao co chUng thl!c)=Phi~~khi~·b~~h~ghe~ghi~p··h~i~···phi~~·h~i~h&~·(bi~·~hi~h·h~j~;~~···bii~····~·~·~···~6···~·h~g··th~~) .··=-B~;:;hi~b~~h~ghr~ghi~p(bi~~hj~hh~j~;~~bi~~;~~6~h~g·th~~5·······················Neu chet do tai giao thong dugc xac djnh llilitai nlilnlao d(\ng: H(\ khiiu thuang tru ho?c giiiy dang ky tlilmtru(Ban sao co chUn2 thl!c)Ta khai hoan cimh gia dinh theo miu 09A - H8B (ban chinh)H3 sO'du di~u ki~n hU'Ongtudt hang thang:Ngoai gilly ta neu tliliphin I, thiin nhiin phai b6 sung them:Giay xac nMn cua chfnh quyen dja phuang nai than nhiin cua nguai laDd(\ng khi con song phai nuoi duang eutru (n€u co, Ban chinh)Gi&ychung nh~n cua nha trtrang nai dang hQcdoi vai trtrang hgp con con di hQctu du 15 tuoi den duai 18 tu6i(n€u co, Ban chinh)Bien ban giam djnh muc suy ghim kha nang lao d(\ng tu 81% tn'y len cua than nhan de nghj huang tuat hangthang (n€u co, Ban chin h)

LU'": y: " "- H6 sa bao htu ho¢c tl! dong tiep BHXH bat bUl)cho¢c dang dong BHXH tl! nguy¢n chef: than nhan n(Jph6 so' t(li BHXH qugn,hUYennai Clf trU.Nguai dang huang luang huu, trr;rClipBHXH hang thang chit: than nhan n(Jphb sa t(li BHXH qugn, huy¢n naidang chi tra luang huu, trr;rClipBHXH hang thang.- Nguai dang huang luang huu chit khOngphai n(Jps6 BHXH.- H6 sa tUlit I Jdn: m6i loqi gitiy ta Igp 02 ban; hb sa tutit hang thang: m6i loqi gidy ta 19p t6i thi~u 03 ban. N~u co d;nh sutitchuy~n huang tinh khac thi ngoai s6lur;rng gidy chung tu, ta khai hoan canh gia dinh neu tren, b6 sung them 01 ban /01 tinh dichuy~n.Ngay tnl kth qua: ./ ./ (Qua h~n tra h6 sO' 30 ngay dO'l1vi chua d~n nh~n, cO'quan BHXH se chuy~n h6 sO'nay vao kho luu trfr)

............... , ngay thang nam .Can bQti~p nh~n h6 sO'

(Ky, ghi h(J ten)NguOi nQp h6 sO'

(Ky, ghi h(J ten)

Phiiu giao nMn h6 sa nay ap dl,mg ki tit ngay 1113/2013

s6 H6 sO': 612/ ./CDBHXH CQNG HOA XA HQI CHU NGHiA VI"E:TNAMDQc I~p - TV do - H~nh phuc

PHIEU GIAO NH~N HO SOLo~i h6 sO":Vira gbli quy~t trQ"c§p Am dau vila bao Itru sA BHXH

(ThOi h~n giai quy~t lo,i h6 SO' nay: 15 ngay lam vifc)

1. Ten dan vi: Mil dan vi:··· '" .

2. f)i~n thoe;ti: Email: .

s6IuQ'n2

H5 sO' l!:iai qUy@t trey clip tlm dauH5 sO'yeu ciu chung:

File du li~u: Glii qua Email DIMS 0 Chuy€n b~ng ilia 0 Chuy€n b~ng USB 0~.Danh. sach nguai lao dQng de.nghj hl16ngche. d96n1 dau theo Il1aU soC66a-l:ID, (O~ban<:hinh).>V~~b~nx~cnh~~dl~ukj~nil'lrnvj~c nQ,ngnt1Qc,dQc hi,li,nguy t1i€m; 3 ca ... kern 02 ban chinhbi€ubb2~TSd€ nghj di€u chinh chuc danh cong vi~c.N~u m€u trj b~nh trong nmyc, ngoai nhfrng h5 sO'tl,ti phin I, bi} sung:

Ban than nguai lao dQng bm:

B~nh nglln ngay:~!?(~~td~2Lii.4:Qi~y~~y.i.~~(I~~~t:~~~~)-Di~u trj ngoi,li tru: GiAy chUng nh~n nghi vi~c hu6TIg BHXH theo m§.u C65-HD (bSn chinh)=fru&nghgpb!iai;:;~;:;·i1iC;:ophl'lCc6i.u&ngi.;:inhciiangu&Cjaod~ng(binchinh)Doi vai b~nh dai ngay:

.···~·r>i~~t~j~¢it;:(;~Gjfiy~~~j~~(Bin~hinh)....

.. ·• • ·-_·····,,·x························ ..•· • ·••...•.......•.•....................•...•...•.....••...•.•...•...•....................•.... ,•..., ..••...•... ,...•.........•...............................•... " ..•...•........................................ " .•...•...•......•..................................... -..•.....•....•.....•...•.•....... ,.....................................•... ".- .•.....•....... , ,. .

- Dieu tri ngoi,li tru: Bien ban hQi chan cua b~nh vi~n (Ban chinh ho,c bSn sao co chU'ng th\fC) va giay xacnh~n dqt di~u trj (bSn chinh) n~u Bien ban hQi ch~n khong th€ hi~n thai gian di~u trj ngoi,li tru .

...!'Jg~i!~§~gc:()IlO''!1: ,- Truang hqp dieu trj nQi tru: Giay ra vi~n (Ban chinh)......................'\ , ;( ?t ,,-- .

~ Dieu trj ngoi,li tru: So y bi,lho~c Giay chung nh~n nghi vi~c hu6TIg BHXH mau C65~HD (banchinh)~Gi~y~~cnt1~n vrnghi~i~cdrchiins6ccon· bin· c~angu&rs&dvng Iaod~ng· nalngu&ilaodQngngh i vi~ctruac do (cha hoQ,cmy) d1ihu6TIg h~t thai gian theo quy djnh theo m§.u 5B-HSB (ban chinh)N~u m€u trj b~nh fI nu-cYcngoai, ngoai nhfrng h6 sO' tl;li phin I, bi} sung:Ban djch ti~ng Vi~t (duqc cong chung) giAy kham, chfra b~nh do CO' sa y t~ nuac ngoai cApH6 sO'bao Iu-u so:Di~u kien: Nguai lao dQng co ten trong danh sach bao giam (mau D02-TS) va dan vi d1i th\l"Chi~n dti nghia vI,!dong BHXH, BHYT~6~Ii~9!;~g~c:~§~!:l~I!y~c:~c:t~~llgtC!T~i;I~()~c:!C!9i~~§y~(;~(;!r~llg!~r(!i,g§'!1:(~~~l:~i~~)

Tarai:TO' bia so:S6 BHXH (m§.u cll):

Danh sach theo m§.u Ol-DSIXNS (02 ban chinh)CMND ban photolI nguaitiv nhi~m chi hoQ,Cgiay chuyen tien (neu co)Con!!; vim cam ket thanh toan nq (neu co)

Ngay tra k€t qua: ./ ./ (Qua hc;mtra h6 so"30 ngay, cac don vi chua d€n nh~n,cO"quan BHXH se chuy€n h6 sO"nay van kho luu tm)

............... , ngay thang nam .Can bQ ti~p nh~n h6 SO'

(Ky, ghi h9 ten)NguOi nQp h6 SO'

(Ky, ghi h9 ten)

Phiiu giao nMn h6 sa nay ap d!mg ki tit ngay 11/3/2013

sA H6 sO': 613/ ....•...••.... .ICDBHXH CQNG HOA XA. HQI CHU NGHiA VI:E:T NAMDQc l~p - T1}'do - H\loh phuc

PHIEU GIAO NHAN HO SO.Lo~.i h8 sO': Vira ghii qlly~t trQ"c§,P thai SaDvlra bao lUll sA BHXH

(ThOi h\lO giai quy~t IO\li ho sO' nay: 15 ogay lam vi~c)

1. Ten dan vi: " ,' Mil dan vi:.·· ,., ., , ,.,,

2. Di~n thol;li: Email: , , , . , .

H8 SO' giai quy~t trQ' cAp thai san.- Danh sach nguai laGdQng d~ nghi huang ch~ dQthai san theo mau 67a-HD (03 ban chinh)

.M •• M ••• _ •• ~~ •• , ••• M •• M ••••••••••• _ •• _ •• _ •• _ ••••••••••••••••• _ ••••••••••••• •••• _,;: ••••••••••• __ •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• _ •••••••••••• M •••••••••••••••••••••••••••••••••••••••••••••••••••••••••• ." •••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• ~ ••••••

- Van ban xac nh~n dieu ki~n lam vi~c n~ng nhQc, dQc h?i, nguy hiem, 3 ca ... kern 02 ban chinh D02-TS denghi di~u chinh chuc danh cong vi~c,Truang hQ'Pnguai laG dQng Kham thai: So kham thai ho~c Giiiy kham thai ho~c Giiiy chUng nh~n nghi vi~chuang BHXH theo mdu C65-HD (Ban chinh)Truang hQ'Pnguai lao dQng bi say thai, n?o, hut thai, thai ch€t luu, th\lc hi~n bi~n phap tranh thai:- Gifiy ra vi~n (Ban chinh) ho~c

..............._ ,.. - _ _ -···················i·· ···..······················· .- Giiiy chung nh~n nghi vi~c huang BHXH theo mau C65-HD (Ban chinh)

I.r.'!.~g~<zp.~.g'!.~i}~?~2.~g~i.~~~?~.:...............- Giay khai sinh ho~c chung sinh cua con (Ban sao co chUng th"c, 01 ban/con)

......._ ,.._.._ _.._ 1.-_ _ _ _ ., _ - _ - - .- Neu con chet phai co them giiiy chung tu, (Ban chinh ho~c ban sao co chUng th\l'C, 01 ban/con),

..... _ ....••..••......•.•.•.•................... _ _ .•...•.•.••..••..•......•......... 1.. .......................•. _ .••..••...•.•.•.....•.. _ _ .....•....••..••...•.........................................•...•....• , ..••... " t. ,..~ _ .+ Truang hgp con chet ngay sau khi sinh ma khong dugc ciip Giay chung tu thi thay bang B~nh an (Ban sao cochUnl!:th"c, 01 ban/I con) ho~c,+ Giiiy ra vi~n cua nguai m~ (Ban chinh ho~c ban sao co chung th\l'c).Truang hgp laGdQng nO'bi tan t~t: Giiiy chung nh~n ty l~ thuang t~t 21% tra len (Ban chinh ho~c ban sao cochUng th"c)Nh(m nuoi con nuoi duai 4 thang tuoi: Quyet dinh cong nh~n vi~c nuoi con nuoi (Ban sao co chUng th"c)

....Tr.'!.~g.~<zp~~l!.!<:.~.i.~.i.~.~..~?~ '?~.<::~~~:.... . .:gi~x~hfr.~J:~..~J!.~~~.'?~JQ!~.~.~~!':l?.~~,~'!~g.t.'!'l.~).....;<._- Dan cua nguai cha ho~c nguai tJVc tiep nuoi dUOngcon theo mau lIA-HSB (ban chinh)

File dO'li~u: Gui qua Email DIMS D Chuy~n b&ngdIa D Chuy~n b&ngUSB DH8 SO' bao lU'U sol>ieu kien: nguai laGdQng co ten trong Danh sach bao giam (mau D02-TS) va dun vi dii th\lc hi~n dil nghl'a VI)

dong BHXH, BHYT,....§?.~tI~!::':..b?~~...~<?..I!.I::T~'::I...y~..<::~~...~r.~l1g..t~1:?i.;.b()~ct?.~.i.~..~<?.y~..<::~<::..tr.'.ll1gt~..r.~i.,.g<?'?.:...(.IJ~Jl...~.~.~Jl.~).....

Tarai:Ta biaso:·········..···············S~rBHXH·(md~··cU):·········· .

Danh sach theo mau 01-DS/XNS (02 ban chinh)CMND ban photo/l nguaiuy nhi~m chi ho~c giay chuyen tien (neu co)Cong van cam ket thanh toan ng (neu co)

Ngay trll k€t qua: ./ ./ (Qua h~n trll h6 sa 30 ngay, cae dan vi chua d€n nh~n,co quan BHXH se chuy~n h6 sa nay vito kho luu trfr)

............... , ngity thang nam .Can b{) ti~p nh~o h6 sO'

(Ky, ghi h9 ten)NgllOi n{)p h6 sO'

(Ky, ghi h9 ten)

Phiiu giao nh(m h6 SO'nay op dlmg ki tit ngiIy 11/3/2013

SelH6 sO': 614/ •.........•... .ICDBHXH CQNG HOA XA HQI CHU NGHiA VI~T NAMDQc I~p - TV do - H~nh phuc

PHIEU GIAO NHAN HO saLo~i h6 sO': Giai quy~t ch~ dQ huu tri va di~u·chinh? nhan than, chu-c danh ngh~

deli vOi ngum bao luu so(Thm h~n giai quy~t lo~i h6 sO' nay: 20 ngay lam vi~c)

1. Ong (ba): .

2. 86 di~n tho~i lien l~c: .

STT

I.

1.

2.

3.4.

5.

6.

7.8.9.10.11.

SelluQ'Il~

H3 sO'hU1l tri~?~J:I?<:J:I;~?~~~?~J:I?<:J:I\'~~~~t~~~~t(yr(yi;~?~~t.l'r~i~~?\'~~~~tr(ll1i?t.?r(yi~i??Il1:(~~llc~il1~)

Tarai:Ta bia s6:S6 BHXH (mdu eii):

- Dan de nghj hu<'mgeh~ d(i hUlltri theo mdu 12-HSB (ban chinh), ho~e=Gidy~hfr~g~h~~~ht;h~d6i~6i~g~t;ii~;d~~g~ghi~i~~~hbd~di~~ki~~~~t~6id&i(bii~~hi~h).Quy~t djnh ehuy8n nganh va cae Quy~t djnh phong quan ham - n~u e6 (Ban saG co chUng th •••·c)Bien b~mgiam djnh mue suy giam kha nang lao d(ing tu 61% tra len eua H(ii dong Giam dinh Y khoa - neu co(Ban chinh, 03 ban)Giay chung nh~n bj nhiem HIV/AIDS do rui ro b~nh nghe nghi~p - neu co (02 Ban chinh ho,c ban saG cochUn2 th\fc)Doi vai nguai chap hanh xong hinh ph~t tu trong truang hgp khong duge hu<'mgan treo, bo sung: Giay chungnh~n chdp hanh xong hinh ph~t tu (02 Ban saG co chu-ng th\fc)Quy€tdinh tra v~nuUcdjnh cu hgp phap - n~uco (02 Ban saGco chUng th.,e)Quy€t djnh ctia Toa an tuyen b6 milt tich tra v~ - n~u co (02 Ban saG co chUng th\fc)Van ban giai trinh vi~c n(ip h6 sa huu tri ch~m so vai thai di8m hu<'mgluang huu (01 ban chinh)Phi~u cung cdp thong tin s6 tai khoan do nguai hu<'mgluang huu d~ nghj (01 ban chinh) (n~u co nhu cAulCac gidy ta khac co lien quan (n~u co)HB sO'di€u chinh nhan than:- CMND, H(i khftu (01 ban saG co chUng th •••·c)=D~d~~ghj~~~~g;;bith~~gi~~~~DOi=TS(Oibi~~hi~hj:

11.=D~~~~~hd~~ghjth~;~;1~D02=TS(Oibii~ ~hi~hj ....................................................... ·x····························· .. ······ll.)··············· , , , , , , , , , , ' , ' , , , , , , , , , " .. " ", " , , , , , ".,.,.",." .. ,.,.""." ..- Van ban de nghj (mau DOlb-TS) ctia dan vi nai dang lam vi~e ho~c dan vi quan Iy truac khi ngirng vi~c ho~c~~yiq~~~ly.<::~P!~~ll!~<J.~g.!~~gh~p~er.~yi~~~~ph~~~ll~gi~it~~:J~!~~~.~~i~~},- Van ban dinh chinh cae lo~i ho sa, giay ta ctia dan vi quan Iy va ea quan co tham quyen.H3 sO'di€u chinh chu-c danh ngh€:

···=·V~~·b~~·d~···~ghj···~~~··dc;;:;~j·(~~~·DOi·b=TSj·(oi·bii~···~hi~hj:············=D~dr~ghi~~~··~g;;&ith~~gi~(~;1~DO·I·=Tsj.(oibi~ chinh).

III. .·=6~~h~~~hd~~ghjth~;~;1~D02=TS(oibi~~hi~h)·· .················· ..······ ..·1•...•...••.•·..·••.·..··..•··..·..•············ ..·········· •....... ·..•·..··1..·· ·· ······..······ ~ 1" .••••...•...•...•...•...•....•.•...•.......•...•......•.....•••••... ,. .•••.••.......•. , ••.........•........ 'l " ,...•.......•................................ " .

-Quyet djnh ho~c hgp dong Ian d(ing, hgp dong lam vi~c, giay ta lien quan den vi~e dieu chinh (kern theo ban.<::.h.!ll~~~~?i<::hi~~):(~~~~~()~~..~~tPg~~v.~) .- Cong van giai trinh ctia dan vi (01 ban)

LU'u P:- Nguai co quydt d;nh chi! huu cua cO'quan BHXH khOng can n(Jp s6 BHXH vi cO'quan BHXH dang giCi'.- Sau khi giai quydt xong, s6 BHXH se luu giCi't(li cO'quan BHXH, khOng tra cho co nhdn.- Niu sai lfch nhan than (h(J, ten ilfm, ten, ngay, thOng, niim sinh) gUra sa BHXH va CMND, Hp Khliu thi ilJ nghi iliJu chinh saBHXH trU'dc khi giiii quyit h6 sO'huu tri. Cd quan BHXH khOng iliJu chinh l(li nhi1'ng sai sot tren sau khi ilti lpp QD hU'u tri.Ngay tra k~t qua: ./ ./ (Qua h~n tra h6 sa 30 ngay, 6ng (ba) chua d~n nh~n, cO'quan BHXH se chuy~n h6 sa filly vao kho lUll tnI)

............... , ngay thang nam .Can bQ ti~p nh~n h6 sO'

(Ky, ghi h9 ten)Ngum nQp h6 sO'

(Ky, ghi h9 ten)

Phi€u giao nhgn h8 s(/ nay ap dl,lng k~ tit ngay 11/3/2013

86 H6 sO': 615/ .ICDBHXH CQNG HOA XA HQI CHU NGHiA VI~T NAMDQcl~p - T1f do - H~nh phuc

PRIED GIAO NR~N HO SOLo~i h6 sO': Giai qlly~t ch~ dQ hUll tri va di~ll chinh nhan than, chfrc danh ngh~

deli v6"ing1fCYidang lam vi~c(ThO; h~n giai quy~t lo~i h6 sO' nay: 20 ngay lam vi~c)

1. Ten dO'l1 vi: Mil dO'l1 vi: ··· .

2. Di~n tho~i: Email: .

H8 sO' hU'U tri:

~?!:3II.~!:!~S'~<;.~?!3I!?9!:!:.c.~c.t.r~rlgt~Jr'!i~(~~c.~?t.iJ~i~:!:<;~<;t.r~rlgt.iJr?:i(~~I1~~il1~):- TiJ riJi:- TiJ bia s6:- S6 BHXH (mdu Cll)

Quyet dinh nghi vi~c hu6ng che d(>huu tri theo mau do B(>LDTB&XH quy dinh (03 Ban chinh).Quyet dinh chuyen ngfmh va cac quyet dinh phong quan ham - neu co (Ban sao co chUng thlfC)02 Oiay chung nMn bi nhiem HIV/AIDS do rui ro b~nh nghe nghi~p - neu co (Ban chinh ho,c ban sao cochUn~th\l'c,Doi vai nguiJi chap hanh xong hinh phl;lttu trong truang hc;rpkhong dugc huang an treo, bo sung: Oiay chungnh~n chdp hanh xong hinh phl;lttu (02 Ban sao co chti'n~ thlfC)Quyet dinh tr6 ve nuac dinh cu hgp phap - neu cO (02 Ban sao co chti'n~thvc)Quyet dinh cua Toa an tuyen bo mat tich tra ve - neu co (02 Ban sao co chu'ng thl,l'C)Phieu cung cap thong tin so tai khoan do nguiJi huang luang huu de nghi (01 ban chin h) (neu co nhu cau)Van ban ghii trinh vi~c n(>pho sa huu tri ch~m so vai thiJi diem huang luang huu (01 ban chinh)H6 sO'dieu chinh nhan than:

::~·~~~~~~i~\~~~~J.~~ft.~~~f.t.~~~~~1~i~>:i~;:~:~~~~i:~~)~::::::::m- Van ban de nghi (mau DOlb-TS) cua dan vi nai dang lam vi~c ho~c dan vi quan Iy truac khi ngung vi~c

~:~~~h~~1~~~tgg6Lrt:~~t~~~J.~~9~~f$7:!~~~~;~i;~j~~~~~~~~~,~i~i~~~.~~I=~~~~:~~).- Van ban dinh chinh, cac 10l;liho sa, giay tiJ cua dan vi quan ly va ca quan co tham quyen. (ban sao co chu'ngthlfC);I!~s«!~i~lIl:ltil1ltl:~li:l:~lll1ltl1glt~:- Van bim d8 nghi cua dan vi (mdu DOlb-TS) (01 ban chinh) .

................................•. ., .- Dan de nghi cua nguiJi tham gia (mdu DO1-TS). (01 ban chinh).·~·Danh·sichd~·nghTtheom·[~·D02=TS(Oiblinchinh):········ .

••• ~ •••• _M •••••••••• _•••••• ., •••••••••••••••••••••••••••• _ ••••••• _ •••••••••••••••• •• •• • •••••••••••••• x · ········..········..· ·· · " J:. , ~ *•••..•...-.•-.•...-.--.•-_._....••

- Quyet dinh ho~c hc;rpdong lao d(>ng,hc;rpdong lam vi~c, giay tiJ lien quan den vi~c dieu chinh (kern theo ban...c:~!rl.~..~~ ~~ic:~i~~).:(~.~.'t.~.~~c:..~':~li:IlJ~.!~1[c:.) .- Cong van giai trinh cua dan vi (01 ban)

Luu P:- Sau khi giai quy€t xong, s6 BHXH se hru t{li C(J quan BHXH kh6ng tra eho ngzrO'i lao d(mg.- Nfu sai lfeh nhan than (h{J, ten itfm, ten, ngay, thang, niim sinh) giira sa BHXH va CMND, Hp khau thi it€ nghi iti€u ehinhsa BHXH trzrue khi gitii quyft h6 sO' huu trf. CO' quan BHXH khfmg iti€u ehinh l(li nhirng sai sot tren sau khi ita l~p QD hzrutrio

Ngay tn\ k€t qua: ./ ./ (Qua h<;lntra h6 sO'30 ngay, don vi chua d€n nh~n h6 sO'cO'quan BHXH se chuy€n h6 sO'nay vao kho luu trfr)

............... , ngay thang nam .Can hi}ti~p nh,n h6 sO'

(Ky, ghi ho ten)Ngm'yj ni}p h6 sO'

(Ky, ghi ho ten)

Phi~u giao nhtJnh6 sa nlly ap dyng k~ tit ngay 11/3/2013

S6 H6 sa: 6211•.•........... .ICDBHXH CQNG HOA XA HQI CHU NGHiA VI~T NAMDQcl~p - T,! do - H~.lDhphuc

PHIEU GIAO NHAN HO SO.Lo~i ha sO':Giii quy~t ch~ dQhU'Utri do cO'quan BHXH giOithi~u giam djnh y khoa

(ThOi h~n giai quy~t lo~i h6 sa nay: 45 ngay lam vi~c)

1. Ong (ba): .

2. S6 di~n tho~i lien l~c: .

Lo,i gi§y to', biSu miu

....~~...~.tI.~tI;...~.~~.(;....~.~....:E.3tI.~tI.y~(;~(;..tr<lJ1gt(y ...r(yi; ....~~.~(; ..t.(y.~I.<l...~.i)...y~.(;~(;..t.r.<ll1g..t(y ..r(yi •...g~Il1.: ...( ~.~I1...<:.~.il1.~)....Tarai:

So10"

LU'u v:- NguiJi hiw luu s6 ho(lc dang dong BHXH tl! nguy¢n, ni)p h6 sa t(li BHXH qUtJn,huy¢n nai cu tru.- NguiJi co quyh djnh cM huu cua BHXH Tp.HCM kh6ng cJn ni)p s6 BHXH vi ca quan BHXH dang giu s6.- Sau khi giai quyit huu tri, s6 BHXH se luu giu t(li ca quan BHXH, kh6ng tra cho nguo'i lao di)ng.- N€u sai /fch nhan than (hr, ten afm, ten, ngay, thang, nom sinh) giii'a s6 BHXH va CMND,Hv khiiu thi a€ nghj di€u chinhs6 BHXH truuc khi giai quy€t h6 SO'hU'Utri. CO'quan BHXH khong ai€u chinh l{li nhii'ng sai sot tren sau khi au lq.pQD huutri.

Ngay tra k€t qua: ./ ./ (Qua h~n tra h6 sO'30 ngay, 6ng (ba) chua d€n nh~n, cO'quan BHXH se chuy~n h6 sO'nay vao kho lUll tm)

............... , ngay thang niim .C~nbOti~pnh.nh6sa

(Ky, ghi h9 ten)NglfOi nOp h6 So'

(Ky, ghi h9 ten)