D01b-TS

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    Mu s: D01b-TS(Ban hnh km theo Q s:1111 /Q-BHXH

    ngy 25./10/2011 ca BHXH !"t #am$

    n v:..........S:.....................

    CNG HA X HI CH NGHA !I"T NAM#$ %&' - T( )* - H+n, ',$

    ................% ngy ..... th&ng ..... n'm ...........

    Knh gi: Bo him x hi.............................................

    - Tn n v:..................................................................................................

    - M s qun !:.............................................................................................

    - "# $h%:........................................................................................................

    N# )un/:

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    Tn n v:...........................M s:...................................

    DANH S=CH > NGH?(3m theo c4ng 'n s:.................... ngy......................$

    STT H@ v 8Bn M s N# )un/