CNG HO X HI CH NGHA VIT NAMc lp - T do - Hnh phc----------oOo---------

..., ngy.... thng ..... nm 20....

N XIN LY HN

Knh gi:TO N NHN DN ...............................................................

H v tn ngi lm n:sinh nm:.....Ngh nghip:...Ni lm vic: :.....Ni ng k HKTT: ...Ch hin ti:..............H v tn chng (v): :sinh nm:...Ngh nghip:...Ni lm vic:.......Ni ng k HKTT:....Ch hin ti:..ng k kt hn ngy:..../..../...Ni ng k kt hn:...V tnh cm: (V/chng sng hnh phc n khi no pht sinh mu thun? Nguyn nhn pht sinh mu thun? L do ly hn?)..

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.V con chung: (H tn, ngy thng nm sinh ca tng con, sau ly hn ai nui con? ng gp nui con nh th no?)................V ti sn:- Ti sn chung ca v chng gm nhng th g? Nguyn vng sau khi ly hn? (T nh gi gi tr ti sn)...........- Ti sn ring (nu c) ghi r nguyn vng v ti sn ring nu ly hn (t nh gi gi tr ti sn):..........V nh : (Nh t nhn hay thu ca nh nc, din tch, nguyn vng nh sau ly hn)...........

H s km theo: .., ngy..thng..nm 20...- ng k kt hn (bn chnh);-Bn sao giy khai sinh ca cc con (chng thc);-Bn sao S H khu (chng thc);-Bn saochng minh th (chng thc);-V mi giy t v nh t, ti sn c gi tr khc (bn sao c chng thc); Ngi lm n

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