- AMao so 1To trinh th6m dinh, phe duyet chu truong adu tu chuang trinh adu tu cong

CO QUAN L~P BAo cAoDE XUAT CHU TRUONGDAu TU CHUaNG TRiNH

CQNG HOA xA HQI CHU NGHiA VI.E:TNAMDQc l~p - T1}'do - Hanh phuc

se: ..... .lTTr- ...... . , ngay thdng nam .

TO TRINHVIv Th§.m dinh, phe duyet chu tnrong d~u tu... (ten chuang trinh adu tu cong. .)

Kinh giri: - Celp co th§.mquyen quyet dinh chu tnrong d~u tu chuang trinh;- Co quan th§.mdinh.

Can cir Luat D~u tir cong;Can cir Nghi dinh huang dfin thirc hien Luat d~u tu cong;Can cir ..... (cac din cu phap 1y khac co lien quan);

r (Co quan 19p bao cao tid xudt 9hu truang? adu tu chuang trinh) trinh ....(cap co thdm quyen) .... ; (Co quan thdm dinh) tham dinh, phe duyet chu tnrongd~u tu chuang trinh thea nQi dung sau:- Ten chuang trinh d~u nr.- Chu chuang trinh d~u tu,- Dia diem, dien ttch (n~u co) th\lc hi~n chuang trinh d~u tu.1. S\l c~n thi~t cua chuang trinh d~u tu.2. M\lc tieu, ph~m vi, va quy mo chuang trinh.3. D\l ki~n tfmg muc v6n va ca celungu6n l\lc th\lc hi~n chuang trinh (danh m,¥cd'lf an hoq.c aai tU(Jrlgadu tu,· khd nang can tiai ngu6n van tidu tu, huy ti9ng cacngu6n van khac).3.1. D\l ki~n t6ng muc d~u tu:3.2. Ca celungu6n l\lc th\lc hi~n chuang trinh:3.3. Kha nang can d6i v6n:

* V6n Trung uang:* V6n ngan sach tinh:* V6n ngan sach huy~n, xa:* Cac ngu6n v6n huy dQng hgp phap khac (n~u co):

4. D\l ki~n ti~n dQ th\lc hi~n chuang trinh phil hgp vai diSu ki~n va kha nang huydQng cac ngu6n l\lc thea thu t\l uu tien hQ'Ply dam bao d~u tu co hi~u qua.5. Xac dinh chi phi lien quan6. Phan tich, danh gia sa b9 anh huemg, tac d9ng vS m6i truOng xa h9i, tinh toanhi~u qua dfiu tu vS KT-XH cua chuang trinh.7. Phan chia cac d\l an thanh ph~n cua chuang trinh.8. Cac giai phap t6 chuc th\lc hi~n.

12. D\I ki~n tien dQ trien khai thirc hien dfiu ur (phil h9]J WYi di~u kien thuc ti vakha nang huy dong cdc nguon luc theo thtr tv U'U tien hop Iy bao dam d6u tu tQPtrung, co hieu qua). Phan chia giai doan dfiu ur (neu co)13. Phan tich, danh gia sa bQtac dong vS moi tnrong, xa hoi; xac dinh sa bQ hieuqua dfiu tu vS kinh t~ - xa hoi,14. NQi dung cong tac se thuc hien trong giai doan chuan bi dfiu tu.14.1. Cac nQi dung cong viec cfin thuc hien trong giai doan chuan bi dfiu tu,

- Khao sat, thu thap s6 lieu, tai lieu, thoa thuan voi cac co quan lien quan ...phuc vu lap du an dfiu ur,

- Khao sat xay dung (dia hinh, dia chftt...)- L~p du an dfiu tu / ho~c l~p bao cao kinh t~ ky thu~t xay dvng cong trinh- L~p, thftm dinh va phe duy~t bao cao danh gia tac dQng moi truOng (niu

cdn).- Trinh thftm dinh, dS nghi phe duy~t d\I an dfiu tu ho~c bao cao kinh t~ ky

thu~t xay d\fllg cong trinh.- Nhling nQi dung chuftn bi dfiu tu khac (n~u co).

14.2. Kinh phi chuftn bi dfiu tu va ngu6n v6n chuftn bi dfiu tu:- Kinh phi chuftn bi dfiu tu: (Kinh phi chudn bi ddu tu dur;c tinh toan tren

co sa cac dtnh muc, dan gia va tY l¢ theo quy dtnh hi¢n hanh).- Ngu6n v6n chuftn bi dfiu tu.

14.3. Thai gian triSn khai cong tac chuftn bi dfiu tu d\I an:- Ti~n dQtriSn khai chi ti~t cac cong vi~c chuftn bi dfiu tu, ...- Thai gian chuftn bi dfiu tu (Ghi ro thai gian bat ddu, trinh dv an ddu tu va

kdt thuc cong tac chudn bi ddu tu)15. Xac dinh chi phi lien quan d~n qua trinh th\l'c hi~n va chi phi v~n hanh, baoduang sau khi hoan thanh.16. T6 chuc th\Ic hi~n

co QUAN L~P BAocAoDE XUAT cuiJ TRUONG DAu TU

Dl/ AN(Ky ten, dong ddu)

T~i li~u kern theo trong hB so d~ xu it cho phep thuc hi~n chuan b] d~u to'gom:

1. Cac bieu tinh toan so b{>v~ kh6i hrong cong viec va sa b{>tinh toan tfmgmire d~u ttr, chi phi chuan bi d~u tu, ...

2. Cac tai lieu lien quan vS quy hoach phat trien nganh, linh vue, quy hoachxay dung (bao gbm ca van ban phe duyet quy hoach, so db hoac trich luc ban d6vi tri, tai lieu hoac van ban gioi thieu dia diem, ban ve quy hoach ...).

3. Cac tai lieu, van ban lien quan khac (neu co)

- AMau SO 2To trinh thdm dinh, phe duyet chu truong ddu tu du em nhom A

(Baa g6m ccldu an khong co cdu phdn xdy dung thi ap dung tuong tvthuc hien thea quy dinh cua phap ludt v~ xdy dung)

co QUAN L~P BAo cAoDE XUAT cui; TRUONG

DAUTUD1! AN

CONG UOA xA HOI CHD NGHiA VIET NAM. . .DQcl~p - TV do - Hanh phuc

sf>: ..... .ITTr-...... . , ngay thang ndm .

TO TRiNHVIv ThAm dinh, phe duyet chu tnrong dfiu tu

.. (ten du an ddu tu cong. )

Kinh gui: - Cap co thfrm quyen quyet dinh chu tnrong dfiu tu du an;- Co quan tham dinh.

Can cir Luat ufiu tu cong; Luat Xay dung;Can cir Nghi dinh huang dful thirc hien Luat dfiu tu cong; Luat Xay dung;Can cir ..... (cdc din cli'phap If;khdc co lien quan);(CO'quan ldp baa caa d~ xUdt chu truong ddu tu dl! an) trinh .... (cdp co

tham quy~n) .... ; (CO'quan tham dtnh) thfrm dinh, phe duy~t chu truang dfiu tu dvan theo nQi dung sau:- Ten dVan.- LOC;licong trinh, c§.p cong trinh- Chli dfiu tu.- Ca quan qUlin ly, su d\mg, khai thac san phfrm, cong trinh sau khi dfiu tu.1. Sv cfin thiSt phcii dfiu tu va cac diSu ki~n d@thvc hi~n dfiu tu, danh gia vS cvphil hgp voi quy hOC;lCh,kS hOC;lChdfiu tu.2. Dv bao nhu cfiu, phC;lmvi ph\lc V\l va dv kiSn m\lc tieu dfiu tu, quy rno va hinhthuc dfiu tu.3. Khu vvc, dia di@mdfiu tu, dV kiSn nhu cfiu di~n tich su d\lng d§.tva nhu cfiu Slrd\lng tai nguyen khac;4. Phan tich, h,ra ch9n sa bQvS cong ngh~, ky thu~t va cac diSu ki~n cung c§.pv~ttu, thiSt bi, nguyen li~u, nang luqng, dich V\l,hC;ltfing;5. Phan tich, Iva ch9n sa bQ cac phuang an dfiu tu va quy mo cac hC;lngm\lc dfiutu;6. Phuang an t6ng th@dSn bil, giai phong m~t b~ng, tai dinh cu, bi~n phap bao v~moi truang;7. Phan tich, danh gia sa bQtac dQng vS moi truOng, xa hQi cua d\I an;8. Dl,l'kiSn ngu&n v6n dfiu tu, phuang an huy dQng v6n, ca c§.ungu&n v6n.8.1. D\I kiSn t6ng muc dfiu tu:8.2. Phuang an huy dQng v6n:

9. KSt luan.(Dan vi 19p baa caa d~ xudt chu truong ddu tic chuang trinh) kinh trinh

(cdp co thdm quyen), (co' quan thdm dinh) xem xet, tham dinh va quyet dinh chutnrong d~u tu chuang trinh.l. ",.Nui nhpn: DON VI L~P BAo cAo..................., DE XUA.TCHU TRUONG DAu TV'..................., CHUONG TRINH

- LUll. (Ky ten, dong ddu)

- J.Mall so 3To trinh thdm dinh, phe duyet chu truong tldu ttr die an nhom B, C

CO QUANL~P BAo cAoDE XUAT CHU TRUONG

DA.UTUDVAN

C<)NG HOA xA HQI CHU NGHiA VI~T NAMDQc I~p - T., do - Hanh phuc

s6: ..... .lTTr- ...... ......... , ngay thdng nam .......

TO TRiNHVIv Tham dinh, phe duyet chu tnrong d~u ttr

...... ... (ten dl! an tldu tu cong ...... .)

Kinh gtri: - C~p co th~m quyen quyet dinh chu truang d~u tir du an;- Co quan tham dinh,

Can cir Ludt £)~utu cong; Luat Xay dung;Can cir Nghi dinh huang d~n thirc hien Luat d~u tu cong; Luat Xay dung;Can cir ..... (cdc din cu phdp If khac co lien quan);(CO'quan ldp baa cao tl~ xudt chu truong tldu tu du an) trinh .... (cdp co

tham quyen) ....; (CO'quan tham dinh) tham dinh, phe duyet chu truang d~u tu duan theo nQi dung sau:- Ten du an.- Nhom du an.- Loai cong trinh, c~p cong trinh.- Chli d~u tu.- Co guan quan ly, sir d\lng, khai thac san ph~m, cong trinh sau khi d~u tu.1. Sg c~n thi~t d~u tu, cac diSu ki~n dS thvc hi~n d~u tu, danh gia vS sg phil hQ'Pvai quy ho~ch, k~ ho~ch d~u tu;2. M\lc tieu, guy mo, dia di~m va ph~ vi d~u tu;3. Dg ki~n t6ng muc d~u tu va co c~u ngu6n v6n d~u tu, kha nang can d6i ngu6nv6n d~u tu cong va vi~c huy dQng cac ngu6n v6n, ngu6n Ivc khac dS thgc hi~n dVan:3.1. Dg ki~n t6ng muc dfiu tu:3.2. Phuang an huy dQng v6n:3.3. Co c~u ngu6n v6n:

* V6n Trung uang:* V6n ngan sach tinh:* V6n ngan sach huy~n, xii:* Cac ngu6n v6n huy dQng hQ'Pphap khac (n~u co):

4. Du ki~n ti~n dQtriSn khai th\!c hi~n d~u tu phil hQ'Pvai diSu ki~n thgc t~ va khanang huy dQng cac ngu6n Igc theo thu tg Uti tien hQ'Ply bao dam d~u tu t~p trung,co hi~u qua;

8.3. CO' cau nguon vim:* V6n Trung irong:* V6n ngan sach tinh:* V6n ngan sach huyen, xa:* Cac nguon van huy dong hQ'Pphap khac (neu co):

9. Xac dinh so bQ chi phi van hanh, bao dirong, duy tu, sua chua 1611trong giaidoan khai thac du an;10. Du kien tien dQthuc hien du an, phan chia giai doan d~u nr;11. Xac dinh so bQhieu quit d~u tu v~ kinh t~ - xa hQi cua du an;12. Phan chia cac du an thanh phan hoac tiSu du an (neu co);13. Cac giai phap t6 chirc thuc hien.

(Chi ti~t co thuyet minh DJ cuong va khai toan cong tac chu(ln bi ddu tic

kem thea Til trinh nay).(Don vi ItJp baa cao c1J xudt chit truang ddu tu du an) kinh trinh (cdp co

thdm quyen), (co quan thdm dinh) xem xet, tham dinh va quyet dinh chu truangd~u tu d\f an.!.

•• " •• 0 •••••••••••••••••• ,

DONVI L~P BAo cAo DEXUATCHU TRUONG DAu TU Dl/ AN

(Ky ten, dong ddu)

NO'i nhQ,n:........................,

- LUll.

M§u 88 4Bao cao dJ xudt chu truong ddu tu chuang trinh, du an ddu ttr

CO QUAN L~P BAo cAoDE XUAT CHU TRUONG

DAuTU

CONG HOA XA HOI CHU NGHiA VIET NAM. . .DQc I~p - Tt,r do - Hanh phuc

, th ' V.......... , ngay ang nam .

BAo cAo DE XUAT CHU TRUONG DAu TV'HO~C BAo cAo NGHIEN CUu TIEN KHA.THI

1. Ten chuong trinh, du an.2. CO'quan lap bao cao d8 xufit chu truong d~u tu3. CO'quan quan ly, sir dung sau d~u tu.4. Sir c~n thiet d~u tu.

- Danh gia v~ hien trang, nhu c~u.- Phan tich danh gia vi tri, vai tro cua Dir an dBi voi sir phat triSn kinh tS- xa hoi, nganh ...- Danh gia tinh cfip thiet phai d~u tu du an.

5. Dia diSrn d~u tu.Thuyet rninh hien trang dia diSrn d~u tir.

6. Sir phu hop voi quy hoach, kS hoach phat trien kinh tS xa hoi.- Su phu hop voi quy hoach phat trien kinh tS - xa hQi tinh, dia phuong.- Sv phu hqp vai quy ho~ch ph:it triSn nganh.

7. Mvc tieu d~u tu, quy rno va nQi dung d~u tu.- Mvc tieu d~u tu.- Quy rno d~u tu (Lugngiiii chi tiit vJ vi?c xac djnh quy rnaddu tuJ.- NQi dung d~u tu chu ySu (neu ro nhimg hgng rn1!-cddu tu chu yiu dv kiin

se ddu tuJ.8. Phan tich, Iva chQn sO'bQv8 xay dlJflg, cong ngh~, ky thu~t va thiSt bi phu hQP.9. Dv kiSn t6ng rnuc d~u tu va cO'cfiu ngu6n vBn d~u tu, kha nang can d6i ngu6nv6n d~u tu cong va vi~c huy dQng cae ngu6n vBn, ngu6n h.rc khac dS thvc hi~n d\}'an.9.1. Dv kiSn t6ng rnuc d~u tu9.2. PhuO'ng an huy dQng v6n va kha nang can d6i v6n9.3. CO' cfiu ngu6n v6n d~u tu:

* V6n Trung uong:* V6n ngan sach tinh:* V6n ngan sach huy~n, xa:* Cae ngu6n v6n huy dQng hqp phap khac (nSu co):

10. Phuong an t6ng thS d8n bu, giai phong rn~t b~ng, tai dinh cu (nSu co).11. Phan chia cae dvan thanh ph~n cua chuong trinh, dV an (nSu co).

5. Xac dinh so bQ chi phi lien quan trong qua trinh thuc hien va chi phi van hanhdu an sau khi hoan thanh;6. Phan tich, danh gia so bQ tac dQng v~ moi tnrong, xa hoi; xac dinh so bQhieuqua dfiu nr v~ kinh tS - xa hoi;7. Phan chia cac du an thanh phfin (neu co);8. Cac giai phap t6 chirc thuc hien.

(Chi tidt co thuyet minh DJ cuang va khdi toan cong tac chuan hi ddu 'urkem thea To trinh nay).

(Dan vi ldp baa caa dJ xudt chu truang ddu tu du an) kinh trinh (cap cotham quyen), (co quan thdm dinh) xem xet, thAm dinh va quyet dinh chu tnrongdfiu tu du an.!.

........................,

DONVI L~P BAo cAo DEXUATCHU TRUONG DAu TU mr AN

(Ky ten, dong ddu)

Nai nh{in:........................,

- LUll.

M:t ,(v.~ b 7 ~ , au so 5an an de nghi thdm di h ~ ,: , ./I'\o':' , .d' , In nguon von va kha nang cdn ~o':· ,:IV I VOl U an ' d A ~ W I von. su l:lngmot phan ngdn sdch cap tren)

" DON VI DE NGHITHAM DlNH NGUON VON

CONG HOA XA HOI CHU NGHiA VIET NAMDQc I~p - TV do - Hanh phuc .

V/v tham dinh nguon v6n va kihoach von thuc hien du an

......... , ngay thdng nam .

Kinhgiri:

...................................................................................

C~n c~ Lu~t.f)~u tu c?ng; ~u~t Xay dung;C~n c~ Nghl dIn? h,:ong,dan ,th\I~hi~n L~~t dAutu cong; Luat xs, dung;Can e~ ..:.... (cae ~an ellphap ~ khac co lien quan),

, Don VI de nghi tham din~ nguon v6n va kS hoach vim du anv...; (ten dtran} ...., co nhtrng nQidung chu yeu sau: .1. Ten du an:2. Chu dAutu:3. CO'qu~ qU,anly, su dung-khai thac san pham, cong trinh sau khi dAutu:4. Dia diem dau tu:5. M\lCtieu dAutu:6. Quy rno dAutu:7. Di~n tieh su d\lng dftt:8. LOlili,cftpcong trinh:9. Phuong an giai ph6ng rn~tb~ng, tai dinh eu (nSu co):10.Hinh thue dAutu:11.Tang muc dAutu (ucrctinh). Trong do:

- Chi phi xay d\Illg:- Chi phi thiSt bi:_Chi phi b6i thuang giai phong m~tb~ng, tai dinh cu:_Chi phi quan ly d\I an:_Chi phi tu vftndAutu xay d\Illg:- Chi phi khac:- Chi phi d\I phong:

12.Ngu6n v6n dAutu. Trong do:- V6n TW quan Iy:_ V6n do cap tinh quan Iy:_ V6n do cap huy?n, XQ quan Iy:_Cac ngu6n v6n khac (ghi c¥ thd timg ngu6n v6n):

13.TiSndQva phan leY dAutu t~\IC,hi~nd\I an:Phan ky kha nang can doi von va thai gian th\IChi~n d\I an (tuy thea d\I an

thuoc nhorn AlBIC du kiSn kha nang can d6i v6n se theo cac thai gian khac. .nhau):

DVT: tw« ang

Von Nguon Nguon von Nguon von kh~c (g~i cu, ,

c~p huy~n, th~ timg nguon von)TW von dip

Nam quan 1)' tinh xa quan ly ......... .......

quan 1")'- Nam thir nhat- Nam thir hai- Nam thir ........ "" " r

* De nghi giai trinh ro nQi dung, kha nang huy dQng von ngan sach caphuyen, xa quan ly.14. NQi dung cong tac chuan hi dAutu:15. Kinh phi chuan hi dAutu:16. Thai gian thuc hien chuan hi dAutu: (B&tddu va kit thuc).(eo thuyet minh D~ cuong va khdi toan cong tac chudn hi ddu tu kem thea)

D~ nghi quy co quan co van han dS co co sa thdm dinh vaphe duyet bao cao d~ xu§t chu tnrong dAuur, cho phep thuc hien chudn bi dAu tudu an ..... (ten du an) ...., thea quy dinh hien hanh.

Noi nh(i.n:- Nhir kinh giri;- Luu VT.

DON VI DE NGHI• •

B ' ,? M~u sB 6ao cao th ~ ·d· ,:,am 'inhnguon von va kha nang can a6i vonI?ON vr rHAMDINH

THAM DJNH NGUON VON CQNG HOA xA HQI CHU NGHiA VIET NAMDQcI~p - T" do - Hanh phuc .

V/v thdm dinh ngu6n win va kihoach v6n thuc hien d" an

... ... ..., ngay thong nam .......

BAocAo TRAM DINH NGUON VON vA KHA NANG CAN DOl VON........................ (ten chuang trinh/du an} .

Kinh ?1 gUl: .

Can cir Lu~t DAu tu cong; Lu~t Xay dung;Can cir Nghi dinh huang d~n thuc hien Luat d~u tu cong; Luat Xay dung;Can ell' (cdc din cUophap If;khdc co lien quan),Sau khi xern xet noi dung Van ban & bao cao d~ xuat chu tnrong d~u

tu cua ....(co quan ldp baa cao d~ xudt chu truong ddu tu), Bien ban tham dinhcua (Hoi dang tham dinh noi bo) va h~ sa tai lieu co lien quan, dan vithArn dinh Bao cao thAm dinh ngu6n v6n va kha nang can d6i v6n v6i nQi dungnhu sau:I. Danb muc cac titi lieu tbAm dinh. . .* V~ b? dA gh'an an en t ........ ·

* Bao cao d~ xu~t chu truang d~u tu .....* H6 sa tai li~u khac co lien quan (nSu co).

II. Thong tin chung- Ten Chuang trinhlD\l an._Ca quan giao l~p bao eao d~ xu~t ehu truang d~u tu:_Ca quan qUIDly, su d\.mgsau dau tu._Nhorn, Lo~i, e~p d\l ani cong trinh- Quy rno d~u tu.- Dia diSrn d~u tu._DV kiSn t6ng rnuc d~u tu eua d\I an ...

III. K~t qua tbAm dinh1. Ten d\l an:2. Chu d~u tu: '3. Ca quan quan ly, su d\lng, khai thae san pharn, eong trinh sau khi dau tu:

4. Dia diSrn d~u tu:5. M\lc tieu d~u tu:6. Quy rno d~u tu:7. Di~n tieh su d\lng d~t:8. Lo~i, e~p eong trinh: ,9. Phuang an giai phong rn~t bftng, tai dinh eu (neu co):

10. Hinh tmrc d~u tu:11. T6ng rmrc d~u tu (uoc tinh). Trong do:

- Chi phi xay dung:- Chi phi thiSt bi: , ,.' ._Chi phi b6i thirong giai phong m~t bang, tal dinh cu:- Chi phi quan ly du an:- Chi phi tir v~n d~u tu xay dung:- Chi phi khac:- Chi phi du phong:

12. Nguon vim d~u tu. Trong do:- V6n TW quem ly:- v6n do cdp tinh quem ly:- v6n do cap huyen, XQ quem ly:- Cdc nguon v6n khac (ghi cu thd tung nguon v6n):

13. TiSn dQva phan ky d~u tu thuc hien du.an:Phan ky kha nang can d6i vim va thai gian thuc hien du an (tuy thea du an

thuoc nhom AlBIC du kien kha nang can d6i v6n se thea cac tho; gian khacnhau):

DVT. 11·A a~neu ongVon Nguon Nguon von Nguon von khac (ghi c\l, , ,

th~ timg ngu6n vfm)TW " " cap huyen,Nam von capquanly tinh xii quan ly ......... , ......

quanly- Nam thu nhat- Nam thu hai- Nam thu ........14 " . " , .,--

" ". N9I dung cong tac chuan bl dau tu.15. Kinh phi chu~n bi d~u tu:16.Thai~gian ~hl,l'c,hi~n chu~n bi d~u tu: (l!iit adu va kit thue).

De nghl quy ca quan co van ban de '? ~ • ," '" co ca sa tham dInh vaphe, duy~t bao cao de xuat chu truang d~u tu, cho phep thuc hien chu~n b' d~ tdl,l'an ..... (ten d1! an) ...., thea quy dinh hi~n hfmh. " ! au u

NO'inh(in:- Nhu kinh gui;- Luu VT.

DON VI THAM DINH. .

- /..Mau so 7Baa caa thdm dinh Baa cao d~ xudt chu truong ddu tic

DON • chuang tri,!hld1! ~n ddu ticBA.OCA.~~TE~M< DJNH CQNG HOA xA HQI CHi) NGHiA VIET NAM

VAT CTDT DQcl~p - Tv do - Hanh phuc

S6: 1 . . , ngay thang nam ,.

BAo cAo THAM BINH BE XUAT CHU TRUONG DAu TU........................ (ten chuang trinh/du an} ,'.,

K'nh_ .,. ,?"1 gin: (cap co thdm quyen quyet dinh chu truong ddu tu)

C~n c~ Lu~t.£)~u nr cong; Lu~t xs, dung; ,Can cir Nghi dinh huang dan thuc hien Luat dau tu congo Luat Xay dung'crm cir (fac "c_iinCtep,ha~ If' khac co/~en C],uan}, ," . , '

, Sau khi xem xet not dung to trinh & bao cao de xuat chu tnrong dau tucua ....(co ,quan ((lp baa caa ae xudt chu truong ddu tu), Bien ban tham dinh cua..... (Hoi dO(1g thdm dinh) ...... vji ho sa titi li~u co ~ien quaT\, ...... (dan vi thiml dtn}1Baa caa ae xl-lat chu truang aau tu} ..... bao cao ket qua tham dinh bao cao de xuatchu truang dau tu chuang triph/d\1' an v6i nQi dung nhu sau:1.Danh muc cae tili lieu tham tlinh. . .* T' 'nho tn ...,..... , '* Bao cao de xuat chu truang dau tu ..... , , '* Bi,en bim hQi nghi tham dinh bao c~o de xuat chu truang dau tu ....

* Ho so tai li~u khac co lien quan (neu co).2. Thong tin chung

- Ten Chuang trinhlD\1' an., , '_Co quan giao l~p bao cao de xu~t chu truang dau tu:_Co quan qmin ty, su d\mg sau dau tu._Nhom, Lop,i. cap d\1'ani cong trinh- Quy m,o da\! tu.- Dia di~m p:au tu. ,_Du kien tong muc dau tu cua du an...

/.. • A •3. Ket qua th~m tliJ}.h ,

_Tinh cap thtet phfli dau tu du an , " ._ M\lc tieu dau tu phil hgp v6i quy ho~ch, ke ho~ch phat trien kinh te xli

hQi, quy h.o~ch phat trien nganq.:.. ,.. ." ,_Tong muc dau tu; N~ip~.onvon; :Ihm gIan ~hlfchl~n dv;:,an.. ;:. .,_Cac noi dung cong Vl~Cth\fc hl~n tr:ong glp,1do~n chuan b! dau tu; ChI phI

va n&U(\n,.,v6n;·Thai gian th\1'Chi~n cho chuan bi dau tu.4. Ket luan " ' , h h' " h;:' b' d;:'_Bao cao de xuat chu truang dau tu Q\1'an (chQph,ep t \1'C l~,nc uan ! ~utu, Dv an) aam bac:.ha¥. kh:..ongqpm ba~ ~ieu"ki~n .~e t~~m dinh tham dinh nguonvon va khfl nang can dOl vop, tntin khat cac cong Vl~Ctlep theo.

_Nhfmg luu y, yeu cau (neu co). "Noi nh~n: DON VI THAM DINH- Nhutren;- Lanh d~o;_Dan vi d~ xu~t chu truang dfiutu;- Luu:

M~n sA 8 ,, , h d rn dd« tu

Q :t dinh phe duyet chit truong ddu tu chuang trinn, if auye . ., - -T NAM

CO QUA~ CO THAM9UYT~~ CQNG H~tc~ ~~~~:~ ~~!I~h:~~ ';,QD CHU TRUONG DAU lJ ••••

S6: IQD- ........ Bac Ninh, ngay thang nam 201.. ..

QUYET DINH >.

V~ vi~c phe dny~tchii truong dan nr..................... (ten chuang trinh/du an} .

(CHUC DANH)

Can cu ..... quy dinh, chirc nang, nhiem vu, quyen han va co c~u t6 chirc~~;'If.:.; ,

'<1)~, Can cir Luat Dau tu cong; ~u~t Xay .~l)11g;,,~ " "" .Can cu Nghi dinh hu6ng dan thuc hien Luat Dau tu cong; Lu~t Xay dimg;Can cu (cdc can pu phap If khdc c,alien qUfln}J " t , ~ ?

Can ~u Cong van tham dinhpguo~ VOl}va)ma~nan& can dOl vpn (c~a ~O'q¥:anc~ t~pm quyen) kern thea ho sa bao cao de xuat chu tnrong dau tu va cacho sa co hen, quan; , , ,

Xet de nghi cua (co quan ldp Bao cao ae xuat chit truong ddu tuchuang trinh/dv an} tiili tatrinh so .1 ngay lhang narn v~ vapban sO .1 \ ngay thang narn cua (co, quan tham ainh Bao cao de xudtchit truang aau tu chuang trinh/d¥ an} ,

A QuytT DJNH:, Dien 1.Phe duy~t chu truang dau tu (ten chuang trinhld¥ an} , Cl)

the nhu sau:1. Ten chuang trinh/dl,l'an;- Nl)om dl,l'an;- Cap dl,l'anlcon¥ trinh.2. Dan vi Ch4 dau tu;3. Dja diem d~u tu;4. Ml)c tieu dau tu; ,5. NQi dun~ va,quy mo da;utu; , , ,6. Tong mue d~u tu d\l:kieij va nguon vQn dau tu;7. Chi phi ya tong nguon von ch,uan vi dal,}tu; ,8. Phan chla cac dg an thanh phaI1ho~c ti~u dg an (neu co),9·.Thai gi'!ll thgc hi~n; Phan ky dau tu (neu co); "

, DIeD 2. ,Glao cho ...... (~enac:n vi~.....:"chil! tracQ nhi~rn tiep tl)c h9an thanhthu t\1c thea dung quy d!nh cua phap ll,l~thl~n hanh to chuc thuc hien tot chuangtrinh/dl,l'4n thea ca~ n(>idung neu a Bieu 1. ' ". " DieD ~. Quyet djnh nay co hi~u Ivc kS tu ngay kY. Cac ca quan dan vi cohen quan ch!u trach nhi~m thi hanh quyet dinh nay./. . ' .

NO'inh~n:- 1';-ihU'Di~u 3: cAp co THAM QUYEN.......................

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