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Ph lc s IMU GIY NGH CP CHNG CH HNH NGH CHNG KHON
(Ban hnh km theo Quy ch hnh ngh chng khon)
CNG HA X HI CH! NGH"A #I$% NAM
&c l'( ) %* +, ) H-.h (h/c00000000000000000000000000000000000000000
GIY NGH CP CHNG CH HNH NGH CHNG KHON
Knh gi: !1 23. Ch4.5 6h,7. Nh8 .9:c
1. H v tn: ..........................................; !"! t#nh: ..................................$. %gy thng n&m '!nh:..........................; %! '!nh...................................
. Qu*c t+ch:..................................................................................................,. !-y /%0H2 ch!u '*:.................... c-3 ngy :............ t4!...................5. %! 6&ng k7 h2 kh8u th9ng tn: ............................................................................L. Mn v+ c>ng tc:......................................... (gh! N tn 6n v+= chc vO= v+ t#= P2
3hCn h!Dn 6ang m v!Dc R nu c@)
S. T* 6!Dn tho4! !n 4c:..................... M+a chE !n 4c:..............................1U. Vo4! chng chE hnh ngh chng khon 6 ngh+ 69Wc c-3:
.............................................................................................................(chX !n hoa).
J>! m !-y ny 6 ngh+ Yy Pan hng khon %h n9"c ?em ?Zt c-3 hng chEhnh ngh chng khon cho t>!. J>! ?!n cam kt hon ton ch+u tch nh!Dm t9"c 3h3 uCtv t#nh ch#nh ?c= tung th[c c\a n2! ]ung !-y 6 ngh+ ny v h^ ' km theo.
H s gi km:R _h!u V7 +ch J9 3h3;R T yu 7 +ch;R B`n 'ao hW3 D Png J% 64! hcth4c 'bt!n 'b;R B`n 'ao hW3 D cc chuyn m>n v ;R t u` th! 't h4ch;R U$ `nh ,?F;R B`n 'ao hW3 6^ng ao 62ng v"! c>ng tychng khon c>ng ty QVQ c>ng ty 6du t9chng khon (nu c@);R J! !Du khc (nu cO th).
.........., ngy........ thng....... nm......
NG;
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Ph lcMU KHAI =>N %H?NG %IN C NH@N
(f3 ]Ong cho ng9! 6 ngh+ c-3 chng chE hnh ngh chng khon)(Ban hnh km theo Jh>ng t9 '* 1,I$U1$JJRBJ ngy 1U thng S n&m $U1$c\a B2 J! ch#nh)
CNG HA X HI CH! NGH"A #I$% NAM&c l'( ) %* +, ) H-.h (h/c
=>N %H?NG %IN C NH@N
1) H v tn:.........................................................................................
2) %gy thng n&m '!nh:......................................................................
3) Qu*c t+ch:.................................................................................................
4) %guyn un:...........................................................................................
5) %! 6&ng k7 h2 kh8u th9ng tn:
%hB 5B3.%9.5 D%E.5 F
8, F-,ChE1J. .58.h 8,
F-,Kh.
Fh9L.5K lE'F
J.............6n............
J..............6n.............
) Qu tKnh m v!Dc:
%hB 5B3. NB l8 Bc #Q FRDCh4c Kh. Fh9L.5 K lE'F
J.............6n............J.............6n............
1) Quan hD nhin thin:
$
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MB SE3.h
HT 8 FJ.NsB.h
ChV LN5hW
.5hB(. Q c.5 F7c
(nu c)
=
MA.hDchQD E&F#ZDch[.5
C,.
J>! cam kt cc n2! ]ung k kha! tn ch#nh ?c v ?!n hon ton ch+u tch nh!Dm t9"c
3h3 uCt v t#nh tung th[c= hW3 3h3 c\a B`n th>ng t!n c nhin ny..
................, ngy.......thng........nm........N59B 6h3B
(K, ghi r h tn)
Ph\. ch4.5 Fh*c ch] 6^ .59B 6h3B c_3 C SE3. c` Fha SE1W.
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