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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:

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    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)

    =

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    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)

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