Mu s 03/

CNG HO X HI CH NGHA VIT NAM

c lp - T do - Hnh phc

N XIN GIAO T
(Dng cho t chc trong nc, c s tn gio,
ngi Vit Nam nh c nc ngoi)

Knh gi: U ban nhn dn tnh (thnh ph trc thuc Trung ng).....
........................................................................................................
1. Ngi xin giao t (vit ch in hoa)*:............................................................................
........................................................................................................................................
........................................................................................................................................
2. a ch tr s chnh:...................................................................................................
3. a ch lin h:....................................................................in thoi:..................
4. a im khu t xin giao:.........................................................................................
5. Din tch xin giao (m2):.............................................................................................
6. s dng vo mc ch:..........................................................................................
7. Thi hn s dng (nm):............
8. Cam kt s dng t ng mc ch, chp hnh ng cc quy nh ca php lut
t ai, np tin s dng t (nu c) y , ng hn;
Cc cam kt khc (nu c).............................................................................................
........................................................................................................................................

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

Ngi xin giao t
(K, ghi r h tn, nu t chc th phi ng du)

i vi t chc phi ghi r tn t chc, ngy thnh lp, s v ngy, c quan k quyt nh thnh lp
hoc giy chng nhn ng k kinh doanh hoc giy php u t; i vi ngi Vit Nam nh c
nc ngoi th ghi h v tn, quc tch, s v ngy, ni cp h chiu.