CNG HO X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
MU NG K NGI PH THUC GIM TR GIA CNH
Chnh thc: [

B sung: [ ]

Ln: [

Mu s: 16/K-TNCN
(Ban hnh km theo
Thng t s 84/2008/TT-BTC
ngy 30/9/2008 ca B Ti chnh)

1. H v tn c nhn c thu nhp: L Khc Ton

2. M s thu:

3. Tn ca t chc, c nhn tr thu nhp:

4. M s thu:
Stt
1

H v tn
L Minh Khnh

0
Ngy sinh

M s thu

14/05/1999

S CMND/
h chiu

Quan h vi
TNT

Thi im tnh
gim tr
(thng/nm)

Thi im kt
thc gim tr
(thng/nm)

Em rut

2
3
...
...
Tng cng

Ti cam oan nhng ni dung k khai l ng v chu trch nhim trc php lut v nhng ni dung khai./.

, ngy thng nm ...

C NHN C THU NHP

(K v ghi r h tn)

40