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n v...........

CNG HA X HI CH NGHA VIT NAM

Mu s 04- LTL

B phn.......

c lp - T do - Hnh phc

(Ban hnh theo Q S :

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48/2006/Q-BTC ngy
14/9/2006 ca B trng BTC)

GIY I NG
S........................
Cp cho:............................................................................................................................
Chc v:............................................................................................................................
c c i cng tc
ti:........................................................................................................
Theo cng lnh ( hoc giy gii thiu) s.... ngy.... thng.... nm....
T ngy.....thng.....nm.......n ngy..... thng.... nm.......
Ngy....thng.....nm.....
Ngi duyt
(K, h tn, ng du)
Tin ng trc
Lng...........................................
Cng tc ph.................................
Cng.............................................
Ni i...
Ni n...
1

Ngy

Phng tin
s dng

di
chng
ng

S ngy
cng tc

L do lu
tr

Chng nhn ca c quan

(Ktn, ng du)

Ni i...
Ni n...
Ni i...
Ni n...
- V ngi..............................................v x..................... = ...........................
- V cc ...............................................v x..................... = ...........................
- Ph ph ly v bng in thoi.............v x..................... = ..........................
- Phng ngh............................................v x...................... = ..........................
1- Ph cp i ng: Cng................................................................................................
2- Ph cp lu tr: ..........................................................................................................
Tng cng ngy cng tc:................................................................................................
Ngy....thng....nm....
Duyt
S tin c thanh ton l...........................
Ngi i cng tc

Ph trch b phn

K ton trng

(K, h tn)

(K, h tn)

(K, h tn)