CNG HA X HI CH NGHA VIT NAM

c lp T do Hnh phc

S HS: 311/../SO

BNG K H S
Loi h s: Xc nhn qu trnh ng BHXH, Bo him tht nghip.
1.

Tn n v (c nhn):.M n v:

2.

in thoi:..Fax:
.............................

STT

Loi giy t, biu mu

S lng

(1)

(2)

(3)

1.

iu kin: Ngi lao ng c tn trong danh sch bo gim ( mu 3a-TBH) v n v

thc hin y ngha v ng BHXH, BHYT, BHTN.
Xc nhn qu trnh ng bo him x hi, bo him tht nghip (Mu 01/SHB-XN, 01
bn/ngi).
T ba s BHXH (mi)

2.
3.

Ngy tr kt qu:.././200

Cn b TNHS

TP.H Ch Minh, ngy..thng..nm 200.

Ngi np h s
(k, ghi r h tn)

Ghi ch:
n v k khai chnh xc v y qu trnh ng bo him x hi, bo him tht nghip ca ngi lao
ng vo mu 01/SBH-XN. Cc n v vo trang web: www.bhxhhcm.org.vn ly mu 01/SBH-XN.