CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc

N XIN PHC KHO IM BI THI

K thi tuyn sinh vo lp 10 trung hc ph thng nm hc 2012 - 2013
(Kha thi ngy 21 thng 6 nm 2012)
Knh gi: Hi ng phc kho im bi thi k thi tuyn sinh 10
H v tn th sinh: ...............................................................
Sinh ngy:...........................................thng....nm...........................................
Ni sinh: Qun, Huyn: .Tnh, thnh ph:.............................................
Hc sinh trng:. Qun, Huyn:................................................
d thi tuyn sinh 10 trung hc ph thng ti Hi ng coi thi:............................................
Qun, Huyn: ..SBD:Phng thi s:............................
Mn xin phc kho:
STT

Mn

Ng vn

Ngoi ng: ..

Ton

Mn chuyn:

Xc nhn ca Trng, Trung tm

Ngy thng 7 nm 2012
Hiu trng, Gim c trung tm
(K tn v ng du)

im thi
tuyn sinh

nh du (X) vo
mn xin phc kho

Ghi ch

Ghi r Anh, Php, Nht

Ghi r mn chuyn
Thnh ph H Ch Minh, ngy thng 7 nm 2012
Th sinh k tn
(ghi r h tn)