YCKH-01

Mu s 01 km theo Cng vn s .ngy ./../. ca BVNT

GIY NGH THAY I THNG TIN KHCH HNG

Knh g
i: BO VIT NHN TH HI DNG
Bn mua bo him: ..................................................................................

S in thoi: .................................. .........

Hp ng s: .............................................................................................

Cp ngy: ........................................... ........

Ti ngh thay i, b sung mt s thng tin lin quan n
Bn mua bo him/
Ngi c bo him/
Ngi
th hng theo cc hng mc di y (Qu khch vui lng nh du (
) vo cc mc v k khai cc ni
dung  ngh thay i). Ti hiu v ng rng cc ni dung ngh thay i s ch c hiu lc k t ngy Cng
ty c vn bn ng gii quyt.
THNG TIN HIN TI CA HP NG

THNG TIN NGH THAY I

1.
H v tn
2.
Ngy sinh/Gii tnh

. / .. /..

Nam / N

... / .. /.

Nam / N

3.
S CMND/HC/GKS
Cp ngy ./ ./. Ti:

Cp ngy ../ ../... Ti:..

4.
a ch lin h
(Ghi r s nh - ng/Ph X/Phng - Qun/HuynTnh/Thnh ph)

5.
in thoi lin h
6.
ng k li ch k

Mi giao dch ca hp ng bo him v sau s theo ch k mi di y.

7.
ngh chuyn tnh

ngh chuyn hp ng sang Cng ty BVNT .......................................... thun

tin cho vic giao dch.

i l qun l H
(K, ghi r h tn v m s)

., ngythng..nm.
Bn mua bo him
(K, ghi r h tn)
Ch k 1
Ch k 2

(trng hp c thay i ch k so vi ch k trn GYCBH)

Phn dnh ring cho Bo Vit Nhn Th

H s km theo/ Lu :

Tip nhn h s ngy ...../......./........

CB tip nhn (k, ghi r h tn)

Thng bo kt qu gii quyt ngy../.../..

Mi thng tin xin vui lng lin h vi Bo Vit Nhn th Hi Dng, a ch 203 ng Nguyn Lng Bng Tp HD,
T(0320) 3890.507

Hng dn k khai

GIY NGH THAY I THNG TIN KHCH HNG

1. Quy nh chung.
- Mt s t vit tt:
+ BVNT
+ CMND
+ HC
+ GKS
+ BMBH
+ NBH

: Bo Vit Nhn th
: Chng minh nhn dn
: H chiu
: Giy khai sinh
: Bn mua bo him, Ngi tham gia bo him
: Ngi c bo him

Nu Qu khch thay i ch k (so vi ch k trn Giy yu cu bo him), Qu

khch vui lng ng k ch k mu bng cch k vo c 2 ch k 1 v ch k 2,
ng thi cung cp cho BVNT 01 bn ph t CMND c ch k xc nhn ca Qu
khch.

2. Giy t cn gi km theo Giy ngh

i vi cc thay i lin quan n nhn thn ca BMBH/NBH/Ngi th hng (h
tn, ngy sinh, gii tnh, s CMND/HC/GKS), Qu khch cn cung cp cc giy t
sau:
-

Bn ph t CMND/HC/GKS ca ngi c ngh thay i.

Bn ph t cc giy t khc theo yu cu ca BVNT ty tng trng hp c th: s
h khu, quyt nh thay i h tn ca c quan c thm quyn
Khi giao dch vi BVNT, Qu khch vui lng cung cp bn gc BVNT tin i
chiu.

Mi thng tin xin vui lng lin h vi Bo Vit Nhn th Hi Dng, a ch 203 ng Nguyn Lng Bng Tp HD,
T(0320) 3890.507