You are on page 1of 1

CNG HA X HI CH NGHA VIT NAM

c lp T do Hnh phc

......., ngy .. thng..nm 2013


PHIU XUT I LM VIC NGOI N V
Phiu ny phi nh km vi cng lnh lm th tc i
v lc thanh ton cng lnh
1. H v tn ngi i cng tc
ng:
Chc v:
ng:
Chc v:
2. Ni n: ............
* Ni dung kim tra:
3. Thi gian:..........ngy
- Ngy i:
- Ngy v (c mt ti n v):
4. Phng tin:
T tc.
NGI XUT CNG TC

TRNG N V XUT XC NHN