Mu 11-KN

NG CNG SN VIT NAM

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

BN NHN XT
ng vin d b
Knh gi: Chi u................................................................................................
Ti tn l:................................................Sinh ngy.........thng.........nm.........
Vo ng ngy.....thng.....nm........, chnh thc ngy.....thng.......nm.........
ang sinh hot ti chi b:..................................................................................
c chi b phn cng (ngy..........thng.........nm...........) gip ng
vin d b.............................................phn u tr thnh ng vin chnh thc;
nay xin bo co chi b nhng vn ch yu ca ng vin d b nh sau:
u im:
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Khuyt im v nhng vn cn lu :......................................................
............................................................................................................................
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............................................................................................................................
i chiu vi tiu chun ng vin v kt qu phn u rn luyn ca ng
vin d b, ti ngh chi b xt, ngh cng nhn ng ch...............................
..................................................tr thnh ng vin chnh thc.
Ti xin chu trch nhim trc ng v li nhn xt ca mnh.

NG VIN C PHN CNG GIP

(K, ghi r h, tn)