Mu: 04/HSTK-GC/2011, Kh A4

BNG TNG HP NGUYN LIU, VT T DO BN NHN GIA CNG CUNG

NG
Trang s:
Hp ng gia cng s:...........................................................Ngy:
................................................................................................Thi hn:................................
Ph lc Hp ng gia cng s:..............................................Ngy:
................................................................................................Thi hn:................................
Bn thu gia cng:.................................................................a ch:
Bn nhn gia cng:.................................................................a ch:
Mt hng gia cng:.................................................................S lng:
n v Hi quan lm th tc:................................................................................................................................
STT

Tn nguyn liu,
vt t

(1)
1

(2)
HT TO MU

n v
tnh
(3)
KG

S lng
(4)
1000

n gi

Tng
tr gi

(5)

(6)

Hnh thc cung

ng
(7)
T CUNG
NG

Ngythngnm
i din theo php lut ca thng nhn
(k tn, ng du)

Ghi ch
(8)