CNG HO X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
----------------------------------GIY NG K KIM DCH THC VT
Knh gi: ......................................................................
Tn t chc, c nhn ng k:
a ch: .......................................................... in thoi :
Tn hng : ....................................................................................................................
Khi lng tnh : ..........................................................................................................
Khi lng c b : .........................................................................................................
S lng v loi bao b : ...............................................................................................
K m hiu, s hp ng hoc L/C : .............................................................................
Ni sn xut : ...............................................................................................................
S vn n : .................................................................................................................
Phng tin chuyn ch : .............................................................................................
Nc xut hng, ngi gi : .........................................................................................
......................................................................................................................................
Ca khu i : ................................................................................................................
Nc nhp hng, ngi nhn : ......................................................................................
......................................................................................................................................
Ca khu n : .............................................................................................................
Ni hng n :...............................................................................................................
Mc ch s dng: ........................................................................................................

a im gieo trng (nu l ging cy nhp khu) : ......................................................

a im kim dch : ....................................................................................................
Thi gian kim dch : ...................................................................................................
a im, thi gian gim st x l (nu c): ..................................................................
S lng giy chng nhn kim dch: ...........................................................................
Bn sao:
Bn chnh:

Vo s s: .........ngy ....../....../......
Ngy .........thng ........ nm ..........

Cn b nhn giy ng k
Ngi ng k