81 2011 Tt-Bca 133482

B CNG AN
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CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
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S: 81/2011/TT-BCA
H Ni, ngy 15 thng 12 nm 2011
THNG T
QUY NH V BIU MU C S DNG TRONG NG K, QUN L C TR
Cn c Lut C tr ngy 29/11/2006;
Cn c Ngh nh s 107/2007/N-CP ngy 25/6/2007 quy nh chi tit v hng dn thi hnh mt s
iu ca Lut C tr c sa i, b sung theo Ngh nh s 56/2010/N-CP ngy 24/5/2010;
Cn c Ngh nh s 77/2009/N-CP ngy 15/9/2009 quy nh v chc nng, nhim v, quyn hn v
c cu t chc ca B Cng an;
B Cng an quy nh v biu mu c s dng trong ng k, qun l c tr nh sau:
Chng 1.
NHNG QUY NH CHUNG

iu 1. Phm vi iu chnh
Thng t ny quy nh c th v biu mu, yu cu, cch ghi biu mu v qun l biu mu c s
dng trong ng k, qun l c tr.
iu 2. i tng p dng
1. C quan, ngi lm cng tc ng k, qun l c tr.
2. C quan, t chc, h gia nh, cng dn Vit Nam, ngi Vit Nam nh c nc ngoi vn cn
quc tch Vit Nam tr v Vit Nam sinh sng.
iu 3. Cc biu mu c s dng trong ng k, qun l c tr
Cc biu mu c s dng trong ng k, qun l c tr (sau y vit gn l biu mu) k hiu l
HK, bao gm:
1. Bn khai nhn khu (k hiu l HK01) c dng k khai nhn khu khi ng k thng tr,
ng k tm tr.
2. Phiu bo thay i h khu, nhn khu (k hiu l HK02) c s dng thng bo khi c s
thay i v h khu, nhn khu nh: ng k thng tr, ng k tm tr, iu chnh nhng thay i
trong s h khu, s tm tr, thay i ni ng k thng tr, tm tr, xa ng k thng tr, xa
ng k tm tr, tch s h khu, i, cp li s h khu, s tm tr, cp giy chuyn h khu, xc
nhn trc y ng k thng tr
3. Phiu xc minh h khu, nhn khu (k hiu l HK03) c s dng xc minh nhng h, nhn
khu c nhng thng tin cha r, cha thng nht
4. Phiu thng tin thay i v h khu, nhn khu (k hiu l HK04) c c quan ng k, qun l
c tr, cc n v s dng trao i thng tin khi c s thay i v h khu, nhn khu.
5. Phiu khai bo tm vng (k hiu l HK05) c s dng cho ngi phi khai bo tm vng khai
bo vi Cng an x, phng, th trn ni c tr.
6. Phiu theo di h s h khu (k hiu l HK06) c c quan Cng an huyn, qun, th x, thnh
ph thuc tnh lp phc v vic theo di, tra cu h s h khu.
7. Giy chuyn h khu (k hiu l HK07) c dng cp cho cc trng hp chuyn ni thng
tr.
8. S h khu (k hiu l HK08) c dng cp cho h gia nh hoc c nhn ng k thng
tr.
9. S tm tr (k hiu l HK09) c dng cp cho h gia nh hoc c nhn ng k tm tr.
10. S theo di gii quyt h khu (k hiu l HK10) c c quan ng k, qun l c tr s dng
theo di, ghi chp thng tin qu trnh gii quyt ng k thng tr, ng k tm tr, thay i ni
ng k thng tr, tm tr, iu chnh nhng thay i trong s h khu, s tm tr, gii quyt khiu
ni, t co
11. S ng k thng tr (k hiu l HK11) c c quan ng k, qun l c tr s dng ghi
chp kt qu ng k thng tr; iu chnh nhng thay i trong s h khu; cp giy chuyn h
khu, xa ng k thng tr Mu HK11 c lp theo thn, xm, lng, p, bn, bun, phum, sc,
ng ph, t dn ph hoc theo nh tp th ca cc c quan, t chc. Khi c nhng thay i

thng tin ca tng nhn khu trong h, c quan Cng an lp s phi tin hnh iu chnh kp thi ni
dung thay i. S ng k thng tr c lu gi v khai thc lu di.
12. S ng k tm tr (k hiu l HK12) c Cng an x, phng, th trn s dng ghi kt qu
ng k tm tr; iu chnh nhng thay i trong s tm tr; xa ng k tm tr; xc nhn ni tm
tr; i, cp li s tm tr cho cng dn.
13. S tip nhn lu tr (k hiu l HK13) c Cng an x, phng, th trn s dng theo di
vic tip nhn thng bo lu tr theo quy nh ca Lut C tr.
14. Ti h s h khu (k hiu l HK14) c Cng an huyn, qun, th x, thnh ph thuc tnh s
dng lu tr h s h khu. Mi h ng k thng tr lp mt ti h s h khu ring.
15. Thng k h khu, nhn khu (k hiu l HK15) c Cng an cp x, cp huyn, cp tnh s
dng thng k h khu, nhn khu ti a phng theo thng, 06 thng, nm v bo co ln c
quan Cng an cp trn.
iu 4. Qun l cc biu mu
1. Cng an cc a phng t chc in, pht hnh tt c cc biu mu, tr mu HK08 v mu HK09 do
B Cng an in. Khi in, Cng an cc n v, a phng khng c thay i ni dung ca biu mu;
c trch nhim qun l vic in, cp pht, s dng biu mu v c s sch theo di.
2. Mu HK01, HK02, HK03, HK04, HK07, HK10, HK11, HK12, HK13 v mu HK15 in trn kh giy
210 mm x 297 mm, in en trng. Mu HK05 in trn kh giy 205 mm x 145 mm, mu HK06 in trn kh
giy 80 mm x 130 mm, mu HK14 in trn kh giy 270 mm x 350 mm, in en trng.
Mu HK08 (20 trang bao gm c ba) v HK09 (12 trang bao gm c ba) in theo m s ca tng tnh,
thnh ph trc thuc Trung ng quy nh ti Ph lc s 01 v Ph lc s 02 ban hnh km theo
Thng t ny. Mu HK08, HK09 in trn kh giy 120 mm x 165 mm, in mu, c hoa vn, mt hiu bo
v v c ng s sn.
3. Mu HK05 v HK07 c ng thnh quyn, gm 02 phn c ni dung nh nhau, mt phn cp
cho ngi n lm th tc khai bo tm vng hoc cp giy chuyn h khu, mt phn lu ti c
quan Cng an c thm quyn.
4. Biu mu v ng k, qun l c tr c ng ti trn Cng thng tin in t B Cng an.
Chng 2.
CCH GHI BIU MU

iu 5. Yu cu ghi biu mu
1. Ghi chnh xc nhng ni dung trong tng biu mu, ch vit phi r rng, vit cng mt loi mc,
khng vit tt.
2. Ngi n lm th tc ng k c tr khng bit ch hoc khng th t k khai c th nh
ngi khc k khai h theo li khai ca mnh. Ngi k khai h phi k khai trung thc, k, ghi r h
tn v chu trch nhim v vic k khai h .
3. Cc s phi c vit lin tc theo th t tng trang, khng c b trng; phi ghi y , r
rng cc ni dung ba v cc trang ca s.
4. Cc ct, mc trong biu mu phi c ghi theo ng ch thch hng dn trong cc biu mu
(nu c) v quy nh ti Thng t ny.
5. Nghim cm vic t ty xa, sa cha, b sung lm sai lch ni dung ghi trong biu mu.
iu 6. Thng tin chung trong biu mu
1. Thng tin chung trong cc loi biu mu bao gm: Thng tin v c nhn, v a ch c tr v v c
quan c thm quyn ng k, qun l c tr.
2. Cch ghi thng tin v c nhn
Khi ghi thng tin v c nhn phi cn c vo giy khai sinh v cc giy t h tch khc. Nu khng c
cc giy t trn th ghi theo s h khu, chng minh nhn dn, h chiu Vit Nam hoc giy t khc
do c quan c thm quyn cp.
a) Mc H v tn: Ghi bng ch in hoa, du;
b) Mc Ngy, thng, nm sinh: Xc nh theo ngy, thng, nm dng lch v c ghi y 02
ch s cho ngy sinh, 02 ch s cho cc thng sinh l thng 01 v thng 02, 04 ch s cho nm sinh;
c) Mc CMND s v mc H chiu s: Ghi y s CMND v s h chiu (nu c c hai giy t
ny);
d) Mc Gii tnh: Nu gii tnh Nam th ghi l Nam, nu gii tnh N th ghi l N;
) Mc Ni sinh: Ghi ni sinh theo giy khai sinh;

e) Mc Qu qun: Ghi qu qun theo giy khai sinh. Nu giy khai sinh khng c mc ny th ghi
theo qu qun ca cha hoc qu qun ca m theo tp qun hoc theo tha thun ca cha, m.
Trng hp con ngoi gi th, nu khng c quyt nh cng nhn cha cho con th qu qun ca con
c xc nh theo qu qun ca m. Phi ghi c th a danh hnh chnh cp x, cp huyn, cp
tnh. Trng hp a danh hnh chnh c thay i th ghi theo a danh hnh chnh hin ti;
g) Mc Quc tch: Ghi quc tch Vit Nam, quc tch khc (nu c);
h) Mc Dn tc v Tn gio: Ghi dn tc, tn gio theo giy khai sinh. Trng hp khng c giy
khai sinh th ghi theo s h khu, chng minh nhn dn hoc giy t khc do c quan c thm quyn
cp;
i) Mc Ngh nghip, ni lm vic: Ghi r hin nay lm ngh g v tn c quan, n v, t chc, a
ch ni lm vic.
3. Cch ghi thng tin v a ch c tr
Ghi c th, y s nh, ph, ng ph; t, thn, xm, lng, p, bn, bun, phum, sc; x,
phng, th trn; huyn, qun, th x, thnh ph thuc tnh; tnh, thnh ph trc thuc Trung ng.
Trng hp nc ngoi v ng k c tr th ghi r a ch c tr nc ngoi (ghi r tn nc
phin m bng ting Vit).
4. Ghi thng tin v c quan c thm quyn ng k, qun l c tr
Dng trn ghi c quan Cng an cp trn trc tip, dng di ghi tn c quan Cng an c thm quyn
ng k, qun l c tr.
iu 7. Cch ghi Bn khai nhn khu
1. Mc Trnh hc vn: Ghi r trnh hc vn cao nht (Tin s, Thc s, i hc, Cao ng,
Trung cp, tt nghip ph thng trung hc, tt nghip ph thng c s; nu khng bit ch th ghi
r khng bit ch);
2. Mc Trnh chuyn mn: Ghi r chuyn ngnh c o to hoc trnh tay ngh, bc th,
chuyn mn k thut khc c ghi trong vn bng, chng ch;
3. Mc Trnh ngoi ng: Ghi r tn vn bng, chng ch cao nht c cp (Anh A, Anh B hoc
Php A, Php B hoc Nga A, Nga B );
4. Mc Tm tt v bn thn (t 14 tui tr ln n nay u, lm g): Ghi r tng khong thi
gian (t thng, nm no n thng, nm no) thay i v ch v ngh nghip, ni lm vic).
5. Mc Tin n, tin s: Ghi r ti danh, hnh pht theo bn n s, ngy, thng, nm ca Ta n;
c xa n tch hay cha hoc ang trong giai on b khi t, iu tra, truy t, xt x; hoc
ang chp hnh hnh pht; b kt n pht t c hng n treo; hnh pht b sung; hoc ang b
p dng bin php ngn chn ca t tng hnh s hoc b p dng bin php gio dc ti x, phng,
th trn, a vo c s gio dc, c s cha bnh, trng gio dng. Thi gian b p dng bin
php .
iu 8. Cch ghi Phiu bo thay i h khu, nhn khu
1. Mc H v tn ch h v Quan h vi ch h ghi nh sau:
a) Trng hp ng k thng tr hoc ng k tm tr vo ch hp php, c cp s h khu
hoc s tm tr th mc h v tn ch h ghi h, tn ngi n ng k thng tr hoc ng k tm
tr, mc quan h vi ch h ghi l ch h.
b) Trng hp c ch h ng cho nhp vo s h khu hoc s tm tr th h v tn ch h ghi
h, tn ch h ng cho nhp vo s h khu hoc s tm tr, mc quan h vi ch h ghi mi
quan h thc t vi ch h .
c) Trng hp iu chnh nhng thay i trong s h khu, s tm tr; xa ng k thng tr, xa
ng k tm tr; tch s h khu; i, cp li s h khu, s tm tr hoc xc nhn trc y ng
k thng tr th ghi h, tn ch h, quan h vi ch h theo s h khu, s tm tr.
2. Mc Ni dung thay i h khu, nhn khu: Ghi tm tt ni dung thay i h khu, nhn khu. V
d: ng k thng tr, tm tr; thay i ni ng k thng tr, tm tr; tch s h khu; iu chnh
nhng thay i trong s h khu
3. Mc kin ca ch h: Ghi r kin ca ch h l ng cho ng k thng tr, ng k tm
tr hoc ng cho tch s h khu; ch h k v ghi r h, tn, ngy, thng, nm.
4. Mc Xc nhn ca Cng an ghi nh sau:
a) Trng hp xc nhn vic trc y ng k thng tr th c quan Cng an c thm quyn
ng k thng tr trc y xc nhn ni dung theo quy nh ti Khon 3 iu 13 Thng t s
52/2010/TT-BCA ngy 30/11/2010 ca B trng B Cng an quy nh chi tit thi hnh mt s iu
ca Lut C tr, Ngh nh s 107/2007/N-CP ngy 25/6/2007 v Ngh nh s 56/2010/N-CP ngy

24/5/2010 v c tr (sau y vit gn l Thng t s 52).
b) Trng hp cp li s h khu do b mt th Cng an x, phng, th trn ni ng k thng tr
xc nhn vic b mt .
iu 9. Cch ghi Phiu xc minh h khu, nhn khu
1. Mc Knh gi: Ghi tn c quan nhn phiu xc minh h khu, nhn khu v cp trn trc tip ca
c quan . Trng hp gi phiu xc minh cho c quan Cng an cp x ngoi phm vi a gii hnh
chnh cp tnh, thnh ph trc thuc trung ng th phi ghi y a gii hnh chnh ca Cng an
x (x, huyn, tnh).
2. Phn yu cu xc minh (mt trc):
a) Mc Ni dung xc minh: Ghi tm tt, r ni dung cn xc minh v thng tin v cc nhn khu km
theo (nu c);
b) Mc Kt qu xc minh gi v : Ghi tn c quan ni lp phiu xc minh v cp trn trc tip ca
c quan . Trng hp c quan Cng an cp x lp phiu xc minh gi i ngoi phm vi tnh, thnh
ph trc thuc trung ng th phi ghi y a gii hnh chnh ca Cng an x (x, huyn, tnh);
c) Mc Trng Cng an: : Trng Cng an ni gi phiu xc minh phi k, ghi r h, tn, chc v
v ng du. i vi Cng an qun, huyn, th x ca thnh ph trc thuc trung ng v Cng an
th x, thnh ph thuc tnh th Ch huy i Cnh st qun l hnh chnh v trt t x hi k phiu xc
minh trong phm vi cp huyn, ngoi phm vi cp huyn th Trng Cng an cp huyn k phiu xc
minh.
3. Phn tr li xc minh (mt sau):
a) Mc Kt qu xc minh: Tr li y kt qu xc minh theo cc ni dung yu cu xc minh.
Trng hp khng c i tng xc minh hoc thng tin v i tng khng chnh xc cng phi tr
li;
b) Mc Trng Cng an: : Trng Cng an ni gi tr li xc minh phi k, ghi r h, tn, chc
v v ng du.
iu 10. Cch ghi Phiu thng tin thay i v h khu, nhn khu
1. Mc Knh gi: Ghi tn c quan ng k, qun l c tr ni nhn phiu v cp trn trc tip ca c
quan . Trng hp thng bo v vic ng k thng tr phi gi trc tip cho c quan Cng
an ni cp giy chuyn h khu lm th tc xa ng k thng tr. Nu c quan Cng an ni cp
giy chuyn h khu (ni ng k thng tr c) l c quan Cng an cp x th phi ghi y a
gii hnh chnh ca Cng an x (x, huyn, tnh).
2. Mc Ni dung thay i: Ghi y , r rng nhng ni dung thay i nh: ng k thng tr,
iu chnh nhng thay i trong s h khu, xa ng k thng tr Trng hp thng bo v vic
ng k thng tr th c quan Cng an ni chuyn n phi ghi y cc thng tin sau: H v tn,
ngy, thng, nm sinh, ni ng k thng tr c, ni chuyn n, h v tn cc nhn khu km theo
cng ng k thng tr, giy chuyn h khu (s, ngy, thng, nm cp).
3. Mc xut, kin ngh: Ghi c th kin xut, kin ngh (nu c). Trng hp thng bo v
vic ng k thng tr th phi ngh c quan Cng an ni cp giy chuyn h khu lm th tc
ng k thng tr.
iu 11. Cch ghi Phiu khai bo tm vng
1. Mc Ni thng tr/ ni tm tr: Nu ghi ni thng tr th gch ni tm tr v ngc li.
2. Mc L do tm vng: Ghi r l do i khi ni c tr.
3. Phn phiu cp cho cng dn th Trng cng an x, phng, th trn ni cp phiu khai bo tm
vng phi k, ghi r h, tn v ng du; phn lu th Trng Cng an x, phng, th trn v ngi
khai bo ch cn k, ghi r h, tn.
iu 12. Cch ghi Phiu theo di h s h khu
1. Mt trc
a) Mc H s h khu s: Ghi theo s h s h khu trong tng th h s h khu;
b) Mc Danh sch nhng ngi trong h: Ghi y , chnh xc tng ngi trong h.
2. Mt sau: Ghi tip danh sch nhng ngi trong h theo hng dn ti mt trc (nu mt trc
khng ghi).
iu 13. Cch ghi Giy chuyn h khu
1. S giy chuyn h khu: Ghi theo s th t cp giy chuyn h khu tng nm ti c quan Cng
an c thm quyn.
2. Mc L do chuyn h khu: Ghi r l do chuyn h khu.

3. Mc H v tn ch h ni i v quan h vi ch h: Ghi h, tn, mi quan h trc tip vi ch
h ni ngi ng k thng tr chuyn i (ni ngh cp giy chuyn h khu).
4. Mc Nhng ngi trong h cng chuyn h khu: Ghi theo s ng k thng tr, s h khu
cc thng tin ca ngi trong h cng chuyn h khu.
Trng hp chuyn c h th c quan Cng an ni cp giy chuyn h khu phi ghi r chuyn i c
h thng bo cho c quan Cng an ni ngi ng k thng tr chuyn n. Trc khi cp s
h khu mi, c quan Cng an ni ngi ng k thng tr chuyn n thu li s h khu c lu
ti tng th h s h khu.
iu 14. Cch ghi S h khu
1. Mt trong ca ba trc
a) Mc Cng an Tnh/TP: Ghi hoc in tn tnh/thnh ph trc thuc trung ng;
b) Mc S: Mi s h khu c cp mt s ring. Trng hp i, cp li s h khu th s ca s
h khu i, cp li l s ca s h khu trc;
c) Mc H s h khu s v mc S ng k thng tr s: Ghi theo s h s h khu v s ca
s ng k thng tr lu ti tng th h s h khu.
2. Trang Ch h: Mc L do xa ng k thng tr ghi r l do xa ng k thng tr theo quy
nh ti Khon 1 iu 22 Lut C tr, nh: Cht, ra nc ngoi nh c (ghi r tn nc), thay i ni
ng k thng tr
3. Cc trang nhn khu c quan h vi ch h: Ghi theo cch ghi ca trang ch h. Mc quan h vi
ch h th ghi r nh: ng, b, cha, m, v, chng, con, anh, ch, em, chu rut Trng hp c
ch h ng cho nhp vo s h khu th ghi theo mi quan h thc t.
4. Cc trang iu chnh thay i: Ghi r ni dung iu chnh nh thay i ch h; thay i h, tn, ch
m; ngy, thng, nm sinh; thay i a gii hnh chnh C quan c thm quyn iu chnh thay
i trong s h khu l c quan c thm quyn ng k thng tr.
5. Cn b ng k phi k, ghi r h, tn ti cc trang ch h, tng trang nhn khu v iu chnh
thay i (nu c). Th trng c quan c thm quyn ng k thng tr phi k, ghi r h, tn v
ng du ti mt trong ca ba trc, trang ch h, tng trang nhn khu c trong s v trang iu
chnh thay i (nu c).
6. Mi s h khu c dng cho 01 h. Trng hp s nhn khu trong h nhiu hn s trang c
mc quan h vi ch h th ghi vo mt trong trang ba trc l Quyn s 01 v c thnh lp
Quyn s 2, Quyn s 3, v.v, c s trng vi s ca quyn s 01. Mt trong trang ba trc ghi r
l Quyn s 2, Quyn s 3, v.v v ng du treo, trang ch h ghi ging nh quyn s 01, cc
trang cn li ghi nhn khu tip theo.
7. Trng hp chuyn n c h, trc khi cp s h khu mi, c quan ng k, qun l c tr ni
chuyn n thu s h khu c v ng du Hy vo mt trong ca ba trc ti mc ghi h v tn
ch h v ni thng tr, lu vo tng th. Trng hp chuyn mt ngi hoc mt s ngi
trong h th ghi r vo trang iu chnh thay i thng tin ngi chuyn i, thi gian cp giy chuyn
h khu, a ch ni n.
iu 15. Cch ghi S tm tr
Cch ghi cc thng tin trong s tm tr ging cch ghi s h khu v cn ch mt s im sau y:
1. Mc S ng k tm tr s: Ghi theo s ca s ng k tm tr.
2. Mc L do xa ng k tm tr: Ghi r l do nh: b hy kt qu ng k, khng tm tr ti ni
ng k tm tr qu 6 thng hoc ng k thng tr
3. Mc iu chnh thay i: Ghi y ni dung thay i cc thng tin trong s tm tr.
iu 16. Cch ghi S theo di gii quyt h khu
1. Mc Ni dung yu cu gii quyt: Ghi tm tt, y ni dung yu cu gii quyt.
2. Mc H s km theo: Ghi y , chnh xc, cc loi giy t c trong h s tip nhn.
3. Mc Nhn h s: Nu cng mt ngi tip nhn nhiu h s trong ngy th ch cn ghi h, tn
ngi nhn, ngy, thng, nm ti dng tip nhn h s u tin. Nu mt ngy tip nhn nhiu h s
th ch cn ghi ngy, thng, nm nhn h s ti dng tip nhn h s u tin. i vi tng trng
hp tip nhn h s phi ghi r thi gian (ngy, thng, nm) s phi tr kt qu.
4. Mc Tr kt qu: Ghi ngy, thng, nm v kt qu gii quyt (ng k thng tr; iu chnh
nhng thay i; i, cp li s h khu; b sung th tc, k khai li h s, giy t; khng gii quyt
ng k thng tr ).
iu 17. Cch ghi S ng k thng tr

1. Phn Mc lc: Ghi y cc thng tin theo mu.
2. Phn ni dung: Mi trang ca s dng ghi thng tin v mt h ng k thng tr. Dng u
tin ghi ch h, cc dng tip theo ghi ln lt cc nhn khu c trong h.
a) Mc H s h khu s: Ghi theo s h s h khu lu ti tng th h s h khu;
b) Mc Ngi c thm quyn ng k: Ch huy i Cnh st qun l hnh chnh v trt t x hi,
Trng Cng an x, th trn ca huyn thuc tnh k, ghi r h, tn. Trng hp ng k mt ln cho
nhiu ngi th ngi c thm quyn ch cn k, ghi r h, tn hng ghi nhn khu cui cng;
c) Mc Ni dung iu chnh, thay i: Ghi r ni dung nh: thay i ch h, thay i h, tn, ch
m, ngy, thng, nm sinh; thay i a gii hnh chnh; xa ng k thng tr (ngy, thng, nm
xa ng k thng tr, ni chuyn n); cp giy chuyn h khu (ngy, thng, nm cp giy
chuyn h khu, ni chuyn n); i, cp li s h khu;
d) Mc T s: Ghi theo s th t ti mc lc.
iu 18. Cch ghi S ng k tm tr
1. Mc Ni tm tr: Ghi r s nh, ng ph, t, thn, xm, lng, p, bn, bun, phum, sc;
2. Mc H v tn cn b ng k: Nu ng k cho nhiu ngi mt ln th ch cn ghi r h, tn
cn b ng k hng ghi nhn khu cui cng;
3. Mc Ni dung iu chnh, thay i: Ghi ni dung iu chnh, thay i v ngy, thng, nm iu
chnh, thay i ni dung .
iu 19. Cch ghi S tip nhn lu tr
1. Mc L do lu tr: Ghi r l do nh cha bnh, thm thn, du lch;
2. Mc a ch lu tr: Ghi r s nh, ng ph, t, thn, xm, lng, p, bn, bun, phum, sc;
3. Mc Hnh thc, thi gian thng bo: Ghi r hnh thc trc tip hoc bng in thoi, thi gian, h,
tn ngi thng bo lu tr, s in thoi (nu c);
4. Mc Ghi ch: Cn b tip nhn lu tr ghi cc trng hp c nghi vn, trng hp cn thit do
yu cu m bo an ninh, trt t th phi bo co ngay v Cng an x, phng, th trn
iu 20. Cch ghi ti h s h khu
Mc Np lu ngy: Ghi theo ngy, thng, nm a h s h khu vo lu ti tng th h s h
khu.
iu 21. Cch ghi Thng k h khu, nhn khu
1. Phn h, nhn khu hin ang c tr (phn I)
Mc Nhn khu thnh th: Thng k s nhn khu hin ang c tr ti cc qun, phng v th trn.
2. Phn cc loi h, nhn khu (phn II)
a) Mc i ngoi tnh: Thng k s h, nhn khu ng k thng tr nhng chuyn i tnh, thnh
ph trc thuc trung ng khc;
b) Mc i ngoi huyn trong tnh: Thng k s h, nhn khu ng k thng tr nhng chuyn
i huyn, qun, th x, thnh ph khc trong cng phm vi tnh, thnh ph trc thuc trung ng;
c) Mc i ngoi x trong huyn: Thng k s h, nhn khu ng k thng tr nhng chuyn i
phng, x, th trn khc trong cng phm vi huyn, qun, th x, thnh ph thuc tnh;
d) Mc Ngoi tnh n: Thng k s h, nhn khu t tnh, thnh ph trc thuc trung ng khc
n ng k tm tr;
) Mc Ngoi huyn trong tnh n: Thng k s h, nhn khu t huyn, qun, th x, thnh ph
khc trong cng phm vi tnh, thnh ph trc thuc trung ng n ng k tm tr;
e) Mc Ngoi x trong huyn n: Thng k s h, nhn khu t phng, x, th trn khc trong
cng phm vi huyn, qun, th x, thnh ph thuc tnh n ng k tm tr.
3. Phn kt qu ng k, qun l c tr (phn III)
Mc Ngoi tnh n: Thng k s h, nhn khu t tnh, thnh ph trc thuc trung ng khc
chuyn n ng k thng tr.
4. Khi thng k phi ghi chnh xc, y cc ch tiu thng tin, thi im bo co, cn b thng k
k, ghi r h v tn; th trng n v thng k k, ghi r h, tn, ng du.
iu 22. Cch tnh tng s h, nhn khu hin ang c tr
(Tng s h hin ang c tr gi l X; Tng s nhn khu hin ang c tr gi l Y).

1. i vi c quan Cng an cp tnh
a) X = Tng s h ng k thng tr - Tng s h khng c tr ti ni ng k thng tr i
ngoi tnh + Tng s h ng k tm tr ngoi tnh n.
b) Y = Tng s nhn khu ng k thng tr - Tng s nhn khu khng c tr ti ni ng k
thng tr i ngoi tnh + Tng s nhn khu ng k tm tr ngoi tnh n.
2. i vi c quan Cng an cp huyn
a) X = Tng s h ng k thng tr - (Tng s h khng c tr ti ni ng k thng tr i
ngoi tnh + Tng s h khng c tr ti ni ng k thng tr i ngoi huyn trong tnh) + (Tng
s h ng k tm tr ngoi tnh n + Tng s h ng k tm tr ngoi huyn trong tnh n).
b) Y = Tng s nhn khu ng k thng tr - (Tng s nhn khu khng c tr ti ni ng k
thng tr i ngoi tnh + Tng s nhn khu khng c tr ti ni ng k thng tr i ngoi
huyn trong tnh) + (Tng s nhn khu ng k tm tr ngoi tnh n + Tng s nhn khu ng k
tm tr ngoi huyn trong tnh n).
3. i vi Cng an cp x
a) X = Tng s h ng k thng tr - (Tng s h khng c tr ti ni ng k thng tr i
ngoi tnh + Tng s h khng c tr ti ni ng k thng tr i ngoi huyn trong tnh + Tng
s h khng c tr ti ni ng k thng tr i ngoi x trong huyn) + (Tng s h ng k tm
tr ngoi tnh n + Tng s h ng k tm tr ngoi huyn trong tnh n + Tng s h ng k tm
tr ngoi x trong huyn n).
b) Y = Tng s nhn khu ng k thng tr - (Tng s nhn khu khng c tr ti ni ng k
thng tr i ngoi tnh + Tng s nhn khu khng c tr ti ni ng k thng tr i ngoi
huyn trong tnh + Tng s nhn khu khng c tr ti ni ng k thng tr i ngoi x trong
huyn) + (Tng s nhn khu ng k tm tr ngoi tnh n + Tng s nhn khu ng k tm tr
ngoi huyn trong tnh n + Tng s nhn khu ng k tm tr ngoi x trong huyn n).
4. Tng s nhn khu thnh th; nhn khu n; nhn khu t 14 tui tr ln hin ang c tr thc
hin nh cch tnh nh tng s nhn khu hin ang c tr (Y) trn.
5. Ct i tng qun l: Ch cn ghi tng s i tng thuc din qun l theo chc nng ca lc
lng Cnh st qun l hnh chnh v trt t x hi.
Chng 3.
T CHC THC HIN

iu 23. Hiu lc thi hnh
1. Thng t ny c hiu lc thi hnh k t ngy 08/02/2012 v thay th Quyt nh s 698/2007/QBCA-C11 ngy 01/07/2007 ca B trng B Cng an v vic ban hnh biu mu s dng trong
ng k, qun l c tr.
2. Cc biu mu in theo quy nh ti Quyt nh s 698/2007/Q-BCA-C11 th c s dng cho
n ht.
iu 24. Trch nhim thi hnh
1. Tng cc Cnh st Qun l hnh chnh v trt t, an ton x hi c trch nhim hng dn, theo
di, n c, kim tra vic thc hin Thng t ny.
2. Tng cc trng cc Tng cc, Th trng cc n v trc thuc B trong phm vi chc nng,
nhim v v quyn hn c giao c trch nhim phi hp thc hin Thng t ny.
3 Gim c Cng an cc tnh, thnh ph trc thuc trung ng, Gim c S Cnh st phng chy
v cha chy, cc t chc, c nhn c lin quan chu trch nhim thi hnh Thng t ny.
Trong qu trnh thc hin Thng t ny, nu c vng mc ny sinh th phn nh kp thi v B Cng
an (qua Tng cc Cnh st qun l hnh chnh v trt t, an ton x hi) kp thi hng dn.
B TRNG
Ni nhn:
- Cc ng ch Th trng ( ch o);
- Cc Tng cc, n v trc thuc B ( thc hin);
- Cng an tnh, TP trc thuc TW; S Cnh st PCCC (
thc hin);
- Cng bo;
- Lu: VT, C61 (C64).
Thng tng Trn i Quang
PH LC S 01
S S H KHU CA CC TNH, THNH PH TRC THUC TRUNG NG
(Ban hnh km theo Thng t s 81/2011/TT-BCA ngy 15 thng 12 nm 2011 ca B Cng an quy
nh v biu mu c s dng trong ng k, qun l c tr)
S s h khu gm 09 s (chn s), mi tnh c cp m s c nh (02 s u).
STT
TN TNH
M
S
STT
TN TNH
M
S
STT
TN TNH
M
S
An Giang
01
23
H Nam
23
45
Ph Yn
46
B Ra - Vng
Tu
02
24
H Ni
24;
25
46
Qung Bnh
47
Bc Liu
03
25
H Tnh
26
47
Qung Nam
48
Bc Giang
04
26
Hi Dng
27
48
Qung Ngi
49
Bc Cn
05
27
Hi Phng
28
49
Qung Ninh
50
Bc Ninh
06
28
Hu Giang
29
50
Qung Tr
51
Bn Tre
07
29
Ha Bnh
30
51
Sc Trng
52
Bnh Dng
08
30
TP. H Ch
Minh
31
52
Sn La
53
Bnh nh
09
31
Hng Yn
32
53
Ty Ninh
54
10
Bnh Phc
10
32
Khnh Ha
33
54
Thi Bnh
55
11
Bnh Thun
11
33
Kin Giang
34
55
Thi Nguyn
56
12
C Mau
12
34
Kon Tum
35
56
Thanh Ha
57
13
Cao Bng
13
35
Lai Chu
36
57
Tha Thin Hu
58
14
Cn Th
14
36
Lng Sn
37
58
Tin Giang
59
15
Nng
15
37
Lo Cai
38
59
Tr Vinh
60
16
k Lk
16
38
Lm ng
39
60
Tuyn Quang
61
17
c Nng
17
39
Long An
40
61
Vnh Long
62
18
in Bin
18
40
Nam nh
41
62
Vnh Phc
63
19
ng Nai
19
41
Ngh An
42
63
Yn Bi
64
20
ng Thp
20
42
Ninh Bnh
43
21
Gia Lai
21
43
Ninh Thun
44
22
H Giang
22
44
Ph Th
45
PH LC S 02
S S TM TR CA CC TNH, THNH PH TRC THUC TRUNG NG
(Ban hnh km theo Thng t s 81/2011/TT-BCA ngy 15 thng 12 nm 2011 ca B Cng an quy
nh v biu mu c s dng trong ng k, qun l c tr)
S s tm tr gm 09 s (chn s), mi tnh c cp m s c nh (02 s u).
STT
TN TNH
M
S
STT
TN TNH
M
S
STT
TN TNH
M
S
An Giang
01
23
H Nam
23
45
Ph Yn
46
B Ra - Vng
Tu
02
24
H Ni
24;
25
46
Qung Bnh
47
Bc Liu
03
25
H Tnh
26
47
Qung Nam
48
Bc Giang
04
26
Hi Dng
27
48
Qung Ngi
49
Bc Cn
05
27
Hi Phng
28
49
Qung Ninh
50
Bc Ninh
06
28
Hu Giang
29
50
Qung Tr
51
Bn Tre
07
29
Ha Bnh
30
51
Sc Trng
52
Bnh Dng
08
30
TP. H Ch
Minh
31
52
Sn La
53
Bnh nh
09
31
Hng Yn
32
53
Ty Ninh
54
10
Bnh Phc
10
32
Khnh Ha
33
54
Thi Bnh
55
11
Bnh Thun
11
33
Kin Giang
34
55
Thi Nguyn
56
12
C Mau
12
34
Kon Tum
35
56
Thanh Ha
57
13
Cao Bng
13
35
Lai Chu
36
57
Tha Thin Hu
58
14
Cn Th
14
36
Lng Sn
37
58
Tin Giang
59
15
Nng
15
37
Lo Cai
38
59
Tr Vinh
60
16
k Lk
16
38
Lm ng
39
60
Tuyn Quang
61
17
c Nng
17
39
Long An
40
61
Vnh Long
62
18
in Bin
18
40
Nam nh
41
62
Vnh Phc
63
19
ng Nai
19
41
Ngh An
42
63
Yn Bi
64
20
ng Thp
20
42
Ninh Bnh
43
21
Gia Lai
21
43
Ninh Thun
44
22
H Giang
22
44
Ph Th
45

---------------
Mu HK01 ban hnh

theo TT s 81/2011/TTBCA ngy 15/12/2011
BN KHAI NHN KHU

(Dng cho ngi t 14 tui tr ln)
1. H v tn (1) ...............................................................................................................................
2. H v tn gi khc (nu c):.......................................................................................................
3. Ngy, thng, nm sinh: ././ 4. Gii tnh:..................................................
5. Ni sinh:.....................................................................................................................................
6. Qu qun:...................................................................................................................................
7. Dn tc:. 8. Tn gio: 9. Quc tch:...........................
10. CMND s: .. 11. H chiu s:.....................................................
12. Ni thng tr:.........................................................................................................................
.......................................................................................................................................................
13. a ch ch hin nay:.............................................................................................................
.......................................................................................................................................................
14. Trnh hc vn (2) ..15. Trnh chuyn mn (3):................................
16. Bit ting dn tc: 17. Trnh ngoi ng:.......................................
18. Ngh nghip, ni lm vic:.......................................................................................................
.......................................................................................................................................................
19. Tm tt v bn thn (T 14 tui tr ln n nay u, lm g):
T thng, nm
n thng, nm
(1)
Ch
(Ghi r s nh, ng ph: thn xm, lng, p, bn,
bun, phum, sc; x/phng/th trn; qun/huyn;
tnh/thnh ph. Nu nc ngoi th ghi r tn nc)
Ngh nghip, ni
lm vic
Vit ch in hoa du;
(2)
Ghi r trnh hc vn cao nht (Tin s, Thc s, i hc, Cao ng, Trung cp, tt nghip ph
thng trung hc, tt nghip ph thng c s; nu khng bit ch th ghi r khng bit ch);
(3)
Ghi r chuyn ngnh c o to hoc trnh tay ngh, bc th, chuyn mn k thut khc
c ghi trong vn bn, chng ch.
20. Tin n (Ti danh, hnh pht, theo bn n s, ngy, thng, nm ca Ta n):.....................
...................................................................................................................................................
...................................................................................................................................................
21. Tm tt v gia nh (B, m; v/chng; con; anh, ch, em rut)
TT
H v tn
Ngy, thng,
nm sinh
Gii
tnh
Quan
h
(4)
Ngh
nghip
a ch ch hin nay
Ti cam oan nhng li khai trn y l ng s tht v chu trch nhim trc php lut v cam
oan ca mnh./.
.ngythngnm.
NGI KHAI HOC NGI VIT H
(K, ghi r h tn)
____________
(4)
Ghi c cha, m, con nui; ngi nui dng; ngi gim h theo quy nh ca php lut (nu c)

---------------
Mu HK02 ban hnh

PHIU BO THAY I H KHU, NHN KHU

Knh gi: ..
I. Thng tin v ngi vit phiu bo
1. H v tn(1): . 2. Gii tnh:................
3. CMND s:. 4. H chiu s:..............................................
5. Ni thng tr:.............................................................................................................................
6. a ch ch hin nay:.................................................................................................................
..S in thoi lin h:..............................................
II. Thng tin v ngi c thay i h khu, nhn khu
1. H v tn(1): . 2. Gii tnh:................
3. Ngy, thng, nm sinh: ..// 4. Dn tc: . 5. Quc tch:........................
6. CMND s:. 7. H chiu s:..............................................
8. Ni sinh:.......................................................................................................................................
9. Qu qun:.....................................................................................................................................
10. Ngh nghip, ni lm vic:.........................................................................................................
11. Ni thng tr:...........................................................................................................................
12. a ch ch hin nay:...............................................................................................................
..S in thoi lin h:..............................................
13. H v tn ch h: . 14. Quan h vi ch h:............................
15. Ni dung thay i h khu, nhn khu(2):....................................................................................
.........................................................................................................................................................
...................................................................................................................................................
____________
(1)
Vit ch in hoa du;
(2) Ghi tm tt ni dung thay i h khu, nhn khu. V d: ng k thng tr, tm tr; thay i ni
ng k thng tr, tm tr; tch s h khu; iu chnh nhng thay i trong s h khu
16. Nhng ngi cng thay i:

TT
H v tn
Ngy,
thng,
nm
sinh
Gii
tnh
Ni
sinh
.ngythngnm.
KIN CA CH H (3)
(Ghi r ni dung v k, ghi r h tn)
XC NHN CA CNG AN
Ngh
nghip
Dn
tc
Quc
tch
CMND s
(hoc H
chiu s)
Quan h
vi
ngi c
thay i
.ngythngnm.
NGI VIT PHIU BO
(K, ghi r h tn)
(4)
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
...................................................................................................................................................
.ngythngnm.
TRNG CNG AN: ..
(K, ghi r h tn v ng du)
____________
(3)
Ghi r kin ca ch h l ng cho ng k thng tr, ng k tm tr hoc ng cho tch s

h khu; ch h k v ghi r h tn, ngy, thng, nm.
(4)
p dng i vi trng hp: Xc nhn vic cng dn trc y ng k thng tr v trng

hp cp li s h khu do b mt.
.
.

---------------
Mu HK03 ban hnh

PHIU XC MINH H KHU, NHN KHU

Knh gi:
.
.
ngh xc minh trng hp:

1. H v tn(1):..................................................................................................................................
2. H v tn gi khc (nu c):.........................................................................................................

3. Ngy, thng, nm sinh: ././. 4. Gii tnh:....................................................
5. Ni sinh:.......................................................................................................................................
6. Qu qun:.....................................................................................................................................
7. Dn tc:. 8. Tn gio: 9. Quc tch:...................
10. CMND s:. 11. H chiu s:.........................................................
12. H tn cha: . 13. H tn m:.................................................
14. H v tn ch h:.15. Quan h vi ch h:..........................
16. Ni thng tr:...........................................................................................................................
.........................................................................................................................................................
17. a ch ch hin nay:...............................................................................................................
.........................................................................................................................................................
18. Ngh nghip, ni lm vic:.........................................................................................................
.........................................................................................................................................................
NI DUNG XC MINH (2)
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
Kt qu xc minh gi v:..................................................................................................................
............................................................................................... trc ngythng.nm.
CN B LP PHIU
(K, ghi r h tn)
. ngythngnm....
TRNG CNG AN.
.
.

---------------
Mu HK04 ban hnh

PHIU THNG TIN THAY I V H KHU, NHN KHU

Knh gi:
.
.
1. H v tn ngi c thay i
(1)
:.....................................................................................................
2. H v tn gi khc (nu c):.........................................................................................................

5. Ni sinh:.......................................................................................................................................
6. Qu qun:.....................................................................................................................................
10. CMND s:. 11. H chiu s:.........................................................
12. H s h khu s: ... 13. S h khu s:...................................................
14. H v tn ch h:.15. Quan h vi ch h:..........................
16. Ni thng tr:...........................................................................................................................
.........................................................................................................................................................
NI DUNG THAY I (2)
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
XUT, KIN NGH (nu c)
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
.........................................................................................................................................................
CN B LP PHIU
(K, ghi r h tn)
.ngythngnm....
TRNG CNG AN..
____________
(1) Vit ch in hoa du
(2) Ghi y , r rng nhng thng tin thay i nh: ng k thng tr; iu chnh nhng thay i
trong s h khu; xa ng k thng tr Trng hp thng bo v vic ng k thng tr th
Cng an ni n phi ghi y cc thng tin sau: h v tn; ngy, thng, nm sinh; ni ng k
thng tr c; ni chuyn n; h v tn cc nhn khu km theo cng ng k thng tr; giy
chuyn h khu (s, ngy, thng, nm cp).
.
.
S:

---------------
Mu HK05 ban hnh

/TV
PHIU KHAI BO TM VNG
(Phn cp cho ngi tm vng)
1. H v tn (1):.................................................................................................................................
2. Ngy, thng, nm sinh: //.... 3. Gii tnh: 4. Quc tch:.....................................
5. CMND s:.. 6. H chiu s:........................................................
7. Ni thng tr/tm tr (2):.............................................................................................................
.........................................................................................................................................................
8. Tm vng t ngy, thng, nm: ././ n ngy // 9. L do tm vng v ni n
(3)
.........................................................................................................................................................
.. ngy.thng.nm.
TRNG CNG AN
ngythng.nm.
NGI KHAI BO
(K, ghi r h tn)
____________
(1) Vit ch in hoa du. (2) Nu ghi ni thng tr th gch ni tm tr v ngc li (3) Ghi r s
nh, ng ph, t, thn, xm, lng, p, bn, bun, phum, sc; x/phng/th trn; qun/huyn;
tnh/thnh ph.
.
.
S:

---------------
Mu HK05 ban hnh

/TV
PHIU KHAI BO TM VNG
(Phn lu ti Cng an x, phng, th trn)
1. H v tn (1):..................................................................................................................................
2. Ngy, thng, nm sinh: //... 3. Gii tnh: 4. Quc tch:.......................................
5. CMND s:.. 6. H chiu s:.........................................................
7. Ni thng tr/tm tr (2):..............................................................................................................
..........................................................................................................................................................
8. Tm vng t ngy, thng, nm: ././ n ngy // 9. L do tm vng v ni n
(3)
..........................................................................................................................................................
.. ngy.thng.nm.
TRNG CNG AN
(K, ghi r h tn)
ngythng.nm.
NGI KHAI BO
(K, ghi r h tn)
____________
(1) Vit ch in hoa du. (2) Nu ghi ni thng tr th gch ni tm tr v ngc li (3) Ghi r s
nh, ng ph, t, thn, xm, lng, p, bn, bun, phum, sc; x/phng/th trn; qun/huyn;
tnh/thnh ph.
NHNG IU CN CH
1. Cc trng hp sau y phi n tr s Cng an x, phng, th trn khai bo tm vng:
- B can, b co ang ti ngoi; ngi b kt n pht t nhng cha c quyt nh thi hnh n
hoc c hon, tm nh ch chp hnh hnh pht t; ngi b kt n pht t c hng n
treo; ngi b pht ci to khng giam gi; ngi ang b qun ch; ngi ang chp hnh bin
php gio dc ti x, phng, th trn; ngi b p dng bin php a vo c s gio dc, c
s cha bnh, trng gio dng nhng ang c hon chp hnh hoc tm nh ch thi hnh
khi i khi noi c tr t mt ngy tr ln c trch nhim khai bo tm vng.
- Ngi trong tui lm ngha v qun s, d b ng vin i khi huyn, qun, th x, thnh
ph thuc tnh ni mnh c tr t ba thng tr ln.
2. Ngi n khai bo tm vng phi xut trnh CMND v ghi vo phiu khai bo tm vng.
3. Cng an x, phng, th trn c trch nhim hng dn ni dung khai bo, kim tra v k,
ng du xc nhn vo phn phiu cp cho ngi khai bo tm vng.
PHIU THEO DI H S H KHU

HSHK s: ............................................... S K thng tr s: ....................... T s:.................
H v tn ch h:..........................................................................................................................
Ni thng tr:..............................................................................................................................
......................................................................................................................................................
DANH SCH NHNG NGI TRONG H
TT
H v tn
Nm sinh
Gii tnh
Quan h
vi ch h
i tng
Mu HK06 ban hnh theo TT s 81/2011/TT-BCA ngy 15/12/2011
Ngy i
(Mt sau)
TT
H v tn
Nm sinh
Gii tnh
Quan h
vi ch h
i tng
Ngy i
.
.

---------------
Mu HK07 ban hnh

S: /GCHK
GIY CHUYN H KHU
(Phn cp cho ngi chuyn h khu)
(1)
1. H v tn :.................................................................................................................................
2. Tn gi khc (nu c):..................................................................................................................
5. Ni sinh:.......................................................................................................................................
6. Qu qun:.....................................................................................................................................
10. Ni thng tr:...........................................................................................................................
.........................................................................................................................................................
11. H v tn ch h ni i: 12. Quan h vi ch h:....................
13. L do chuyn h khu:...............................................................................................................
.........................................................................................................................................................
14. Ni chuyn n:.........................................................................................................................
.........................................................................................................................................................
15. Nhng ngi trong h cng chuyn h khu
TT
H v tn
Ngy,
thng,
nm sinh
Gii
tnh
(2)
Qu
qun
Dn tc
Quc
tch
CMND s
(hoc H
chiu s)
Quan
h (3)
.. ngy. thng.nm.
TRNG CNG AN
____________
(1) Vit ch in hoa du;
(2) Ghi theo s ng k thng tr, s h khu cc thng tin ca ngi trong h cng chuyn h
khu.
(3) Ghi mi quan h vi ngi chuyn h khu ti Mc 1.
Ghi ch: Lp 02 bn, mt bn cp cho cng dn np ti ni ng k thng tr, mt bn lu ti ni
cp giy.
.
.

---------------
Mu HK07 ban hnh

S: /GCHK
GIY CHUYN H KHU
(Phn lu ti c quan cp giy)
(1)
1. H v tn :...............................................................................................................................
2. Tn gi khc (nu c):................................................................................................................
3. Ngy, thng, nm sinh: ././. 4. Gii tnh:.................................................
5. Ni sinh:.....................................................................................................................................
6. Qu qun:...................................................................................................................................
7. Dn tc:. 8. Tn gio: 9. Quc tch:.................
10. Ni thng tr:.........................................................................................................................
.......................................................................................................................................................
11. H v tn ch h ni i: 12. Quan h vi ch h:..................
13. L do chuyn h khu:.............................................................................................................
.......................................................................................................................................................
14. Ni chuyn n:.......................................................................................................................
.......................................................................................................................................................
15. Nhng ngi trong h cng chuyn h khu
TT
H v tn
Ngy,
thng,
nm sinh
Gii
tnh
(2)
Qu
qun
Dn tc
Quc
tch
CMND s
(hoc H
chiu s)
Quan
h (3)
.. ngy.thng.nm.
TRNG CNG AN
(K, ghi r h tn)
____________
(1) Vit ch in hoa du;
(2) Ghi theo s ng k thng tr, s h khu cc thng tin ca ngi trong h cng chuyn h
khu.
(3) Ghi mi quan h vi ngi chuyn h khu ti Mc 1.
Ghi ch: Lp 02 bn, mt bn cp cho cng dn np ti ni ng k thng tr, mt bn lu ti ni
cp giy.

--------------------
S H KHU
CNG AN TNH/TP..
Mu HK08 ban hnh

theo TT s 81/2011/TT-BCA
ngy 15/12/2011
S H KHU
S:..
NHNG IU CN CH
H v tn ch h:.................................................................................
1. S h khu c cp cho h gia nh hoc c nhn ng k

thng tr v c gi tr xc nh ni thng tr ca cng dn.
.............................................................................................................
2. S h khu b h hng th c cp i, b mt th c cp li.
Ni thng tr:....................................................................................
3. S h khu do B Cng an in v pht hnh s dng thng nht

trong ton quc.
.............................................................................................................
.............................................................................................................
Ngythng..nm..
TRNG CNG AN.
4. Khi c nhng thay i trong s h khu, ch h hoc ngi trong h

phi n c quan ng k thng tr lm th tc thay i theo quy
nh.
5. Ch h hoc ngi trong h c trch nhim xut trnh s h khu khi
c quan, ngi c thm quyn yu cu. Ch h c trch nhim to
iu kin thun li cho nhng ngi c tn trong s h khu c s
dng s gii quyt cc cng vic theo quy nh.
6. Nghim cm vic thu, cho thu, mn, cho mn, lm gi, sa
cha, lm sai lch ni dung, t vit thm thng tin vo s h khu.
7. Cng dn cn kim tra k cc thng tin ng k, iu chnh trc
khi nhn s.
H s h khu s:........................................
S ng k thng tr s:. T s:...................
IU CHNH THAY I
CH H
Ni dung:.......................
H v tn:...............................................................................................
...................
H v tn gi khc (nu c):..................................................................
...................
Ngy, thng, nm sinh: .../.../....... Gii tnh:.................................
....................
Qu qun:...............................................................................................
Dn tc:................... Quc tch:.........................................
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
CMND s: ................................... H chiu s: ......................................

Ngh nghip, ni lm vic:.....................................................................
................................................................................................................
Ni thng tr trc khi chuyn n:.....................................................
................................................................................................................
IU CHNH THAY I
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
Ni dung:.......................
...................
...................
L do xa ng k thng tr:.....................
....................
.................
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
16
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
QUAN H VI CH H:..
IU CHNH THAY I
H v tn:.....................
Ni dung:.......................
H v tn gi khc (nu c):.....................
...................
Ngy, thng, nm sinh: .../.../............Gii tnh:
...................
Qu qun:.......................
....................
Dn tc:.................. Quc tch:..

CMND s: ................................... H chiu s: ...............................
Ngh nghip, ni lm vic:................
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
...............
Ni thng tr trc khi chuyn n:...............
..............
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
IU CHNH THAY I
Ni dung:.......................
...................
L do xa ng k thng tr:.........................
...................
............................
....................
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
15
QUAN H VI CH H:..
QUAN H VI CH H:..
H v tn:.....................
H v tn:.....................
H v tn gi khc (nu c):.....................
H v tn gi khc (nu c):.....................
Qu qun:.......................
Qu qun:.......................
Dn tc:.................. Quc tch:..
Dn tc:.................. Quc tch:..
CMND s: ................................... H chiu s: ...............................
CMND s: ................................... H chiu s: ...............................
...............
...............
..............
..............
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
L do xa ng k thng tr:.........................
L do xa ng k thng tr:.........................
............................
............................
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
14
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
QUAN H VI CH H:..
QUAN H VI CH H:..
H v tn:.....................
H v tn:.....................
H v tn gi khc (nu c):.....................
H v tn gi khc (nu c):.....................
Qu qun:.......................
Qu qun:.......................
Dn tc:.................. Quc tch:..
Dn tc:.................. Quc tch:..
CMND s: ................................... H chiu s: ...............................
CMND s: ................................... H chiu s: ...............................
...............
...............
..............
..............
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
L do xa ng k thng tr:.........................
L do xa ng k thng tr:.........................
............................
............................
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
13
QUAN H VI CH H:..
QUAN H VI CH H:..
H v tn:.....................
H v tn:.....................
H v tn gi khc (nu c):.....................
H v tn gi khc (nu c):.....................
Qu qun:.......................
Qu qun:.......................
Dn tc:.................. Quc tch:..
Dn tc:.................. Quc tch:..
CMND s: ................................... H chiu s: ...............................
CMND s: ................................... H chiu s: ...............................
...............
...............
..............
..............
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
L do xa ng k thng tr:.........................
L do xa ng k thng tr:.........................
............................
............................
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
12
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
QUAN H VI CH H:..
QUAN H VI CH H:..
H v tn:.....................
H v tn:.....................
H v tn gi khc (nu c):.....................
H v tn gi khc (nu c):.....................
Qu qun:.......................
Qu qun:.......................
Dn tc:.................. Quc tch:..
Dn tc:.................. Quc tch:..
CMND s: ................................... H chiu s: ...............................
CMND s: ................................... H chiu s: ...............................
...............
...............
..............
..............
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
L do xa ng k thng tr:.........................
L do xa ng k thng tr:.........................
............................
............................
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
11
QUAN H VI CH H:..
QUAN H VI CH H:..
H v tn:.....................
H v tn:.....................
H v tn gi khc (nu c):.....................
H v tn gi khc (nu c):.....................
Qu qun:.......................
Qu qun:.......................
Dn tc:.................. Quc tch:..
Dn tc:.................. Quc tch:..
CMND s: ................................... H chiu s: ...............................
CMND s: ................................... H chiu s: ...............................
...............
...............
..............
..............
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
L do xa ng k thng tr:.........................
L do xa ng k thng tr:.........................
............................
............................
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
10
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
QUAN H VI CH H:..
QUAN H VI CH H:..
H v tn:.....................
H v tn:.....................
H v tn gi khc (nu c):.....................
H v tn gi khc (nu c):.....................
Qu qun:.......................
Qu qun:.......................
Dn tc:.................. Quc tch:..
Dn tc:.................. Quc tch:..
CMND s: ................................... H chiu s: ...............................
CMND s: ................................... H chiu s: ...............................
...............
...............
..............
..............
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
L do xa ng k thng tr:.........................
L do xa ng k thng tr:.........................
............................
............................
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
Ngy.thngnm.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)

-----------------
S TM TR
CNG AN TNH/TP................
S TM TR
Mu HK09 ban hnh

ngy 15/12/2011
NHNG IU CN CH
S:
H v tn ch h:.................................................................................
.............................................................................................................
Ni tm tr:..........................................................................................
.............................................................................................................
.............................................................................................................
.............................................................................................................
Ngy .. thng .. nm .
TRNG CNG AN ..
1- S tm tr c cp cho h gia nh hoc c nhn ng k

tm tr, c gi tr xc nh ni tm tr ca cng dn v khng xc
nh thi hn.
2- S tm tr b h hng th c cp i, b mt th c cp li.
3- S tm tr do B Cng an in v pht hnh s dng thng nht
trong ton quc.
4- Khi c nhng thay i trong s tm tr, ch h hoc ngi trong
h phi n c quan ng k tm tr lm th tc thay i theo quy
nh.
5- Ch h hoc ngi trong h c trch nhim xut trnh s tm tr
khi c quan, ngi c thm quyn yu cu. Ch h c trch nhim
to iu kin thun li cho nhng ngi c tn trong s tm tr
c s dng s gii quyt cc cng vic theo quy nh.
6- Nghim cm vic thu, cho thu, mn, cho mn, lm gi, sa
cha, lm sai lch ni dung, t vit thm thng tin vo s tm tr.
7- Cng dn cn kim tra k cc thng tin ng k, iu chnh
trc khi nhn s.
S ng k tm tr s: .. T s: .........
IU CHNH THAY I
CH H
H v tn:........................................................................................
Ni dung: ..
H v tn gi khc (nu c):............................................................
Ngy, thng, nm sinh: .//.. Gii tnh:.....................
Qu qun:........................................................................................
Dn tc: .. Quc tch:..............................................

CMND s: .. H chiu s:...........................................
CN B NG K
(K, ghi r h tn)
Ngy .. thng .. nm
.
TRNG CNG AN
Ngh nghip, ni lm vic:..............................................................

.........................................................................................................
Ni thng tr:................................................................................
.........................................................................................................
IU CHNH THAY I
CN B NG K
(K, ghi r h tn)
Ngy thng .. nm
TRNG CNG AN
Ni dung: ..
.
.
L do xa ng k tm tr:
CN B NG K
(K, ghi r h tn)
Ngy .. thng .. nm
.
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
Ngy .. thng . nm
TRNG CNG AN
QUAN H VI CH H: .............
IU CHNH THAY I
H v tn:............................................................................................
H v tn gi khc (nu c):................................................................
Ni dung: ..
Ngy, thng, nm sinh: .//.. Gii tnh:.........................
Qu qun:............................................................................................
Dn tc: .. Quc tch:..................................................
CMND s: .. H chiu s:...............................................

Ngh nghip, ni lm vic:..................................................................
............................................................................................................
CN B NG K
(K, ghi r h tn)
Ngy .. thng .. nm .
TRNG CNG AN
Ni thng tr:....................................................................................
............................................................................................................
IU CHNH THAY I
CN B NG K
(K, ghi r h tn)
Ngy thng .. nm
TRNG CNG AN
L do xa ng k tm tr:
.
CN B NG K
(K, ghi r h tn)
Ngy .. thng . nm
TRNG CNG AN
Ni dung: ..
.
.
.
CN B NG K
(K, ghi r h tn)
Ngy .. thng .. nm .
TRNG CNG AN
QUAN H VI CH H: .............
QUAN H VI CH H: .............
H v tn:............................................................................................
H v tn:............................................................................................
H v tn gi khc (nu c):................................................................
H v tn gi khc (nu c):................................................................
Qu qun:............................................................................................
Qu qun:............................................................................................
Dn tc: .. Quc tch:..................................................
Dn tc: .. Quc tch:..................................................
CMND s: .. H chiu s:...............................................
CMND s: .. H chiu s:...............................................
............................................................................................................
............................................................................................................
Ni thng tr:....................................................................................
Ni thng tr:....................................................................................
............................................................................................................
............................................................................................................
CN B NG K
(K, ghi r h tn)
Ngy thng .. nm
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
Ngy thng .. nm
TRNG CNG AN
L do xa ng k tm tr:
L do xa ng k tm tr:
CN B NG K
(K, ghi r h tn)
Ngy .. thng . nm
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
Ngy .. thng . nm
TRNG CNG AN
QUAN H VI CH H: .............
QUAN H VI CH H: .............
H v tn:............................................................................................
H v tn:............................................................................................
H v tn gi khc (nu c):................................................................
H v tn gi khc (nu c):................................................................
Qu qun:............................................................................................
Qu qun:............................................................................................
Dn tc: .. Quc tch:..................................................
Dn tc: .. Quc tch:..................................................
CMND s: .. H chiu s:...............................................
CMND s: .. H chiu s:...............................................
............................................................................................................
............................................................................................................
Ni thng tr:....................................................................................
Ni thng tr:....................................................................................
............................................................................................................
............................................................................................................
CN B NG K
(K, ghi r h tn)
Ngy thng .. nm
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
Ngy thng .. nm
TRNG CNG AN
L do xa ng k tm tr:
L do xa ng k tm tr:
CN B NG K
(K, ghi r h tn)
Ngy .. thng . nm
TRNG CNG AN
CN B NG K
(K, ghi r h tn)
Ngy .. thng . nm
TRNG CNG AN
CNG AN TNH/TP
Mu HK10 ban hnh

ngy 15/12/2011
(1) .
S THEO DI GII QUYT H KHU

X/ PHNG/ TH TRN
QUYN S: ..
- Bt u ngy: ..
- Kt thc ngy: .
(1) Cng an qun/huyn/th x/ TP thuc tnh
TT
H V TN CA NGI YU CU GII
QUYT
NI DUNG YU CU GII
QUYT
H S KM THEO
IN THOI LIN H
NHN H S
TR KT QU
H v tn ngi
nhn
Nhn ngy, thng,

nm
Hn tr kt qu
ngy, thng, nm
Tr ngy, thng,
nm
Kt qu gii quyt
Ngi nhn
(k, ghi r h tn)
Ghi ch
10
11
12
CNG AN TNH/TP
Mu HK11 ban hnh

(1) .
ngy 15/12/2011
S NG K THNG TR
X/ PHNG/ TH TRN
(2) ..
QUYN S: ..
- Bt u ngy: ..
- Kt thc ngy: .
(1) Cng an qun/huyn/th x/ TP thuc tnh. (2) Thn/p/bn
MC LC
S
TT
H V TN CH H
T
S
S
TT
H V TN CH H
T
S
S
TT
H V TN CH H
T
S
H V TN CH H: NI THNG TR:.
TT
H V TN
QUAN H
VI CH H
NGY,
THNG,
NM SINH
GII TNH
NI SINH
QU QUN
CMND S
HOC H
CHIU S
DN TC
QUC
TCH
10
. H S H KHU S: .. S H KHU S:
NGH NGHIP,
NI LM VIC
NI THNG TR TRC KHI CHUYN

N(1)
(ghi r s nh, ng ph, t, thn, xm, lng,
p, bn, bun, phum, sc; x/phng/th trn;
qun/huyn; tnh/thnh ph)
NG K
NGY,
THNG,
NM
NGI C THM
QUYN NG K
(k, ghi r h tn)
NI DUNG IU
CHNH, THAY I (2)
GHI CH
11
12
13
14
15
16
T S: ..
(1) Trng hp khng c ni thng tr th ghi ni tm tr
(2) Ghi r ni dung iu chnh nh: thay i ch h, thay i h tn, ch m, ngy, thng, nm sinh; thay i a gii hnh chnh; xa ng k thng tr (ghi r ngy, thng,
nm xa, ni chuyn n nu c), cp giy chuyn h khu (ghi r ngy, thng, nm cp, ni chuyn n), i, cp li s h khu
CNG AN TNH/TP
Mu HK12 ban hnh

ngy 15/12/2011
(1) .
S NG K TM TR
X/ PHNG/ TH TRN
(2)
QUYN S: ..
- Bt u ngy: ..
- Kt thc ngy: .
(1) Cng an qun/huyn/th x/ TP thuc tnh.
(2) im ng k tm tr
TT
H V TN NGI
TM TR
NGY,
THNG,
NM SINH
GII TNH
QU QUN
DN TC
QUC TCH
CMND S
HOC H
CHIU S
NGH NGHIP,
NI LM VIC
NI THNG TR (1)
(ghi r s nh, ng ph, t, thn,
xm, lng, p, bn, bun, phum,
sc; x/phng/th trn; qun/huyn;
tnh/thnh ph)
NG K, NGY,
THNG, NM
NI TM TR
xm, lng, p, bn, bun, phum, sc)
H V TN
CN B
NG K
NI DUNG IU
CHNH, THAY I
(ghi r ni dung v ngy,
thng, nm iu chnh)
10
11
12
13
14
(1) Trng hp khng c ni thng tr th ghi ni tm tr trc khi chuyn n
CNG AN TNH/TP
Mu HK13 ban hnh

ngy 15/12/2011
(1) .
S TIP NHN LU TR
X/ PHNG/ TH TRN
(2) ..
QUYN S: ..
- Bt u ngy: ..
- Kt thc ngy: .
(1) Cng an qun/huyn/th x/ TP thuc tnh
(2) im tip nhn lu tr
TT
H V TN
NGY,
THNG,
NM SINH
GII TNH
CMND S
HOC H
CHIU S
NGH
NGHIP, NI
LM VIC
DN TC
QUC TCH
NI THNG
TR HOC TM
TR (1)
(1) Ghi r s nh, ng ph, t, thn, xm, lng, p, bn, bun, phum, sc; x/ phng/ th trn; qun/huyn; tnh/thnh ph ni thng tr. Trng hp khng c ni thng
tr th ghi ni tm tr hoc ghi tn, a ch ni lm vic.
L DO LU TR
THI GIAN LU TR
A CH LU TR (2)
HNH THC, THI GIAN
H V TN
GHI CH
10
n ngy
i ngy

xm, lng, p, bn, bun, phum, sc)
THNG BO
CN B
TIP NHN
11
12
13
14
15
(2) Nu l c s cho thu lu tr th ghi r s phng, tng, tn c s v a ch.
16

---------------
Mu HK14 ban hnh

CNG AN TNH/TP.
(*)..
H S H KHU
S:..
H v tn ch h:...........................................................................................................................
................................................................................................................. Gii tnh:.......................
Ngy, thng, nm sinh:............................................................... S h khu s:...........................
Ni thng tr:..............................................................................................................................
......................................................................................................................................................
......................................................................................................................................................
S ng k thng tr s:.. T s:.

Np lu ngy: //..
Bo qun vnh vin
(*) Cng an qun/huyn/th x/thnh ph thuc tnh
CNG AN.......................
THNG K H KHU, NHN

KHU..
(T ngy .// n ngy ./
/.)
.....................
Mu HK15 ban
hnh theo TT s
81/2011/TT-BCA
ngy 15/12/2011
I. H, NHN KHU HIN ANG C TR: Tng s: . h: ........

. nhn khu;
Trong : ..NK thnh th;
NK n; .. NK t 14 tui tr ln
II. CC LOI H, NHN KHU:
H, NHN KHU NG K THNG TR
KHNG C TR TI NI NG K
THNG TR
TNG S
Tng s
H
NK
NK
Thnh th
NK N
NK t
14 tui
tr ln
H
6
NK
NK
Thnh th
NK N
NK t
14 tui
tr ln
10
H, NHN KHU NG K THNG TR

KHNG C TR TI NI NG K THNG TR
i ngoi tnh
i ngoi huyn trong tnh
Tng s
NK
NK
Thnh
th
11
12
13
NK
N
NK
t
14
tui
tr
ln
14
15
Tng s
NK
NK
Thnh
th
16
17
18
i ngoi x trong huyn
NK
N
NK
t
14
tui
tr
ln
19
20
Tng s
NK
NK
Thnh
th
21
22
23
NK
N
NK
t
14
tui
tr
ln
24
25
H, NHN KHU NG K TM TR
Tng s
NK
26
27
NK
Thnh
th
NK
N
28
29
NK
t
14
tui
tr
ln
30
Ngoi tnh n
Tng s
NK
NK
Thnh
th
31
32
33
H, NHN KHU NG K TM
TR
NK
NK
Thnh
th
NK
N
NK
N
NK
t
14
tui
tr
ln
34
35
Tng s
NK
NK
Thnh
th
36
37
38
NHN KHU LU TR
Ngoi x trong huyn n

Tng s
Ngoi huyn trong tnh n
NK
t 14
tui
tr
ln
Tng
s
H
gia
nh
39
40
NHN KHU
TM VNG
Trong
C
s
cho
thu
lu
tr
NK
N
NK
t
14
tui
tr
ln
Tng
s
I
TNG
QUN
L
41
42
43
44
45
46
47
48
49
50
51
52

81 2011 Tt-Bca 133482

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81 2011 Tt-Bca 133482

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B CNG AN

CNG HA X HI CH NGHA VIT NAM

H Ni, ngy 15 thng 12 nm 2011

NHNG QUY NH CHUNG

ng ph, t dn ph hoc theo nh tp th ca cc c quan, t chc. Khi c nhng thay i

CCH GHI BIU MU

) Mc Ni sinh: Ghi ni sinh theo giy khai sinh;

ca Lut C tr, Ngh nh s 107/2007/N-CP ngy 25/6/2007 v Ngh nh s 56/2010/N-CP ngy

2. Mc L do chuyn h khu: Ghi r l do chuyn h khu.

iu 17. Cch ghi S ng k thng tr

(Tng s h hin ang c tr gi l X; Tng s nhn khu hin ang c tr gi l Y).

T CHC THC HIN

Thng tng Trn i Quang

CNG HA X HI CH NGHA VIT NAM

Mu HK01 ban hnh

BN KHAI NHN KHU

Vit ch in hoa du;

CNG HA X HI CH NGHA VIT NAM

Mu HK02 ban hnh

PHIU BO THAY I H KHU, NHN KHU

Vit ch in hoa du;

16. Nhng ngi cng thay i:

Ghi r kin ca ch h l ng cho ng k thng tr, ng k tm tr hoc ng cho tch s

p dng i vi trng hp: Xc nhn vic cng dn trc y ng k thng tr v trng

CNG HA X HI CH NGHA VIT NAM

Mu HK03 ban hnh

PHIU XC MINH H KHU, NHN KHU

ngh xc minh trng hp:

2. H v tn gi khc (nu c):.........................................................................................................

CNG HA X HI CH NGHA VIT NAM

Mu HK04 ban hnh

PHIU THNG TIN THAY I V H KHU, NHN KHU

2. H v tn gi khc (nu c):.........................................................................................................

CNG HA X HI CH NGHA VIT NAM

Mu HK05 ban hnh

CNG HA X HI CH NGHA VIT NAM

Mu HK05 ban hnh

PHIU THEO DI H S H KHU

Mu HK06 ban hnh theo TT s 81/2011/TT-BCA ngy 15/12/2011

CNG HA X HI CH NGHA VIT NAM

Mu HK07 ban hnh

CNG HA X HI CH NGHA VIT NAM

Mu HK07 ban hnh

CNG HA X HI CH NGHA VIT NAM

Mu HK08 ban hnh

1. S h khu c cp cho h gia nh hoc c nhn ng k

2. S h khu b h hng th c cp i, b mt th c cp li.

3. S h khu do B Cng an in v pht hnh s dng thng nht

4. Khi c nhng thay i trong s h khu, ch h hoc ngi trong h

H v tn gi khc (nu c):..................................................................

Ngy, thng, nm sinh: .../.../....... Gii tnh:.................................

CMND s: ................................... H chiu s: ......................................

H v tn gi khc (nu c):.....................

Ngy, thng, nm sinh: .../.../............Gii tnh:

Dn tc:.................. Quc tch:..

H v tn gi khc (nu c):.....................

H v tn gi khc (nu c):.....................

Ngy, thng, nm sinh: .../.../............Gii tnh:

Ngy, thng, nm sinh: .../.../............Gii tnh:

Dn tc:.................. Quc tch:..

Dn tc:.................. Quc tch:..

CMND s: ................................... H chiu s: ...............................

CMND s: ................................... H chiu s: ...............................