TN T CHC/C NHN

CNG HO X HI CH NGHA VIT NAM

c lp - T do Hnh phc

S:...

Mu s: 01/NHT
(Ban hnh km theo Thng t
s 156/2013/TT-BTC ngy
6/11/2013 ca B Ti chnh)

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

GIY NGH
HON TR KHON THU NGN SCH NH NC
[01] Trng hp hon thu trc, kim tra sau:
Trng hp kim tra trc, hon thu sau:
Knh gi: .......(tn c quan thu, c quan c thm quyn hon tr)........
I- Thng tin v t chc, c nhn ngh hon tr:
[02] Tn ngi np thu:................................................................................................................................................
[03] M s thu:
[04] CMND/H chiu s: ..............Ngy cp:........./......./...........Ni cp:....................... Quc tch : .............................
[05] a ch :.....................................................................................................................................................................
[06] Qun/huyn: ............................................................... [07] Tnh/thnh ph: ...........................................................
[08] in thoi: ...................................... [09] Fax: ............................................. [10] Email: .......................................
[11] Tn i l thu (nu c):.........................................................................................................................................
[12] M s thu:
[13] a ch :.....................................................................................................................................................................
[14] Qun/huyn: ............................................................... [15] Tnh/thnh ph: ...........................................................
[16] in thoi: ...................................... [17] Fax: ............................................. [18] Email: .......................................
[19] Hp ng i l thu s:...................................................ngy ................................................................................
II- Ni dung ngh hon tr khon thu ngn sch nh nc (NSNN):
1. Thng tin v khon thu ngh hon tr:
S
S
TT

Loi thu

K tnh
thu

(1)

(2)

(3)

n v tin: ng Vit Nam

S tin thu np
tha (tnh n
thi im
ngh hon)
(4)

S thu GTGT cha

khu tr ht
ngh hon trn t
khai thu GTGT
(5)

S tin
ngh hon

L do ngh
hon tr

(6)

(7)

Tng cng
2. Hnh thc ngh hon tr:
2.1. B tr cho khon phi np NSNN :
n v tin: ng Vit Nam
STT

(1)

Khon
phi np
NSNN
(loi thu,
khon
pht)
(2)

C quan
thu
C quan
C
thu
quan
Hi
quan
(3)
(4)

C
quan
khc

Thi gian
pht sinh
khon phi
np (K tnh
thu)

(5)

(6)

Quyt nh thu/
T khai hi quan
S

Ngy

(7)

(8)

Np vo ti
khon
Thu
Tm
NSNN
thu
(9)

(10)

S
tin

(11)

Cng theo loi thu, c quan thu, k tnh thu

TNG CNG

Tng s tin np NSNN ghi bng ch:.............................................................................................................................

2.2. Hon tr trc tip :
S tin hon tr: Bng s: ................................................. Bng ch:.............................................................................
...........................................................................................................................................................................................
Hnh thc hon tr:
Chuyn khon: Ti khon s:........................Ti Ngn hng (KBNN).......
Tin mt: Ni nhn tin hon thu: Kho bc Nh nc .................................................
III- Ti liu gi km: (ghi r tn ti liu, bn chnh, bn sao)
1 ........................................................................................................................................................................................
2 ........................................................................................................................................................................................
Ti cam oan s liu khai trn l ng v chu trch nhim trc php lut v nhng s liu khai./.

NHN VIN I L THU

H v tn:.......................................
Chng ch hnh ngh s:...............................

NGI NP THU hoc

I DIN HP PHP CA NGI NP THU
K, ghi r h tn; chc v v ng du (nu c)

Ghi ch:
- K thu: Trng hp ngh hon thu cho nhiu thng, nm th ghi r t thng ... nm ... n thng ... nm...
c lin quan.
- L do ngh hon tr: Ghi r ngh hon theo quy nh ti im, Khon, iu ca vn bn quy phm
php lut c lin quan.
- Quyt nh thu/T khai hi quan: Ghi Quyt nh hnh chnh ca c quan c thm quyn hoc t khai hi
quan c n thu cha np NSNN.
- Np vo ti khon: nh du V vo ct ti khon c lin quan.
- KBNN: Kho bc Nh nc.
- NSNN: Ngn sch Nh nc.
- GTGT: Gi tr gia tng.