Tờ Khai Tham Gia: Độc lập - Tự do - Hạnh phúc

Mu s: TK1-TS
(Ban hnh km theo Q s:1018 /Q-BHXH

ngy 10/10/2014 ca BHXH Vit Nam)
BO HIM X HI VIT NAM
CNG HO X HI CH NGHA VIT NAM
c lp - T do - Hnh phc
T KHAI THAM GIA

BO HIM X HI, BO HIM Y T
S nh danh: 0 2 0 6 1 0 9 4 5 3
A. THNG TIN CA NGI THAM GIA:
[01]. H v tn (vit ch in hoa): NG TH THY

0 7
[02]. Ngy thng nm sinh:

[03]. Gii tnh: Nam
0 3
1 9 8 0
X [04]. Dn tc: Kinh
[05]. Quc tch: Vit Nam
[06]. Ni cp giy khai sinh (qu qun): [06.1]. X, phng : Ph Xun

[06.2]. Qun, huyn: V Th
[06.3]. Tnh, TP: Thi Bnh
[07]. Thn nhn

[07.1]. Cha hoc M hoc Ngi gim h: Cha Ng Vn Sinh
[07.1]. Thn nhn khc: Chng Nguyn Vn Nhng
[08]. S chng minh th (H chiu):
[08.1]. Ngy cp:
0 5
0 2
1 5 1 2 0 5 4 0 2
2 0 0 9
[08.2]. Ni cp: Cng an Thi Bnh
[09]. a ch ng k h khu: [09.1]. S nh, ng ph, thn xm: T 1

[09.2]. X, phng : Phng Tin Phong
[09.3]. Qun, huyn: TP.Thi Bnh

[10]. a ch lin h (ni sinh sng):
[10.1]. S nh, ng ph, thn xm: S nh 02/537, ng L Thi T, t 17
[10.2].X, phng : Quang Trung
[10.3].Qun, huyn: TP Thi Bnh
[10.4].Tnh, TP: Thi Bnh

[11]. S in thoi lin h: 01249709779
[12].Email: nhuong1379@gmail.com
[13]. Ni ng k khm cha bnh ban u: Bnh vin a khoa TP. Thi Bnh
B. THAM GIA BO HIM X HI, BO HIM Y T:
I. CNG THAM GIA BO HIM X HI BT BUC, BO HIM Y T
[14]. Quyt nh tuyn dng, hp ng lao ng (hp ng lm vic): s 2455/Q- UBND

ngy 17/10/2014 c hiu lc t ngy 17/10/2014 loi hp ng khng xc nh thi hn.
[15]. Tn c quan, n v: Trng i Hc Thi Bnh X Tn Bnh TP. Thi Bnh
Thi Bnh
[16]. Chc v, chc danh ngh, cng vic: Ging vin
[17]. Lng chnh: 3.0
[18]. Ph cp: [18.1]. Chc v............., [18.2]. TN vt
khung ...., [18.3]. TN ngh : 8%
[18.4]. Khc : 30%
II. THAM GIA BO HIM X HI T NGUYN
[19]. Mc thu nhp thng ng bo him x hi t nguyn: ..

[20]. Phng thc ng: ..
III. CH THAM GIA BO HIM Y T
[21]. Tham gia bo him y t theo i tng: .

[22]. Mc tin lm cn c ng bo him y t:
[23]. Phng thc ng:
Ti cam oan nhng ni dung k khai l
ng v chu trch nhim trc php lut v
nhng ni dung k khai.
Thi Bnh, ngy 16 thng 12 nm 2014
Ngi khai
(K, ghi r h tn)
Ng Th Thy
Mu s: TK1-TS
BO HIM X HI VIT NAM
T KHAI THAM GIA

S nh danh: 0 2 0 6 1 0 9 4 4 8
[01]. H v tn (vit ch in hoa): NGUYN VN NHNG

0 1

[03]. Gii tnh: Nam
X N
0 3
1 9 7 9
[04]. Dn tc: Kinh
[06]. Ni cp giy khai sinh (qu qun): [06.1]. X, phng : Tin Phong
[07]. Thn nhn

[07.1]. Cha hoc M hoc Ngi gim h: Cha Nguyn Vn Quy
[07.1]. Thn nhn khc: V Ng Th Thy
1 5 1 2 0 1 5 3 5

[08.1]. Ngy cp:
1 3
0 4
1 9 9 4
[09]. a ch ng k h khu: [09.1]. S nh, ng ph, thn xm: T 1

[09.2]. X, phng : Phng Tin Phong

[10.1]. S nh, ng ph, thn xm: S nh 02/537, ng L Thi T, t 17

[11]. S in thoi lin h: 0915462779
[12].Email: nhuong1379@gmail.com

Thi Bnh
[17]. Lng chnh: 3.0
[18]. Ph cp: [18.1]. Chc v............., [18.2]. TN vt
khung ...., [18.3]. TN ngh : 8%
[18.4]. Khc : 30%


[23]. Phng thc ng:
Ngi khai
(K, ghi r h tn)
Nguyn Vn Nhng
Mu s: TK1-TS
BO HIM X HI VIT NAM
T KHAI THAM GIA

S nh danh: 0 2 0 7 3 7 5 4 2 5
[01]. H v tn (vit ch in hoa): T TH YN

0 5

[03]. Gii tnh: Nam
1 0
1 9 8 2
X [04]. Dn tc: Kinh
[06]. Ni cp giy khai sinh (qu qun): [06.1]. X, phng : Hng Thi
[06.2]. Qun, huyn: Kin Xng
[07]. Thn nhn

[07.1]. Cha hoc M hoc Ngi gim h: Cha T Nam Hun
[07.1]. Thn nhn khc: Chng Trn Cng Thc
1 5 1 3 5 9 5 2 3

[08.1]. Ngy cp:
1 5
0 6
2 0 0 0
[09]. a ch ng k h khu: [09.1]. S nh, ng ph, thn xm: Xm 8, thn Nam

[09.2]. X, phng : ng Sn
[09.3]. Qun, huyn: ng Hng

[10.1]. S nh, ng ph, thn xm: S nh 42, ng 16, on Nguyn Tun, t 15
[10.2].X, phng : Trn Hng o

[11]. S in thoi lin h: 0986383955
[12].Email: tathiyen1982@gmail.com
[13]. Ni ng k khm cha bnh ban u: Bnh vin i hc Y Thi Bnh


Thi Bnh
[16]. Chc v, chc danh ngh, cng vic: Ging vin Cng ngh may
[17]. Lng chnh: 3.0
[18]. Ph cp: [18.1]. Chc v............., [18.2]. TN vt
khung ...., [18.3]. TN ngh : 6%
[18.4]. Khc : 30%


[23]. Phng thc ng:
Ngi khai
(K, ghi r h tn)
T Th Yn
Mu s: TK1-TS
BO HIM X HI VIT NAM
T KHAI THAM GIA

S nh danh: 0 2 0 6 1 0 6 4 5 4
[01]. H v tn (vit ch in hoa): HONG TH KIM DUNG

2 4

[03]. Gii tnh: Nam
1 0
1 9 7 1
X [04]. Dn tc: Kinh
[06]. Ni cp giy khai sinh (qu qun): [06.1]. X, phng : Hng Thi
[07]. Thn nhn

[07.1]. Cha hoc M hoc Ngi gim h: Cha Hong Vn Thun
[07.1]. Thn nhn khc: Chng Nguyn Quang Thanh
1 5 1 0 5 7 9 8 2

[08.1]. Ngy cp:
1 5
0 4
2 0 1 1
[09]. a ch ng k h khu: [09.1]. S nh, ng ph, thn xm: L2/11, t 30

[09.2]. X, phng : Trn Hng o
[09.3]. Qun, huyn: TP. Thi Bnh

[10.1]. S nh, ng ph, thn xm: L2/11, t 30
[10.2].X, phng : Trn Hng o

[11]. S in thoi lin h: 0945.082236
[12].Email: hoangdung1971tb@gmail.com
[13]. Ni ng k khm cha bnh ban u: Bnh vin i hc Y Thi Bnh


Thi Bnh
[16]. Chc v, chc danh ngh, cng vic: Ging vin Cng ngh may
[17]. Lng chnh: 3.0
[18]. Ph cp: [18.1]. Chc v............., [18.2]. TN vt
khung ...., [18.3]. TN ngh : 8%
[18.4]. Khc : 30%


[23]. Phng thc ng:
Ngi khai
(K, ghi r h tn)
Hong Th Kim Dung
Mu s: TK1-TS
BO HIM X HI VIT NAM
T KHAI THAM GIA

S nh danh: 2 6 9 7 0 1 1 7 4 8
[01]. H v tn (vit ch in hoa): L MNH HNG

2 3

[03]. Gii tnh: Nam
X N
0 1
1 9 7 2
[04]. Dn tc: Kinh
[06]. Ni cp giy khai sinh (qu qun): [06.1]. X, phng : Bnh Nguyn
[07]. Thn nhn

[07.1]. Cha hoc M hoc Ngi gim h: Cha L Vn Cn
[07.1]. Thn nhn khc: V H Th Hi
[08.1]. Ngy cp:
1 8
0 8
1 5 1 0 8 2 2 4 7
1 9 9 9
[09]. a ch ng k h khu: [09.1]. S nh, ng ph, thn xm: Xm 12, thn Ngha
Thng
[09.2]. X, phng : ng Ha

[10.1]. S nh, ng ph, thn xm: Xm 12, thn Ngha Thng
[10.2].X, phng : ng Ha

[11]. S in thoi lin h: 0982.259.322
[12].Email: lemanhhung.hui@gmail.com

Thi Bnh
[17]. Lng chnh: 3.99
[18]. Ph cp: [18.1]. Chc v............., [18.2]. TN vt
khung ...., [18.3]. TN ngh : 17%
[18.4]. Khc : 30%


[23]. Phng thc ng:
Ngi khai
(K, ghi r h tn)
L Mnh Hng
Mu s: TK1-TS
BO HIM X HI VIT NAM
T KHAI THAM GIA

S nh danh: 0 2 0 7 3 7 5 4 3 4
[01]. H v tn (vit ch in hoa): V TH THY LAN

1 6

[03]. Gii tnh: Nam
0 8
1 9 8 1
X [04]. Dn tc: Kinh
[06]. Ni cp giy khai sinh (qu qun): [06.1]. X, phng : Thy Trng
[06.2]. Qun, huyn: Thi Thy
[07]. Thn nhn

[07.1]. Cha hoc M hoc Ngi gim h: Cha V nh Bnh
[07.1]. Thn nhn khc: Chng L Cng Khanh
[08.1]. Ngy cp:
1 4
0 5
1 5 1 2 4 2 3 3 9
2 0 1 4
[09]. a ch ng k h khu: [09.1]. S nh, ng ph : SN 98, Ng Th Nhm

[09.2]. X, phng : Quang Trung
[09.3]. Qun, huyn: TP. Thi Bnh

[10.1]. S nh, ng ph, thn xm: SN 98, Ng Th Nhm

[11]. S in thoi lin h: 0914.608.852
[12].Email: vuthithuylandhcn@gmail.com


Thi Bnh
[17]. Lng chnh: 3.0
[18]. Ph cp: [18.1]. Chc v............., [18.2]. TN vt
khung ...., [18.3]. TN ngh : 6%
[18.4]. Khc : 30%


[23]. Phng thc ng:
Ngi khai
(K, ghi r h tn)
V Th Thy Lan
Mu s: TK1-TS
BO HIM X HI VIT NAM
T KHAI THAM GIA

S nh danh: 7 9 0 9 3 0 9 8 9 9
[01]. H v tn (vit ch in hoa): NGUYN TH BO TH

1 1

[03]. Gii tnh: Nam
1 2
1 9 8 6
X [04]. Dn tc: Kinh
[06]. Ni cp giy khai sinh (qu qun): [06.1]. X, phng : ..

[06.2]. Qun, huyn: Sc Sn
[06.3]. Tnh, TP: H Ni
[07]. Thn nhn

[07.1]. Cha hoc M hoc Ngi gim h: Cha Nguyn Vn Tp
[07.1]. Thn nhn khc: Chng Trng Xun Thi
[08.1]. Ngy cp:
1 5
0 7
1 5 1 6 5 7 4 6 5
2 0 1 3
[09]. a ch ng k h khu: [09.1]. S nh, ng ph : SN 154, Minh Tin

[09.2]. X, phng : TT V Th

[10.1]. S nh, ng ph, thn xm: SN 154, Minh Tin
[10.2].X, phng : TT V Th
[10.3].Qun, huyn: V Th

[11]. S in thoi lin h: 0977.734.472
[12].Email: baothu001@gmail.com


Thi Bnh
[17]. Lng chnh: 2.67
[18]. Ph cp: [18.1]. Chc v............., [18.2]. TN vt
khung ...., [18.3]. TN ngh :
[18.4]. Khc : 30%


[23]. Phng thc ng:
Ngi khai
(K, ghi r h tn)
Nguyn Th Bo Th

Tờ Khai Tham Gia: Độc lập - Tự do - Hạnh phúc

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Tờ Khai Tham Gia: Độc lập - Tự do - Hạnh phúc

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Mu s: TK1-TS

(Ban hnh km theo Q s:1018 /Q-BHXH

BO HIM X HI VIT NAM

CNG HO X HI CH NGHA VIT NAM

T KHAI THAM GIA

[01]. H v tn (vit ch in hoa): NG TH THY

[02]. Ngy thng nm sinh:

X [04]. Dn tc: Kinh

[05]. Quc tch: Vit Nam

[06]. Ni cp giy khai sinh (qu qun): [06.1]. X, phng : Ph Xun

[06.3]. Tnh, TP: Thi Bnh

[07]. Thn nhn

[08.2]. Ni cp: Cng an Thi Bnh

[09]. a ch ng k h khu: [09.1]. S nh, ng ph, thn xm: T 1

[09.3]. Qun, huyn: TP.Thi Bnh

[09.4]. Tnh, TP: Thi Bnh

[10.3].Qun, huyn: TP Thi Bnh

[10.4].Tnh, TP: Thi Bnh

[14]. Quyt nh tuyn dng, hp ng lao ng (hp ng lm vic): s 2455/Q- UBND

[18]. Ph cp: [18.1]. Chc v............., [18.2]. TN vt

khung ...., [18.3]. TN ngh : 8%

[18.4]. Khc : 30%

II. THAM GIA BO HIM X HI T NGUYN

[19]. Mc thu nhp thng ng bo him x hi t nguyn: ..

[21]. Tham gia bo him y t theo i tng: .

BO HIM X HI VIT NAM

CNG HO X HI CH NGHA VIT NAM

T KHAI THAM GIA

[01]. H v tn (vit ch in hoa): NGUYN VN NHNG

[02]. Ngy thng nm sinh:

[04]. Dn tc: Kinh

[05]. Quc tch: Vit Nam

[06.3]. Tnh, TP: Thi Bnh

[07]. Thn nhn

[08]. S chng minh th (H chiu):

[08.2]. Ni cp: Cng an Thi Bnh

[09]. a ch ng k h khu: [09.1]. S nh, ng ph, thn xm: T 1

[09.3]. Qun, huyn: TP.Thi Bnh

[09.4]. Tnh, TP: Thi Bnh

[10.3].Qun, huyn: TP Thi Bnh

[10.4].Tnh, TP: Thi Bnh

I. CNG THAM GIA BO HIM X HI BT BUC, BO HIM Y T

[14]. Quyt nh tuyn dng, hp ng lao ng (hp ng lm vic): s 2455/Q- UBND

[18]. Ph cp: [18.1]. Chc v............., [18.2]. TN vt

khung ...., [18.3]. TN ngh : 8%

[18.4]. Khc : 30%

II. THAM GIA BO HIM X HI T NGUYN

[19]. Mc thu nhp thng ng bo him x hi t nguyn: ..

[21]. Tham gia bo him y t theo i tng: .

BO HIM X HI VIT NAM

CNG HO X HI CH NGHA VIT NAM

T KHAI THAM GIA

[01]. H v tn (vit ch in hoa): T TH YN

[02]. Ngy thng nm sinh:

X [04]. Dn tc: Kinh

[05]. Quc tch: Vit Nam

[06.3]. Tnh, TP: Thi Bnh

[07]. Thn nhn

[08]. S chng minh th (H chiu):

[08.2]. Ni cp: Cng an Thi Bnh

[09]. a ch ng k h khu: [09.1]. S nh, ng ph, thn xm: Xm 8, thn Nam

[09.3]. Qun, huyn: ng Hng

[09.4]. Tnh, TP: Thi Bnh