H v tn: Sinh ngy:............. S CMND: . Ngy cp: .. Ni cp: in thoi: .. Email: .................................. S ti khon: . Ngn hng: ........................... H tn ngi gii thiu: ..M s gii thiu: ...... H tn ngi ch nh: . M s ch nh: ....... , Ngy .. thng . Nm 2015 Khch hng (K & ghi r h tn)