Mu s: 02/K-NPT-TNCN

(Ban hnh km theo Thng t s

92/2015/TT-BTC ngy
15/6/2015 ca B Ti chnh)

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
NG K NGI PH THUC GIM TR GIA CNH
[01] Ln u:

[02] B sung ln th:

[03] H v tn c nhn c thu nhp:......DNG VN KHIM.....................................................................

[04] M s thu:

[05] a ch c nhn nhn thng bo m s NPT:.SN BAY QUC T NI BI,X PH MINH,HUYN SC SN

TP H NI .
[06] Ni ng k gim tr ngi ph thuc (T chc, c nhn tr thu nhp/c quan qun l):....CNG TY TNHH MTV
K THUT MY BAY .

[07] M s thu ca t chc, c nhn tr thu nhp:

I.

Ngi ph thuc c MST/CMND/H chiu

STT

H v tn

Ngy sinh

M s thu

Quc tch

S CMND / H
chiu

Quan h vi
ngi np
thu

[08]

[09]

[10]

[11]

[12]

[13]

[14]

Thi im bt
u tnh gim
tr
(thng/nm)
[15]

Thi im kt
thc tnh gim
tr
(thng/nm)
[16]

1
2
3
...
1

II.

Ngi ph thuc cha c MST/CMND/H chiu

Thng tin trn giy khai sinh

STT

[17]

H v tn

[18]

Ni ng k
Ngy
sinh

Quyn
s

[19]

[20]

[21]

Quc
gia

Tnh/
Thnh
ph

Qun/
Huyn

Phng/
X

[22]

[23]

[24]

[25]

Quc
tch

Quan h
vi
ngi
np thu

Thi im
bt u tnh
gim tr
(thng/nm)

Thi im kt
thc tnh gim
tr
(thng/nm)

[26]

[27]

[28]

[29]

1
2
3

(MST: M s thu; CMND: Chng minh nhn dn)

Ti cam oan nhng ni dung k khai l ng v chu trch nhim trc php lut v nhng ni dung khai./.

..,ngy thng nm ...

NHN VIN I L THU
H v tn: ..
Chng ch hnh ngh s:............

C NHN C THU NHP

(K v ghi r h tn)