CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
HN, ngy 11 thng 5 nm 2016

BN KHAI M TI KHON NG K DCH V

Knh gi:

(Dnh cho c quan, t chc, doanh nghip)

CNG TY C PHN MT BO

1. M Khch Hng
2. Thng tin ca ch th ng
k:
Tn t chc *
Tn giao dch Quc t v tn vit
tt (nu l t chc)
a ch *
Tnh/thnh ph *
Quc gia (nu khng phi l Vit
Nam)*
S in thoi *
Fax
Email *
Postcode
Giy CNKDN s
Ngi i din theo php lut
3. Thng tin Ngi Qun l
H v tn *
S CMTND/H chiu (i vi c
nhn ngi nc ngoi) *
Gii tnh *
a ch *
Tnh/thnh ph *
Quc gia*
S in thoi *
Email *
Postcode
4. Thng tin Ngi qun l k
thut
H v tn *
Gii tnh *
a ch *
Tnh/thnh ph *
Quc gia *
S in thoi *
Fax
Email *
Postcode
5. Thng tin Ngi thanh ton
H v tn *
Gii tnh *
a ch *

MB281614
Ban qun l d n u t xy dng c bn TP Hi Dng
S 106, ng Trn Hng o, thnh ph Hi Dng
Hi Dng
VIT NAM
+84-3203835897
sonnguyen86@gmail.com
170000
0000000000
ng Nguyn c Lam
ng Nguyn c Lam
Nam
S 106 Trn Hng o, thnh ph Hi Dng
Hi Dng
VIT NAM
+84-988678822
sonnguyen86@gmail.com
170000

ng Nguyn c Lam
Nam
S 106 Trn Hng o, thnh ph Hi Dng
Hi Dng
VIT NAM
+84-988678822
sonnguyen86@gmail.com
170000
ng Nguyn c Lam
Nam
S 106 Trn Hng o, thnh ph Hi Dng

Nguyn Th Thanh; thanhnt1@matbao.com; 0904819791

Tng 8 - Ta nh Sng Hng Land - 165 Thi H - ng a - H Ni

Tnh/thnh ph *
Quc gia *
S in thoi *
Fax
Email *
Postcode
6. Thng tin Ngi thay mt ch
th lm th tc ng k
H v tn *
S CMTND/H chiu (i vi c
nhn ngi nc ngoi) *
Gii tnh *
a ch *
Tnh/thnh ph *
Quc gia*
S in thoi *
Email *
Postcode

Hi Dng
VIT NAM
+84-988678822
sonnguyen86@gmail.com
170000

ng Nguyn c Lam
Nam
S 106 Trn Hng o, thnh ph Hi Dng
Hi Dng
VIT NAM
+84-03203835897
sonnguyen86@gmail.com
170000

7. Cam kt ca ch th ng k:
- Chu trch nhim trc php lut v tnh chnh xc v thng tin do mnh cung cp. Thng bo
bng vn bn cho Mt Bo khi c s thay i ni dung nhng thng tin ng k trn.
- ng thng tin trn c s dng vo Bn khai ng k tn min lm th tc ng k,
duy tr tn min theo quy nh ca php lut v ng k s dng cc dch v do Mt Bo cung
cp.
- Tun th quyn v ngha v ca Ch th ng k s dng tn min theo quy nh ca php
lut v qun l v s dng ti nguyn Internet.
Xc nhn ca ch th ng k tn min
(Ngi i din theo php lut k tn v ng du)

Nguyn Th Thanh; thanhnt1@matbao.com; 0904819791

Tng 8 - Ta nh Sng Hng Land - 165 Thi H - ng a - H Ni