Professional Documents
Culture Documents
c lp - T do - Hnh phc
MU NG K NGI PH THUC GIM TR GIA CNH
Chnh thc: [
B sung: [ ]
Ln: [
Mu s: 16/K-TNCN
(Ban hnh km theo
Thng t s 84/2008/TT-BTC
ngy 30/9/2008 ca B Ti chnh)
2. M s thu:
3. Tn ca t chc, c nhn tr thu nhp:
4. M s thu:
Stt
H v tn
Ngy sinh
M s thu
S CMND/
h chiu
Quan h vi
TNT
Thi im tnh
gim tr
(thng/nm)
Thi im kt
thc gim tr
(thng/nm)
1
2
3
...
...
Tng cng
Ti cam oan nhng ni dung k khai l ng v chu trch nhim trc php lut v nhng ni dung khai./.
40
c lp - T do - Hnh phc
Mu s: 22/XN-TNCN
(Ban hnh km theo Thng t s
62 /2009/TT-BTC ngy
27/3/2009 ca B Ti chnh)
BN K KHAI
V NGI TN TT KHNG C KH NNG LAO NG
H v tn
ngi ph thuc
Nm
sinh
S
CMND
/H chiu
Quan h vi
ngi lm n
a ch thng tr
ca ngi ph thuc
Biu hin
tn tt (*)
1
2
Ti cam oan nhng li khai trn l ng s tht, nu sai ti xin chu hon ton trch nhim./.
..
, ngy . thng . nm 20
NGI LM N
(K tn)
XC NHN CA UBND X, PHNG:
thng
tr
............ b tn tt ng nh k khai./.
..
(b)
ti
, ngy . thng . nm 20
TM. UBND..
(k tn, ng du)
41
Ghi ch:
- (*) Biu hin tn tt c khai theo nguyn tc sau: khai r ngi ph thuc b
khim khuyt b phn no trn c th (nh thiu tay, chn, mt,) hoc cn bnh him
ngho mc phi (nh bnh down, di chng cht c mu gia cam,...)
- Xc nhn ca UBND phng, x: trng hp i tng np thu c nhiu ngi
ph thuc nhiu a im khc nhau th ti mi a phng c ngi ph thuc sng, i tng
np thu phi lp t khai v ngh UBND phng, x ni xc nhn.
V d: ng A c 3 ngi ph thuc b tn tt khng c kh nng lao ng sng ti 3 a
im khc; trong c 2 ngi x X, 1 ngi x Y. ng A s phi lp 02 bn khai theo mu
22/XN-TNCN; 01 bn ngh UBND x X xc nhn cho 02 ngi ph thuc sng x X, 01 bn
ngh UBND x Y xc nhn cho 01 ngi sng x Y.
42
BN K KHAI
V NGI PHI TRC TIP NUI DNG
Stt
H v tn
ngi ph thuc
Ngy
sinh
S
CMND
/H chiu
Quan h vi
ngi khai
a ch thng tr ca
ngi ph thuc
1
2
Ti xin cam oan k khai trn l ng s tht, nu sai ti xin chu hon ton trch nhim./.
..,
ngy . thng . nm 20
NGI LM N
(K tn)
ngy . thng . nm 20
TM. UBND..
(k tn, ng du)
43
BN K KHAI
V NGI PHI TRC TIP NUI DNG
Stt
H v tn
ngi ph thuc
Ngy
sinh
S
CMND
/H chiu
Quan h vi
ngi lm n
a ch thng tr ca
ngi ph thuc
1
2
Ti xin cam oan nhng li khai trn l ng s tht, nu sai ti xin chu hon ton trch
nhim./.
..,
ngy . thng . nm 20
NGI LM N
(K tn)
ngy . thng . nm 20
TM. UBND..
(k tn, ng du)
44
Ghi ch:
Xc nhn ca UBND phng, x: trng hp i tng np thu c nhiu ngi
ph thuc nhiu a im khc nhau th ti mi a phng c ngi ph thuc sng, i tng
np thu phi lp t khai v ngh UBND phng, x ni xc nhn.
V d: ng B c 3 ngi ph thuc (khng ni nng ta v ng B ang trc tip nui
dng) ang sng ti 3 a im khc; trong c 02 ngi x K, 01 ngi x M. ng A s
phi lp 02 bn khai theo mu s 21b/XN-TNCN; 01 bn ngh UBND x K xc nhn cho 02
ngi ph thuc sng x K, 01 bn ngh UBND x M xc nhn cho 01 ngi sng x M.
45