CNG HA X HI CH NGHA

VIT NAM
c lp - T do - Hnh phc
----------------

Mu s 02
Ban hnh km theo Thng t s
15/2014/TT-BCA ngy 04/4/2014 ca B
Cng an

GIY KHAI NG K XE (Vehicle registation declaration)

A. PHN CH XE T K KHAI (self declaration vehicle owner's)
Tn ch xe (Owner's full name): .....................................................................................
a ch (Address): ............................................................................................................
S CMND/H chiu (Identity Card N0/Passport): . cp ngy./ ../ ti
in thoi (phone number) Loi ti sn ( t/car, xe my/motorcar):
Nhn hiu (Brand): .... S loi (Model code):..................
Loi xe (Type): ... Mu sn (color): .........................
Nm sn xut (Year of manufacture): . Dung tch (Capacity): ......cm3
S my (Engine N0): .. S khung (Chassis N0): .................
L do: Cp, i li ng k, bin s (Reason: issue, exchange, number plates, registation)
..........................................................................................................................................
Ti xin cam oan v ni dung khai trn l ng v hon ton chu trch nhim trc php lut
v cc chng t trong h s xe (I swear on the content declaration is correct and complely
responsible before law for the vehicle documents in the file).
., ngy (date) .. thng .. nm ..
CH XE (Owner's full name)
(K, ghi r h tn, ng du nu l xe c
quan)
(Sinature, write full name .)

B. PHN KIM TRA XC NH CA C QUAN NG K XE:

BIN S C: ..
..

BIN S MI:

ng k mi

ng k sang tn, di chuyn

i, cp li ng k, bin s

DN BN C S MY S KHUNG (NG K TM THI KHNG PHI DN)

Ni dn bn c s my

Ni dn bn c s khung

Kch thc bao: Di m; Rng ..m; Cao m

T trng: kg; Kch c lp: .......................................................
Ti trng: Hng ha: kg; Trng lng ko theo: ....................................kg;
Kch thc thng: ..mm; Chiu di c s ....................................mm;
S ch: ngi ., ng ., nm ..........................
THNG K CHNG T NG K XE

TT

LOI CHNG T

C QUAN CP

S CHNG
T

NGY CP

1.
2.
3.
4.
..(1).
(K, ghi r h tn)

.., ngy . thng . nm .

CN B NG K XE
(K, ghi r h tn)

..(2)
(K tn v ng du)
_______________
(1) B ghi Trng phng: tnh, TP trc thuc Trung ng ghi i trng: CA cp
Huyn ghi i trng;
(2) B ghi Cc trng: tnh, Tp trc thuc Trung ng ghi Trng phng: CA cp
huyn ghi Trng CA, qun, huyn, th x, TP.

Mu s 03
Ban hnh km theo Thng t s 15/2014/TTBCA
ngy 04/4/2014 ca B Cng an
CNG HA X HI CH NGHA VIT NAM
c lp - T do - Hnh phc
---------------GIY KHAI NG K SANG TN, DI CHUYN XE
A. PHN K KHAI, CAM KT CA NGI ANG S DNG XE
1- H v tn ngi ang s dng xe: ...............................................................................
2- a ch: ........................................................................................................................
..........................................................................................................................................
3- S CMND: cp ngy ./ ./ .. ti .........................................
4- C chic xe vi c im sau:
Xe: Bin s: ....................................
Nhn hiu: .. S loi: .......................................
Loi xe: Mu sn: ...................................
S my: .. S khung: ....................................
S ch: ngi: .. ng.. nm: ; dung tch .........................................cm3
5- Tn ngi ng tn trong giy ng k xe: ................................................................
6- a ch: .............................................................................................................................
7- Trnh by ngun gc xe: (1) .............................................................................................
................................................................................................................................................
................................................................................................................................................
................................................................................................................................................
8- Km theo: .........................................................................................................................
................................................................................................................................................
9- ngh c quan ng k: (2) ...........................................................................................
ng k sang tn

ng k sang tn, di chuyn

10- Ti xin cam kt v hon ton chu trch nhim trc php lut v xe lm th tc sang tn
di chuyn. Nu c tranh chp, khiu kin ti s c trch nhim gii quyt theo quy nh ca
php lut.
XC NHN CA CNG AN X,
PHNG, TH TRN
(V a ch thng tr ca ngi ang s
dng xe)

.., ngy . thng . nm .

NGI ANG S DNG XE
(K, ghi r h tn, ng du nu l c
quan)

B. PHN KIM TRA, XC MINH CA C QUAN NG K XE

BIN S C: ..

BIN S MI: ...........................

DN BN C S MY S KHUNG (NG K TM THI KHNG PHI DN

Ni dn bn c s my

Ni dn bn c s khung

Kt qu kim tra, xc minh: ..................................................................................................

................................................................................................................................................
CN B LM TH TC
(K, ghi r h tn)

(3)
(K, ghi r h tn)

(4)
(K, ghi r h tn, ng
du)

_________________
(1) Trnh by ngun gc xe (xe do mua, cho, tng, tha k)
(2) B ghi Cc CGSTB-S, tnh, Tp ghi Phng CSGT.; huyn, qun, th x, TP
thuc tnh ghi Cng an huyn
(3) B ghi Trng phng; Tnh, Tp ghi i trng; huyn, qun, th x, TP thuc tnh
ghi i Trng.
(4) B ghi Cc trng; Tnh, Tp ghi Trng phng; huyn, qun, th x, TP thuc tnh
ghi Trng Cng an huyn, qun, th x, TP.

Mu s 04
Ban hnh km theo Thng t s 15/2014/TTBCA
ngy 04/4/2014 ca B Cng an
CNG HA X HI CH NGHA VIT NAM
c lp - T do - Hnh phc
---------------GIY KHAI SANG TN, DI CHUYN
(Certificate moving vehicle title transfer)
XE (Vehicle): .BIN S (Number Plate): ...............
1- Tn ch xe (Owner's full name): .................................................................................
2- a ch (Address): .......................................................................................................
3- S CMND (Identity Card N0): cp ngy ./ ./ . ti .....................
4- C chic xe vi c im sau (Characteristics of the vehicle):
Nhn hiu (Brand): . S loi (Model code): .............................
Loi xe (Type): . Mu sn (Color): .............................
S my (Engine No): . S khung (Chassis No): ......................
5- Nay sang tn cho ch xe mi (Now to move the car to new vehicle owners) .............
..........................................................................................................................................
6- a ch (Address) .........................................................................................................
7- L do sang tn, di chuyn (iu ng hoc cho, tng, tha k, mua li) (reason for
transfer): ..........................................................................................................................
..........................................................................................................................................
8- Km theo giy ny c (attached documents) ..............................................................
..........................................................................................................................................
..........................................................................................................................................
Ni dn bn c s my

Ni dn bn c s khung

9- Ti xin hon ton chu trch nhim trc php lut v cc chng t trong h s xe (I bear
full responsibility before law for the papers in the car records). Ch xe mi hon ton chu
trch nhim php l v ng k v s dng lu hnh xe theo quy nh ca php lut; phi lm
th tc sang tn, di chuyn trong vng 30 ngy k t ngy bn, cho, tng, iu chuyn (New
vehicle owners bear full legal responsibility for the registration and use of the vehicle used in
accordance with the law have procedures for transfer, to move within 30 days of sale,
donation, transfer).
10- ngh c quan ng k: (1) ....................................................................................
xem xt v lm th tc sang tn, di chuyn chic xe ni trn (proposed vehicle registration
agency considered and the procedures to name my car).
CN B LM TH TC
(K, ghi r h tn)

.., ngy . thng . nm .

CH XE
(K, ghi r h tn, ng du nu l c
quan)

(2)
(K, ghi r h tn, ng du)
______________
(1) B ghi Cc CSGTB-S, tnh, Tp ghi Phng CSGT., huyn, th x, TP thuc tnh
ghi Cng an huyn ..
(2) B ghi Cc trng, tnh, Tp ghi Trng phng, huyn, th x, TP thuc tnh ghi
Trng Cng an huyn, th x, TP.