Mu 1.

13 Giy bin nhn

TN C QUAN, TC CH
QUN (1)
TN C QUAN, T CHC (2)

S:

/GBN- (3).

CNG HA X HI CH NGHA VIT NAM

c lp T do Hnh phc
. (4). , ngy .. thng .. nm 20
GIY BIN NHN
H s.
--------------

H v tn:.....................(5) .......................................................................
Chc v, n v cng tc:.........................................................................
tip nhn h s ca:
ng (b): .......................................(6) .bao gm:
1................................................................................................................
2. ...................................................(7) .....................................................
3.................................................................................................................
/.

Ni nhn:
- . (8).;
- Lu: H s.

NGI TIP NHN

(K tn, ng du (nu c))
H v tn

Ghi ch:
(1) Tn c quan, t chc ch qun trc tip (nu c).
(2) Tn c quan, t chc cp giy bin nhn h s.
(3) Ch vit tt tn c quan, t chc cp giy bin nhn h s.
(4) a danh
(5) H v tn, chc v v n v cng tc ca ngi tip nhn h s.
(6) H v tn, ni cng tc hoc giy t ty thn ca ngi np h s.
(7) Lit k y , c th cc vn bn, giy t, ti liu c trong h s.
(8) Tn ngi hoc c quan gi h s.