CNG HO X HI CH NGHA VIT NAM

c lp - T do - Hnh phc

nh mu
4x6cm
(c ng du
gip lai ca
ca c quan
xc nhn l
lch)

S YU L LCH
T THUT

H v tn:........................................................................................Nam, n: ........................
Sinh ngy......... thng......... nm..............................................................................................
Ni ng k h khu thng tr hin nay: .........................................................................
..................................................................................................................................................
..................................................................................................................................................
Chng minh th nhn dn s:............................................. Ni cp: .....................................
Ngy................. thng......... nm..............................................................................................
S in thoi lin h: Nh ring ................................ Di ng..............................................
Khi cn bo tin cho ai? u?: ..............................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................

S hiu:..................................
K hiu:..................................

H v tn: ................................................................ B danh:.................................................

Tn thng gi: ......................................................................................................................
Sinh ngy......... thng......... nm...................Ti:....................................................................
Nguyn qun: ..........................................................................................................................
..................................................................................................................................................
Ni ng k thng tr hin nay: ..........................................................................................
..................................................................................................................................................
Dn tc: ........................................................Tn gio:...........................................................
Thnh phn gia nh sau ci cch rung t (hoc ci to cng thng nghip) .................
..................................................................................................................................................
Thnh phn bn thn hin nay: ..............................................................................................
Trnh vn ho: ............................................ Ngoi ng:....................................................
Trnh chuyn mn: .............................................Loi hnh o to:..................................
Chuyn ngnh o to: ...........................................................................................................
Kt np ng cng sn Vit Nam ngy........... thng............nm ........................................
Ni kt np: ............................................................................................................................
Ngy vo on TNCSHCM ngy............ thng...........nm...................................................
Ni kt np: ............................................................................................................................
Tnh hnh sc kho: ..................................... Cao...........................Cn nng:............. kg.......
Ngh nghip hoc trnh chuyn mn: ...............................................................................
Cp bc: ............................................ Lng chnh hin nay: ................................................
Ngy nhp ng: .................................Ngy xut ng: ............................................................
L do: ......................................................................................................................................

HON CNH GIA NH

H v tn b: ....................................................... Tui:......... Ngh nghip ..........................
Trc cch mng Thng 8 lm g? u? ............................................................................
..................................................................................................................................................
..................................................................................................................................................
Trong khng chin chng thc dn Php lm g? u? .....................................................
..................................................................................................................................................
..................................................................................................................................................
T nm 1955 n nay lm g? u? (Ghi r tn c quan, x nghip hin nay ang lm)
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................

H v tn m: ...................................................... Tui:......... Ngh nghip ..........................

Trc cch mng Thng 8 lm g? u? ............................................................................
..................................................................................................................................................
..................................................................................................................................................
Trong khng chin chng thc dn Php lm g? u? .....................................................
..................................................................................................................................................
..................................................................................................................................................
T nm 1955 n nay lm g? u? (Ghi r tn c quan, x nghip hin nay ang lm)
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
H V TN ANH CH EM RUT

(Ghi r tn, tui, ch , ngh nghip v trnh chnh tr ca tng ngi)

..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................
..................................................................................................................................................

H v tn v hoc chng: ........................................... Tui: ..................................................

Ngh nghip: ...........................................................................................................................
Ni lm vic: ..........................................................................................................................
Ch hin nay: .......................................................................................................................
H v tn cc con:
1) ...........................................................Tui:............. Ngh nghip:.....................................
2) ...........................................................Tui:............. Ngh nghip:.....................................
3) ...........................................................Tui:............. Ngh nghip:.....................................
4) ...........................................................Tui:............. Ngh nghip:.....................................
5) ...........................................................Tui:............. Ngh nghip:.....................................
QU TRNH HOT NG CA BN THN
T thng nm
n thng nm

Lm cng tc g?

u?

Gi chc v g?

KHEN THNG V K LUT

Khen thng: ..........................................................................................................................
K lut: ...................................................................................................................................
LI CAM OAN
Ti xin cam oan nhng li khai trn l ng s thc v chu trch nhim v
nhng li khai . Nu sau ny c quan c thm quyn pht hin vn g khng
ng. Ti xin chp hnh bin php x l theo quy nh./.
Xc nhn ca Th trng C quan,
X nghip, Ch tch UBND X, Phng
........................................................................
........................................................................
........................................................................
........................................................................

...............,ngythngnm
Ngi khai k tn

CNG HO X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
nh mu
4x6cm
(c ng du
gip lai ca
ca c quan
xc nhn l
lch)

S YU L LCH
T THUT

H v tn: NGUYN VN ANH

Nam, n: Nam

Sinh ngy: 17/6/1984

Ni ng k h khu thng tr hin nay: Thn Li Hong, x Yn Thng, huyn Gia
Lm, H Ni
Chng minh th nhn dn s: 012491846

Ni cp: Cng an Thnh ph H Ni

Ngy 29 thng 12 nm 2012

S in thoi lin h: Nh ring Thn Li Hong, x Yn Thng, huyn Gia Lm, H
Ni

Di ng: 0983 148 xxx

Khi cn bo tin cho ai? u?:

Nguyn Th Vit Phng
S in thoi: 0973 028 xxx
a ch: Li Hong, Yn Thng, Gia Lm, H Ni

S hiu:..................................
K hiu:..................................

H v tn: NGUYN VN ANH

B danh: Khng c

Tn thng gi: NGUYN VN ANH

Sinh ngy 17 thng 6 nm 1984 ti H Ni
Nguyn qun: Triu Thnh, Triu Phong, Qung Tr
Ni ng k thng tr hin nay: Ninh Nht, Ninh M, Hoa L, Ninh Bnh
Ni hin ti: Li Hong, Yn Thng, Gia Lm, H Ni
Dn tc: Kinh

Tn gio: Khng

Thnh phn gia nh sau ci cch rung t (hoc ci to cng thng nghip)
Cn b
Thnh phn bn thn hin nay: Tt nghip i hc
Trnh vn ha 12/12

Trnh ngoi ng: Ting Anh trnh B

Kt np ng Cng sn Vit Nam ngy 31 thng 2 nm 2010

Ni kt np: Chi b x Yn Thng, Gia Lm, H Ni
Kt np on TNCS HCM ngy 23 thng 10 nm 1992
Ni kt np: Trng THCS Yn Thng, Gia Lm, H Ni
Tnh trng sc khe hin nay: sc khe lm vic
Ngh nghip hoc trnh chuyn mn Chuyn vin t vn
Cp bc: Nhn vin

Lng chnh hin nay: 7 triu/thng

Ngy nhp ng QNDVN(TNXP)........................ngy xut ng..........................

L do:......................................................................................................................

HON CNH GIA NH

H v tn b: NGUYN VN BIU

Tui 55

Ngh nghip: ngh hu

Trc cch mng Thng 8 lm g? u?

Cha sinh
Trong khng chin chng thc dn Php lm g? u?
Cha sinh
T nm 1955 n nay lm g? u? (Ghi r tn c quan, x nghip hin nay ang lm)
Cng tc ti Truyn hnh An Vin, s 15AV H Xun Hng, Hai B Trng, H Ni

H v tn m: NGUYN TH CHUYN

Tui 50

Ngh nghip: Ni tr

Trc cch mng Thng 8 lm g? u?

Cha sinh
Trong khng chin chng thc dn Php lm g? u?
Cha sinh
T nm 1955 n nay lm g? u? (Ghi r tn c quan, x nghip hin nay ang lm)
nh ni tr
H V TN ANH CH EM RUT
(Ghi r tn, tui, ch , ngh nghip v trnh chnh tr ca tng ngi)
Ch gi: NGUYN TH DUYN sinh nm: 1982
Ch hin ti: Khu tp th Du lch, Ng 210 Nghi Tm, Ty H, H Ni
Ngh nghip: K ton vin ti Trng i hc FPT
L ng vin ng cng sn Vit Nam
Em trai: NGUYN VN C sinh nm 1995
Ch hin ti: Thn Li Hong, x Yn Thng, huyn Gia Lm, H Ni
Ngh nghip: Sinh vin i hc Giao thng vn ti H Ni
........................................................................................................................................................
........................................................................................................................................................
........................................................................................................................................................
........................................................................................................................................................
........................................................................................................................................................
........................................................................................................................................................
........................................................................................................................................................
........................................................................................................................................................
........................................................................................................................................................
........................................................................................................................................................
........................................................................................................................................................
........................................................................................................................................................
........................................................................................................................................................
........................................................................................................................................................
........................................................................................................................................................

H v tn v hoc chng: NGUYN TH GIANG Tui 25

Ngh nghip: K ton
Ni lm vic: Cng ty c phn xy dng Kin Hng
Ch hin nay: Li Hong, Yn Thng, Gia Lm, H Ni
H v tn cc con
1) NGUYN VN HNG

Tui: 2

Ngh nghip:

2) ...................................................................................................................................................
QU TRNH HOT NG CA BN THN
T thng nm
n thng nm

Lm cng tc g?

u?

Gi chc v g?

1990-1995

Hc tiu hc

Trn tiu
Yn thng

hc Lp trng

1995-1999

Hc trung hc c s

Trng THCS Yn Lp trng

thng

1999-2002

Hc trung hc ph thng

Trng THPT Yn Lp trng

vin

2002-2008

Hc i hc

Trng hc vin Lp trng

ngn hng

10/200806/2015

Chuyn vin t vn

Cng ty bt ng Nhn vin

sn Tn Long

KHEN THNG V K LUT

Khen thng: Hc sinh gii quc gia mn Ton lp 11 nm 2001
K lut: Khng
LI CAM OAN
Ti xin cam oan nhng li khai trn l ng s tht, nu c iu g khai man ti
chu trch nhim hon ton.
........., ngy.....thng.....nm.....

Xc nhn ca Th trng C quan,

X nghip, Ch tch UBND X, Phng

Ngi khai k tn
NGUYN VN ANH