CNG HA X HI CH NGHA VIT NAM Mu HK07 ban hnh theo TT

c lp - T do - Hnh phc s 36/2014/TT-BCA ngy

---------------- 09/9/2014

S:./GCHK

GIY CHUYN H KHU

(Phn lu ti c quan cp giy)
1. H v tn (1):.......................................................................................................................................
2. Tn gi khc (nu c):.......................................................................................................................
3. Ngy, thng, nm sinh:.................................................. 4. Gii tnh:................................................
5. Ni sinh:.............................................................................................................................................
6. Nguyn qun:.....................................................................................................................................
7. Dn tc:......................................8. Tn gio:........................ 9. Quc tch:.......................................
10. Ni thng tr:................................................................................................................................
................................................................................................................................................................
11. H v tn ch h ni i:...............................................12. Quan h vi ch h:.............................
13. L do chuyn h khu:.....................................................................................................................
................................................................................................................................................................
14. Ni chuyn n:...............................................................................................................................
................................................................................................................................................................
15. Nhng ngi trong h cng chuyn h khu (2):
CMND
Ngy,
Nguyn Quc s (hoc Quan h
TT H v tn thng, Gii tnh Dn tc (3)
qun tch H chiu
nm sinh
s)

.., ngythngnm
TRNG CNG AN
(K, ghi r h tn)
____________
(1) Vit ch in hoa du;
(2) Ghi theo s ng k thng tr, s h khu cc thng tin ca ngi trong h cng chuyn h
khu.
(3) Ghi mi quan h vi ngi chuyn h khu ti Mc 1.
Ghi ch: Lp 02 bn, mt bn cp cho cng dn np ti ni ng k thng tr, mt bn lu ti
ni cp giy.