CNG HA X HI CH NGHA VIT NAM

c lp T do Hnh phc

1 T KHAI NG K KT HN 2

Knh gi:................................................................................................
(Thng t s: 09b/2013/TT-BTP)

Ngi khai Bn nam Bn n

H v tn

Ngy, thng, nm sinh

Dn tc

Quc tch

Ni thng tr/tm tr
S Giy CMND/H chiu/
Giy t hp l thay th
Mu TP/HT-2013-TKKKH

Ngh nghip

Kt hn ln th my

Chng ti cam oan nhng li khai trn y l ng s tht, vic kt hn ca chng ti khng vi phm
quy nh ca Lut Hn nhn v gia nh Vit Nam v chu trch nhim trc php lut v cam oan ca mnh.
ngh ......................................................................................................................................... ng k.
............................, ngy ..........thng ............ nm............

Xc nhn v tnh trng hn nhn ca Bn nam Bn n

c quan c thm quyn (K, ghi r h tn) (K, ghi r h tn)
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Xc nhn ny c gi tr trong thi hn 6 thng k t ngy xc nhn.
Ngy....thng....nm....
NGI K GIY XC NHN
(K, ghi r h tn, chc v v ng du)

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Ch thch:
(1), (2) Trng hp lm th tc ng k kt hn c yu t nc ngoi, th phi dn nh ca hai bn nam, n