CNG HO X HI CH NGHA VIT NAM

c lp - T do - Hnh phc Mu s: 02/K-NPT-TNCN

(Ban hnh km theo Thng t s
NG K NGI PH THUC GIM TR GIA CNH 92/2015/TT-BTC ngy
15/6/2015 ca B Ti chnh)

[01] Ln u: [02] B sung ln th:

[03] H v tn c nhn c thu nhp:...........................................................................

[04] M s thu:
[05] a ch c nhn nhn thng bo m s NPT:..............................................................................................................
[06] Ni ng k gim tr ngi ph thuc (T chc, c nhn tr thu nhp/c quan qun l):......................................
...........................................................................................................................................................................................

[07] M s thu ca t chc, c nhn tr thu nhp:

I. Ngi ph thuc c MST/CMND/H chiu

Quan h vi Thi im bt Thi im kt

STT H v tn Ngy sinh M s thu S CMND / H ngi np u tnh gim thc tnh gim
Quc tch
chiu thu tr tr
(thng/nm) (thng/nm)
[08] [09] [10] [11] [12] [13] [14] [15] [16]

1
2
3
...
II. Ngi ph thuc cha c MST/CMND/H chiu

1
 Thng tin trn giy khai sinh
Quan h Thi im Thi im kt
Quc vi bt u tnh thc tnh gim
STT H v tn Ni ng k tch ngi gim tr tr
Ngy Quyn Tnh/ np thu
S Quc Qun/ Phng/ (thng/nm) (thng/nm)
sinh s Thnh
gia Huyn X
ph
[17] [18] [19] [20] [21] [22] [23] [24] [25] [26] [27] [28] [29]
1
2
3

(MST: M s thu; CMND: Chng minh nhn dn)

Ti cam oan nhng ni dung k khai l ng v chu trch nhim trc php lut v nhng ni dung khai./.

..,ngy thng nm ...

NHN VIN I L THU C NHN C THU NHP
H v tn: ..
Chng ch hnh ngh s:............ (K v ghi r h tn)

2
3