CNG HA X HI CH NGHA VIT NAM MNV: 00123159

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: L Th Trang Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 10/10/1992
3. Ni sinh: Thanh Ho
4. CMT s: 173748325 Ngy cp: 02/05/2012 Ni cp: Thanh Ho
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

L Th Trang

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00123390

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: ng Ngc nh Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 02/10/1994
3. Ni sinh: H Ni
4. CMT s: 013040674 Ngy cp: 17/03/2008 Ni cp: H Ni
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

ng Ngc nh

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00120805

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Bi Bch Ngc Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 08/09/1994
3. Ni sinh: H Ni
4. CMT s: 013051775 Ngy cp: 27/03/2008 Ni cp: H Ni
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Bi Bch Ngc

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00124356

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Th Luyn Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 14/08/1993
3. Ni sinh: H Ni
4. CMT s: 013042217 Ngy cp: 25/01/2008 Ni cp: H Ni
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Th Luyn

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00124361

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Bi Th Phng Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 06/01/1995
3. Ni sinh: H Ni
4. CMT s: 017112068 Ngy cp: 02/12/2009 Ni cp: H Ni
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Bi Th Phng

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00124365

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Dng Th Nh Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 22/11/1994
3. Ni sinh: Cao Bng
4. CMT s: 085028822 Ngy cp: 11/03/2010 Ni cp: Cao Bng
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Dng Th Nh

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00123806

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Th Hi H Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 28/07/1986
3. Ni sinh: Bc Giang
4. CMT s: 001186009260 Ngy cp: 08/04/2016 Ni cp: Cc CS KQL CT v
DLQG v DC
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Th Hi H
3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00120217

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Phan Diu Linh Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 12/12/1995
3. Ni sinh: H Ni
4. CMT s: 001195001388 Ngy cp: 15/07/2014 Ni cp: H Ni
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Phan Diu Linh

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122607

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: L Bch Ngc Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 23/08/1986
3. Ni sinh: H Ni
4. CMT s: 001186000430 Ngy cp: 30/07/2013 Ni cp: Cc CS KQL CT v
DLQG v DC
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

L Bch Ngc
3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00125676

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Hong Anh Phc Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 27/06/1984
3. Ni sinh: H Ni
4. CMT s: 135835054 Ngy cp: 15/10/2013 Ni cp: Vin h Phuc
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Hong Anh Phc

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00125678

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: o nh Long Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 17/02/1990
3. Ni sinh: Thanh Ho
4. CMT s: 173465307 Ngy cp: 01/01/2017 Ni cp: Thanh Ho
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

o nh Long

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00124089

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Vn Thy Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 13/12/1994
3. Ni sinh: Qung Ninh
4. CMT s: 101251640 Ngy cp: 03/03/2012 Ni cp: Qung Ninh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Vn Thy

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00093413

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Phm Xun Thnh Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 23/07/1994
3. Ni sinh: Ninh Bnh
4. CMT s: 164533420 Ngy cp: 24/02/2009 Ni cp: Ninh Bnh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Phm Xun Thnh

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00123865

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Hu Tng Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 07/07/1992
3. Ni sinh:
4. CMT s: 001092005549 Ngy cp: 08/06/2015 Ni cp: Cc CS KQL CT v
DLQG v DC
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Hu Tng
3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00066956

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Phng nh Hng Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 07/02/1991
3. Ni sinh: Thanh Ho
4. CMT s: 173622863 Ngy cp: 20/12/2008 Ni cp: Thanh Ho
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Phng nh Hng

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122608

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Hong Tin Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 11/11/1992
3. Ni sinh: Bc Giang
4. CMT s: 121987306 Ngy cp: 07/04/2016 Ni cp: Bc Giang
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Hong Tin

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00123309

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: L Th Thu Tho Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 13/09/1994
3. Ni sinh: Lng Sn
4. CMT s: 082264923 Ngy cp: 07/03/2014 Ni cp: Lng Sn
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

L Th Thu Tho

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00118681

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Trnh Th Thy Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 15/07/1991
3. Ni sinh: Nam nh
4. CMT s: 162996318 Ngy cp: 23/05/2006 Ni cp: Nam nh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Trnh Th Thy

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00121006

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: V Th Huyn Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 05/05/1990
3. Ni sinh: Nam nh
4. CMT s: 162953742 Ngy cp: 15/11/2005 Ni cp: Nam nh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

V Th Huyn

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00121008

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Hong Nht Khnh Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 04/04/1993
3. Ni sinh: Bc Giang
4. CMT s: 122075963 Ngy cp: 24/11/2009 Ni cp: Bc Giang
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Hong Nht Khnh

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00121012

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Dng Th nh Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 13/03/1988
3. Ni sinh: H Ni
4. CMT s: 012852361 Ngy cp: 14/02/2006 Ni cp: H Ni
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Dng Th nh

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122201

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Bi Th Nh Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 16/04/1987
3. Ni sinh: H Ni
4. CMT s: 013550901 Ngy cp: 26/02/2014 Ni cp: H Ni
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Bi Th Nh

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122208

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Th Mai Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 04/09/1992
3. Ni sinh: Nam nh
4. CMT s: 163194785 Ngy cp: 08/06/2013 Ni cp: Nam nh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Th Mai

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00121346

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Hong Vit Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 03/11/1991
3. Ni sinh: H Ni
4. CMT s: 001091002800 Ngy cp: 21/08/2014 Ni cp: Cc CS KQL CT v
DLQG v DC
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Hong Vit

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122058

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Th Minh Thy Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 10/09/1993
3. Ni sinh: H Ni
4. CMT s: 001193002108 Ngy cp: 17/11/2014 Ni cp: Cc CS KQL CT v
DLQG v DC
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Th Minh
3.2.1-BM/NS/HDCV/FTEL
Thy
 CNG HA X HI CH NGHA VIT NAM MNV: 00075092

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Trng Vn Dng Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 19/05/1985
3. Ni sinh: H Ni
4. CMT s: 125215618 Ngy cp: 10/12/2014 Ni cp: Bc Ninh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Trng Vn Dng

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00118048

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Th Thanh Tm Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 07/02/1995
3. Ni sinh: Ph Th
4. CMT s: 132097816 Ngy cp: 14/01/2011 Ni cp: Ph Th
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
H Ni, ngy 03 thng 08 nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Th Thanh Tm

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00121055

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Th Hi Yn Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 09/10/1994
3. Ni sinh: Nam nh
4. CMT s: 163324077 Ngy cp: 15/02/2012 Ni cp: Nam nh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Th Hi Yn

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00123608

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Trng Anh Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 09/05/1994
3. Ni sinh: H Nam
4. CMT s: 036094000980 Ngy cp: 04/02/2016 Ni cp: Cc CS KQL CT v
DLQG v DC
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Trng Anh

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00123829

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Quc Thng Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 19/01/1995
3. Ni sinh: Thanh Ho
4. CMT s: 174187212 Ngy cp: 08/01/2011 Ni cp: Thanh Ho
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Quc Thng

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00123860

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Vn Lu Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 25/04/1992
3. Ni sinh: Nam nh
4. CMT s: 163250671 Ngy cp: 19/11/2010 Ni cp: Nam nh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Vn Lu

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00124108

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: L Minh Hong Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 16/05/1994
3. Ni sinh: H Ni
4. CMT s: 013093843 Ngy cp: 30/08/2011 Ni cp: H Ni
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

L Minh Hong

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00121359

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Vn Tin Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 04/01/1994
3. Ni sinh: Bc Giang
4. CMT s: 122140118 Ngy cp: 16/05/2011 Ni cp: Bc Giang
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Vn Tin

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00118591

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Bi Quang Dng Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 30/10/1991
3. Ni sinh: Hi Phng
4. CMT s: 031613304 Ngy cp: 07/09/2006 Ni cp: Hi Phng
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Bi Quang Dng

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00121862

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Phm Vn Trung Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 14/12/1995
3. Ni sinh: Bc Giang
4. CMT s: 122206579 Ngy cp: 19/07/2013 Ni cp: Bc Giang
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : PKK cht lng cao H Ni - Bc Giang
M s (thng tin bt buc) : 24-262
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Phm Vn Trung

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122364

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn ng Ti Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 07/03/1994
3. Ni sinh: Bc Ninh
4. CMT s: 125640695 Ngy cp: 03/08/2011 Ni cp:
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : TTYT Thnh ph Bc Ninh
M s (thng tin bt buc) : 27-001
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn ng Ti

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122368

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Phng Th Yn Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 14/10/1994
3. Ni sinh: Bc Ninh
4. CMT s: 125577671 Ngy cp: 29/05/2010 Ni cp: Bc Ninh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : TTYT Thnh ph Bc Ninh
M s (thng tin bt buc) : 27-001
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Phng Th Yn

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00123578

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Ngc Huyn Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 09/05/1993
3. Ni sinh: Bc Ninh
4. CMT s: 125466665 Ngy cp: 20/05/2015 Ni cp: Bc Ninh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : TTYT Thnh ph Bc Ninh
M s (thng tin bt buc) : 27-001
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Ngc Huyn

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00124134

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Th Phng Tho Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 05/02/1993
3. Ni sinh: Bc Ninh
4. CMT s: 125470715 Ngy cp: 05/02/1993 Ni cp: Bc Ninh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : TTYT Thnh ph Bc Ninh
M s (thng tin bt buc) : 27-001
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Th Phng
Tho
3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00124153

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Th Nhung Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 28/03/1993
3. Ni sinh: Bc Ninh
4. CMT s: 125543692 Ngy cp: 20/03/2017 Ni cp: Bc Ninh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : TTYT Thnh ph Bc Ninh
M s (thng tin bt buc) : 27-001
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Th Nhung

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00117671

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Th Hng Giang Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 07/10/1984
3. Ni sinh: Hi Dng
4. CMT s: 030184002699 Ngy cp: 26/05/2016 Ni cp: Cc CS KQL CT v
DLQG v DC
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : BVK thnh ph Hi Dng
M s (thng tin bt buc) : 30-001
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Th Hng Giang
3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00125866

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: on Huy Hong Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 09/09/1994
3. Ni sinh: H Tnh
4. CMT s: 184169923 Ngy cp: 07/04/2015 Ni cp: H Tnh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bv a khoa Th x H Tnh
M s (thng tin bt buc) : 42-001
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

on Huy Hong

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00076793

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Quc Vit Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 04/12/1989
3. Ni sinh: Hng Yn
4. CMT s: 145316739 Ngy cp: 20/03/2008 Ni cp: Hng Yn
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Trung Tm Y T huyn M Ho
M s (thng tin bt buc) : 33-090
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Quc Vit

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00080642

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: ng Hu Ngc Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 25/10/1992
3. Ni sinh: Hng Yn
4. CMT s: 145444798 Ngy cp: 15/03/2007 Ni cp: Hng Yn
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Trung Tm Y T huyn M Ho
M s (thng tin bt buc) : 33-090
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

ng Hu Ngc

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122233

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Th Bch Ngc Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 21/10/1990
3. Ni sinh: Hi Phng
4. CMT s: 063316302 Ngy cp: 04/04/2008 Ni cp: Lo Cai
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Phng khm KKV Cc Lu - Lo Cai
M s (thng tin bt buc) : 10-014
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Th Bch Ngc

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122251

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Th ng Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 06/11/1987
3. Ni sinh: Ngh An
4. CMT s: 186481873 Ngy cp: 19/04/2011 Ni cp: Ngh An
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bv a khoa Thnh ph Vinh
M s (thng tin bt buc) : 40-019
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Th ng

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122253

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: L Th Hin Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 05/08/1994
3. Ni sinh: Ngh An
4. CMT s: 187437297 Ngy cp: 09/03/2012 Ni cp: Ngh An
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bv a khoa Thnh ph Vinh
M s (thng tin bt buc) : 40-019
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

L Th Hin

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00121910

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Hong Duy Linh Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 14/05/1986
3. Ni sinh: Ninh Bnh
4. CMT s: 162785211 Ngy cp: 17/05/2013 Ni cp: Nam nh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : TTYT TP Ninh Bnh
M s (thng tin bt buc) : 37-103
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Hong Duy Linh

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00121913

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: V Quc Huy Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 15/10/1992
3. Ni sinh: Nam nh
4. CMT s: 036092001725 Ngy cp: 20/04/2016 Ni cp: Nam nh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : TTYT TP Ninh Bnh
M s (thng tin bt buc) : 37-103
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

V Quc Huy

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00123002

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Phm Th Duyn Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 13/10/1990
3. Ni sinh:
4. CMT s: 173278339 Ngy cp: 30/11/2007 Ni cp: Thanh Ho
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : TTYT TP Ninh Bnh
M s (thng tin bt buc) : 37-103
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Phm Th Duyn

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00123004

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Trn Vn Hip Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 20/12/1988
3. Ni sinh: Ninh Bnh
4. CMT s: 164374974 Ngy cp: 06/03/2006 Ni cp: Ninh Bnh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : TTYT TP Ninh Bnh
M s (thng tin bt buc) : 37-103
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Trn Vn Hip

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122514

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: inh Th Thu Hin Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 20/11/1992
3. Ni sinh: Ninh Bnh
4. CMT s: 164439133 Ngy cp: 02/02/2007 Ni cp: Ninh Bnh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : TTYT TP Ninh Bnh
M s (thng tin bt buc) : 37-103
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

inh Th Thu Hin

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00100412

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Khnh Linh Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 08/10/1993
3. Ni sinh: Ph Th
4. CMT s: 132234783 Ngy cp: 03/12/2010 Ni cp: Ph Th
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin K th x Ph Th
M s (thng tin bt buc) : 25-002
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Khnh Linh

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122057

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Trn Ngc T Uyn Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 18/02/1993
3. Ni sinh: Ph Th
4. CMT s: 132169902 Ngy cp: 13/06/2012 Ni cp:
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin K th x Ph Th
M s (thng tin bt buc) : 25-002
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Trn Ngc T Uyn

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00114239

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: L Th Phch Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 14/08/1990
3. Ni sinh: Sn La
4. CMT s: 050631226 Ngy cp: 17/03/2007 Ni cp: Sn La
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin K huyn Mai Sn
M s (thng tin bt buc) : 14-002
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

L Th Phch

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122573

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Mch Ngc Hiu Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 01/08/1995
3. Ni sinh: Sn La
4. CMT s: 040479013 Ngy cp: 09/08/2012 Ni cp: in Bin
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin K huyn Mai Sn
M s (thng tin bt buc) : 14-002
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Mch Ngc Hiu

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00124465

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: V Vn Hp Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 24/11/1994
3. Ni sinh: Sn La
4. CMT s: 050847317 Ngy cp: 18/01/2010 Ni cp: Sn La
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin K huyn Mai Sn
M s (thng tin bt buc) : 14-002
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

V Vn Hp

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122510

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Phm B Cng Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 10/03/1993
3. Ni sinh: Thi Bnh
4. CMT s: 151963170 Ngy cp: 16/01/2008 Ni cp: Thi Bnh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : BVK Thnh ph Thi Bnh
M s (thng tin bt buc) : 34-002
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Phm B Cng

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122511

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: L Minh Hi Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 01/02/1989
3. Ni sinh: Thi Bnh
4. CMT s: 034089002796 Ngy cp: 14/12/2015 Ni cp: Cc CS KQL CT v
DLQG v DC
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : BVK Thnh ph Thi Bnh
M s (thng tin bt buc) : 34-002
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

L Minh Hi
3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122512

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Vn Sn Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 13/12/1993
3. Ni sinh: Thi Bnh
4. CMT s: 017181074 Ngy cp: 14/04/2010 Ni cp: Thi Bnh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : BVK Thnh ph Thi Bnh
M s (thng tin bt buc) : 34-002
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Vn Sn

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122516

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Trn Th Kim Thu Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 04/09/1987
3. Ni sinh: Thi Bnh
4. CMT s: 022187001910 Ngy cp: 17/02/2017 Ni cp: Cc CS KQL CT v
DLQG v DC
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : BVK Thnh ph Thi Bnh
M s (thng tin bt buc) : 34-002
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Trn Th Kim Thu

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122631

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: V Th Hu Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 22/09/1990
3. Ni sinh: Thi Bnh
4. CMT s: 151783627 Ngy cp: 22/03/2005 Ni cp: Thi Bnh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : BVK Thnh ph Thi Bnh
M s (thng tin bt buc) : 34-002
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

V Th Hu

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00114112

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: L c Trng Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 20/02/1985
3. Ni sinh: Thi Nguyn
4. CMT s: 091017052 Ngy cp: 29/04/2014 Ni cp: Thi Nguyn
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Cng ty CP Bnh vin a khoa trung tm
M s (thng tin bt buc) : 19-016
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

L c Trng

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122113

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Hong Cng Sn Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 25/05/1990
3. Ni sinh: Thi Nguyn
4. CMT s: 091659125 Ngy cp: 13/03/2008 Ni cp: Thi Nguyn
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Cng ty CP Bnh vin a khoa trung tm
M s (thng tin bt buc) : 19-016
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Hong Cng Sn

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122118

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Hong Vn Nhn Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 19/10/1993
3. Ni sinh: Bc Kn/Bc Cn
4. CMT s: 095191893 Ngy cp: 07/12/2009 Ni cp: Bc Kn/Bc Cn
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Cng ty CP Bnh vin a khoa trung tm
M s (thng tin bt buc) : 19-016
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Hong Vn Nhn

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122120

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: V Vn Tin Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 21/05/1991
3. Ni sinh: Thi Bnh
4. CMT s: 151839611 Ngy cp: 21/03/2006 Ni cp: Thi Bnh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Cng ty CP Bnh vin a khoa trung tm
M s (thng tin bt buc) : 19-016
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

V Vn Tin

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00063833

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: o Vn Mnh Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 08/02/1988
3. Ni sinh: Vin h Phuc
4. CMT s: 135332061 Ngy cp: 15/08/2013 Ni cp: Vin h Phuc
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin Hu Ngh Lc Vit
M s (thng tin bt buc) : 26-193
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

o Vn Mnh

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122559

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Th Hu Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 03/02/1988
3. Ni sinh: Yn Bi
4. CMT s: 061069378 Ngy cp: 05/03/2014 Ni cp: Yn Bi
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bv a khoa Thnh ph Yn Bi
M s (thng tin bt buc) : 15-104
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Th Hu

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122106

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: V Trung Tch Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 21/03/1994
3. Ni sinh: Nam nh
4. CMT s: 163291026 Ngy cp: 08/06/2011 Ni cp: Nam nh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

V Trung Tch

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122232

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: ng Thanh Tng Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 09/11/1992
3. Ni sinh: H Ni
4. CMT s: 012868303 Ngy cp: 23/04/2011 Ni cp: H Ni
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

ng Thanh Tng

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122234

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Trn Cng Ninh Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 20/04/1989
3. Ni sinh: Thanh Ho
4. CMT s: 173201289 Ngy cp: 08/06/2015 Ni cp: Thanh Ho
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Trn Cng Ninh

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00045746

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Bi Vn Dng Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 11/07/1988
3. Ni sinh: H Ty
4. CMT s: 113313732 Ngy cp: 06/04/2009 Ni cp: Ho Bnh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Bi Vn Dng

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00117109

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Vit Nht Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 28/12/1995
3. Ni sinh: H Tnh
4. CMT s: 184228488 Ngy cp: 14/12/2012 Ni cp: H Tnh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Vit Nht

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00121917

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Khc t Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 11/11/1994
3. Ni sinh: H Ni
4. CMT s: 013182685 Ngy cp: 05/05/2009 Ni cp: H Ni
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Khc t

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122107

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Minh Anh Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 29/09/1995
3. Ni sinh: Lng Sn
4. CMT s: 082190987 Ngy cp: 10/10/2012 Ni cp: Lng Sn
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Minh Anh

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122111

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Vn Hiu Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 18/08/1994
3. Ni sinh: Lo Cai
4. CMT s: 063395135 Ngy cp: 23/07/2010 Ni cp: Lo Cai
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Vn Hiu

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122112

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: L Xun ng Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 23/09/1995
3. Ni sinh: Nam nh
4. CMT s: 163325758 Ngy cp: 07/05/2012 Ni cp: Nam nh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

L Xun ng

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122902

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Phm Th Thu Hoi Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 13/10/1995
3. Ni sinh: Nam nh
4. CMT s: 163374050 Ngy cp: 07/03/2013 Ni cp: Nam nh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Phm Th Thu Hoi

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122915

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Th Thng Thng Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 28/08/1995
3. Ni sinh: Thanh Ho
4. CMT s: 174854604 Ngy cp: 06/11/2012 Ni cp: Thanh Ho
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Th Thng
Thng
3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122238

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Quch Th Bch Ngc Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 14/02/1995
3. Ni sinh: Thanh Ho
4. CMT s: 174832465 Ngy cp: 19/02/2012 Ni cp: Thanh Ho
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Quch Th Bch Ngc

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00104261

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: L c Tng Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 24/09/1993
3. Ni sinh: Thi Bnh
4. CMT s: 034093000194 Ngy cp: 06/08/2014 Ni cp: Thi Bnh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Trung tm y t th x Sn Ty
M s (thng tin bt buc) : 01-836
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

L c Tng

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00121891

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Xun B Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 19/11/1995
3. Ni sinh: Thanh Ho
4. CMT s: 174854445 Ngy cp: 23/10/2012 Ni cp: Thanh Ho
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Trung tm y t th x Sn Ty
M s (thng tin bt buc) : 01-836
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Xun B

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00124056

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Th Thanh Xun Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 21/10/1995
3. Ni sinh: H Ni
4. CMT s: 017169819 Ngy cp: 31/03/2010 Ni cp: H Ni
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Trung tm y t th x Sn Ty
M s (thng tin bt buc) : 01-836
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Th Thanh
Xun
3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00124058

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Th Hng Khanh Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 26/10/1995
3. Ni sinh: H Ni
4. CMT s: 017382489 Ngy cp: 25/04/2012 Ni cp: H Ni
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Trung tm y t th x Sn Ty
M s (thng tin bt buc) : 01-836
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Th Hng
Khanh
3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122567

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Mnh Ton Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 23/09/1993
3. Ni sinh: H Ni
4. CMT s: 001093009714 Ngy cp: 17/02/2017 Ni cp: Cc CS KQL CT v
DLQG v DC
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Mnh Ton

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00026080

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: V Nht Linh Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 29/08/1988
3. Ni sinh: Yn Bi
4. CMT s: 060756984 Ngy cp: 27/11/2003 Ni cp: Yn Bi
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : PK T Hiu (TTYT huyn Thng Tn)
M s (thng tin bt buc) : 01-017
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

V Nht Linh

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00116892

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: L Th Thanh Nga Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 30/01/1995
3. Ni sinh: H Ni
4. CMT s: 001195005838 Ngy cp: 12/06/2016 Ni cp: Cc CS KQL CT v
DLQG v DC
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : PK T Hiu (TTYT huyn Thng Tn)
M s (thng tin bt buc) : 01-017
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

L Th Thanh Nga
3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122487

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Th Yn Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 20/04/1987
3. Ni sinh: H Ni
4. CMT s: 112325713 Ngy cp: 20/08/2010 Ni cp: H Ni
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : PK T Hiu (TTYT huyn Thng Tn)
M s (thng tin bt buc) : 01-017
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Th Yn

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122626

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: o Th Thun Yn Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 13/11/1994
3. Ni sinh: H Ni
4. CMT s: 017337558 Ngy cp: 01/12/2011 Ni cp: H Ni
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : PK T Hiu (TTYT huyn Thng Tn)
M s (thng tin bt buc) : 01-017
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

o Th Thun Yn

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00123005

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Th Huyn Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 08/12/1993
3. Ni sinh: H Ni
4. CMT s: 017235375 Ngy cp: 12/11/2010 Ni cp: H Ni
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Th Huyn

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00123006

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn D Tun Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 08/08/1989
3. Ni sinh: H Ni
4. CMT s: 112254528 Ngy cp: 09/06/2012 Ni cp: H Ni
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn D Tun

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00092588

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: inh Thanh Trung Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 17/01/1993
3. Ni sinh: H Ni
4. CMT s: 001093003310 Ngy cp: 03/11/2016 Ni cp: Cc CS KQL CT v
DLQG v DC
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

inh Thanh Trung

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122488

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Khut Khng Duy Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 12/08/1993
3. Ni sinh: H Ni
4. CMT s: 017241854 Ngy cp: 18/01/2011 Ni cp: H Ni
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Khut Khng Duy

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122738

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Sn Tng Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 26/06/1989
3. Ni sinh: in Bin
4. CMT s: 0982230689 Ngy cp: 13/03/2009 Ni cp: in Bin
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Sn Tng

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00121700

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: L Don Gip Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 01/09/1994
3. Ni sinh: H Tnh
4. CMT s: 184139659 Ngy cp: 19/02/2013 Ni cp: H Tnh
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

L Don Gip

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00121702

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Nguyn Th Thy Dung Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 18/01/1994
3. Ni sinh: Thanh Ho
4. CMT s: 173369270 Ngy cp: 23/12/2009 Ni cp: Thanh Ho
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Nguyn Th Thy
Dung
3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122906

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Trn Xun Trng Gii tnh (Nam/N): Nam
2. Ngy thng nm sinh: 10/12/1995
3. Ni sinh: Vin h Phuc
4. CMT s: 135654322 Ngy cp: 17/07/2010 Ni cp: Vin h Phuc
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Trn Xun Trng

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122909

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Trn Th Lan Anh Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 24/12/1995
3. Ni sinh: Hng Yn
4. CMT s: 145612695 Ngy cp: 05/06/2010 Ni cp: Hng Yn
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Trn Th Lan Anh

3.2.1-BM/NS/HDCV/FTEL
 CNG HA X HI CH NGHA VIT NAM MNV: 00122911

c lp T do Hnh phc

BN CAM KT THNG TIN BHXH

1. H v tn: Mai Thy Ng Gii tnh (Nam/N): N
2. Ngy thng nm sinh: 27/10/1994
3. Ni sinh: H Ni
4. CMT s: 017167174 Ngy cp: 22/01/2013 Ni cp: H Ni
5. ng k ni khm cha bnh BHYT
Ni ng k KCB : Bnh vin 198
M s (thng tin bt buc) : 01-043
6. Tnh trng ng BHXH trc khi lm vic ti FTEL:
Cha tng ng BHXH, BHYT c qu trnh ng BHXH, BHYT

Cc cn b c qu trnh ng BHXH, BHYT tip tc khai cc mc 7, 8, 9, 10, 11, 12, 13

7. Tnh trng s BHXH:
S BHXH cha chuyn FTEL S BHXH chuyn FTEL
8. S s BHXH:
9. Tng s t ri:
10. nhn tr cp BHTN: nhn cho khong thi gian t n
Cha nhn
11. nhn BHXH mt ln: nhn cho khong thi gian t n
Cha nhn
12. Cam kt thi gian np s BHXH cho FTEL: ngy thng nm (ti a khng qu 3 thng t
thi gian k hp ng vi Cng ty)
13. QU TRNH LM VIC C NG BO HIM X HI
(Yu cu k khai y qu trnh lm cn c xp lng v tip tc ng BHXH)

T n Cp bc, chc v, chc danh Thi gian ng BHXH Mc lng

thng/ thng/ ngh, cng vic, n v lm ng BHXH
nm vic, a im n v ng Nm Thng
nm

Ti xin cam oan cc thng tin khai trn y l s thc, nu sai ti xin hon ton chu trch nhim.
, ngy thng nm 2017
Ngi khai
(K, ghi r h tn)

Mai Thy Ng

3.2.1-BM/NS/HDCV/FTEL