Mu s: 20/TXN-TNCN

CNG HA X HI CH NGHA VIT NAM (Ban hnh km theo Thng t

s 28/2011/TT-BTC ngy
c lp T do Hnh phc 28/02/2011 ca B Ti chnh)

TH XC NHN THU NHP NM

Thay mt t chc tr thu nhp (tn t chc):

M s thu:
a ch:
Ti xin xc nhn v vic ng/b:
1. H v tn: Nguyn Vn Hong
2. M s thu TNCN :.....................................................................................
3. Thu nhp trong nm 2015 nh sau:
- Lng c bn:
- Ph cp:
- Tin thng:
- Cc khon thu nhp khc bng tin (chi tit):
4. Cc khon th lao ph cp khc lin quan n vic b nhim cng tc ti Vit
Nam (chi tit):
- Cc khon b khu tr (nu c):
- Thu
- Bo him x hi
- Bo him y t
- Cc khon b khu tr khc (xin cung cp chi tit):
5. Nhng khon thu nhp trn l thu nhp c/khng c thu thu nhp c nhn ti
Vit nam
Tng cc khon chi tr v thu nhp v tin lng, tin cng ca ng/b l:
......................................................................................................................ng
, ngy thng nm .......
I DIN HP PHP
CA T CHC, C NHN TR THU NHP
K, ghi r h tn; chc v v ng du (nu c)