CNG HO X HI CH NGHA VIT NAM

Mu s: 16/K-TNCN
c lp - T do - Hnh phc (Ban hnh km theo
Thng t s 84/2008/TT-BTC
ngy 30/9/2008 ca B Ti chnh)
MU NG K NGI PH THUC GIM TR GIA CNH
Chnh thc: [ ] B sung: [ ] Ln: [ ]
1. H v tn c nhn c thu nhp: .....

2. M s thu:
3. Tn ca t chc, c nhn tr thu nhp:

4. M s thu: -
H v tn Ngy sinh M s thu S CMND/ Quan h vi Thi im tnh Thi im kt
Stt h chiu TNT gim tr thc gim tr
(thng/nm) (thng/nm)
1
2
3
...
...
Tng cng

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

, ngy thng nm ...

C NHN C THU NHP
(K v ghi r h tn)

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