r

I

' - . CQNG HOA XA H(?I CHU NGHiA v1eT NAM
'
09c l~p - Tlf do H<'!nh phLic

t;p.
Ir

.,...

~

~

(/

l

l

-

-=
~

/'\

;?

SOHOKHAU
•

1
l

~·

,
'

~

CHU HO

•

.

f\ " -

Ho va ten ...... .1. \UT.. ·

b., .-'l .•..

SO

"

,._?

HO KHAU

S6: 310~0015 99 3
HQ

va ten chU h9. .

N(rU YR\/ .......VM\L

I

uy.CT\! ... \/ ft.N . ... TirN.. ..
Ho va ten goi ~hac ~
nhe~{~6)~. · )~ i;_ ·G~~·i..~~~~.(~~m·, ~a): NJm
Ngay, thang, nam sin . .
Al
h_ .... Na.dl
Que quan: ............................................................ l.l-:(j,. Gt 1
o

C6'\G .\, THt\1\H Pl ll) HO C'Ht t-.1INH

,.,.?

r-

. .

~

..

Dan toe: ............./(Ln6....................Ton giao: .. .......... ..... .... . .

. .. . .

.'/.j.... HQ chieu s6: ................................. · ··· ·

CMND so: .. Q!:✓.). .. 9.J...J-. .. 9 .

r-ft6J

Nghe nghiep, noi lam viec: .........................................................................

~~~~~ ~;~ ~~~~

/i /;:Q; jfu ~~ ;~~ng iri; t
chuyen den: .........................................................,.. l···r--·11 •""''·~.

.............. ................

._

CAN

.. . . ..~m

B0 DANG K?

m ·· .....

(Ky, ghi ri5 hg ten)

'1S-- .
I

\ T , . , , ~-'
~ t i l l 1~ Vl\,11

1uUY

'

~

.:,.

v•:•

, .... ,::-.1, :

'\._,.;:::,2-:··

~-:- ·, N J

Ly do x6a OK thvang tru: ....................................
-

cAN

so DANG K~

( Ky , gl,i

rii hQ ten)

Ngay ....... ,
TR~NG

co

k~I

\(o I

OU1N H~ VOi c~u HO:

Ho ~

P>u !' .. Ttit.....

t~n:

How t~n goi khac (n~'u cd)·

Ngay, thAng, nam s,nh:

ooo quan:

. .. .

..

........ .

)J,.. 3

lJ.).L

l~

···············

G101 trn~(Nam/ nU): . f.\(

lt-l<, ttnJ

....

....
CMND so t'1. D ~d:l lf f '1.
Dan t0c.

. &u~-LN

QUAN H~ yol CHU ~¢: ..

Jl)(f.11/'. .

Ton glAo. . .

(J

HO chi~u s6·

. .... · · ..........

. ·····••to•·······,·········· .........

Ngh~ ngh1ep, noi lam vi~c· ...................

····················································

HQ

va ten:

(\( &Uy

0\1. .Ttl-j. . . v /w
j ... · ~10:~,oi.

(K,. gm ro h(1 lenJ
~

/1/U '

Que quan: .. . .

oan toe·

·;·

.. .. .

-4'....~-

.,

he,

Ky, &ng dtfu)

~¥ • ..··: \:,•...

Nguyen Thi Bich-Thuy · ·,<.-:~~=- r-· {

• .l

~t1Jng.~
Ly do x6a OK thuong tru: ... ....
CAN

BO DANG Kr'

( K i·. gh, r6 hr /rn )

..

.. ················ ........... ..
Ngay . . ,hang . nllm ' .... ..
TRUONG CONG AN . .
(Ky dong dliu)

2

ja1'. ,

CMND su: /HY.. ·· · · ... . ..
Nghe nghiep, ndi lam viec: ........................................................................

~ i~G -CONG AN --~ ....................... ,
.... I: :

.

.... ,, ,.......
J,-,.
Ton giao·• .. '.. .. .. .. ·
· .. · ····
····•· ...
1&.... f'Jr.,1
o , 11 tjJ "[ chieu so: . ..,... t ....... .....................

- ~ ~xr.~;~ ;~lft~

\ .,1•-:~
\
. ,.

Ci//

HQ vA t~n gQi khac ~ntu ~~
tlnh(Na~;·~~): /\{ /
NgAy, thang, n~m sinh. ,Y.V,....., ..,-1:............ tP-4..~ fl.(

{

- cAN·;o ~ANG. K; ........ -

t..\j,;· ·

. ················..

3

vco cHu HO:
Cn.1.
.
I
,J'
I\
t)l{r.il Y[ ]\/ .Bl /...... Bl {J/ ..... .\(ltJY

ouAN H~

Ho va t~n:

Ho va t~n go1 kh~c (neu co). .. ........
Ngay, tMng. nAm sinh: }lf.. 19.- .Af6. }'
Ooo Qtan:.

v•

QUAN

,.._-

• • •• ...... .......

Ho va ten: .......

........ , ..................................,

Giai tfnh(Nam/ nO): ....

• ........

fm. ..

:..,Vh....

He v(j1 ,fJfU HQ: ..

lfl( trlf YfhL....

Ho va ten gol khac (ntu co):

N.r/

.8/Ct}.__ 7tl fl

· .........

·

· · ........... · ,_,

~~:y~:::·~:".~:-:sinh:)~~~-:
rJ:i;. .... 111.(ft~.

O~n toe.

. . J.u;b.... ......... .... T6n giao: ........................................

CMNO st

HO chieu s6: ......................................,.

tr, ,I\ Ir. ........... .... . TOn giao: ... .. . .. ..........................
y . ...........~'/..I.'~./..
DClAn tAc•
CMND s6: .Ob.Q...
Ho chieu s6: .........................................

Nghe ngh1~p. noi lam vr~c: ..........................................................................

Nghe nghiijp, nai lam viec: ...........................................................................

~ bSJ..pj '1

g.d+...Y. !i

.......... ······· .. ··········•···•············· .
Ch11y~n den ngay ..~S.1 ....5 .... .1....Q/2}_.. .Nc1i thl/Ong tru tntJc khi
J,,,/o/
,1
7hi
~Jf···'·Q ~ ......................
Ch,n.,,1n
...,t: de~'n·. ..._A:
..L ...../1.. ......1.(..Y... .......=<~1
IQ GO ..

............. ........... ······································

,

. . . .~.A~--~·o. ~A·~~··~~............. ·~~II~~~ ~~-·. ·~:~:·.wl·--~J
(Kj. glti

ro Ii<> tell)

~

)i

~

~ch'.l'hily
Ly do x6a OK tht/Ong tru: ........ ... .. . .. ............................................
CAN BO DANG Kr'
Ngay .. rhang .... . 11t1m .............
(K

tht ro hf/ /rn)

TRlJONCiJ CONG AN .... .. ........................ ..
r

( Ky, dt1111: dffu)

,,

r.· -~,~-

~

:-..~}\

~-T~ay,
. . G CONG
fl:N·.\~..~ :·--····----··--···....
I t~~ ,
JKj dtin (l u)
1

I·...]-:. . ,
\·\:·,
_ .. :,,t:1h.?(\.
.·,w
\., .
~ .

r

1- \:-,

'I

, ~~

'/J

Ly do x6a OK thuong tru: ............................................................................
CAN BO E>ANG K~
Ngiiy ....... thang ....... nilm. ..... •·
(K)\ glii ro J,9 ,en)
TRUONG CONG ·AN .................... ...
(Ki, Jong (/,{uJ

I

5

r

_)'.'/1 a_{
t\(fIUYElV .... r!J.1/l .. 1\/(;tt/; _

-

'

Ho va ten: .
Ho va ten goi khac (neu c6)·

.. .. . .

Ngay, thang, n~m sinh:.i.~
ati quan. ......... ,.
Dan tOc· ...

nl··

.. ......... . R r~. . .Cli../.. ..... M..it>t;. ..

K.llJIJ. ..........

.TOn giao: ...........................................
CMND so: (bl5 ,LfJ. lf d -0 Ho chieu so·. ·······································-··
Nghe ngh1~p, no1 lam viec: ..... ....... .... ......................................................

-

/11.

n!

QUAN H~ VOi CHU HQ: .....~ .. U,(.,{

QUAN Ht ,.~(JI CHU HQ:

Ho v~ t~n:

J.1tf\1VI .

Tfti. . .. .N!f. .... frtilfl

'
Ho va ten gQi khac (neu
c6): .... · ... ·· ··· · ... ···· ···· ····· · ·· .. ·· ··

- -,J

;.HLG;a; tlnh_l!Jam; r°O): 1).1 ti
.. ...................Tl.~drc .. (At fl 1Lnh

Ng~y, th.Ing, n~m sinh: S,Jf

au~ quan: ...................... ... ..
An to· c·
1n. ~ t-..
Ton giao: ..................................... ,.........
• ····•·········· .L U.Y..J ............... .
D(l
CMND s6: ...().U\......6-..<1..Lr.7..fHo chi~u s6: .........................................
Nghe nghiep, ndi lam viec: ...........................................................................

~~~~;·~;~ ~~~~ 6 i ii ,J~i( ~; ;~~~~ ;~ tnAlc khi
ll\JCh u,e

"1

,.,1,..
. ···············••U•""............
i .l .~.)c...,_ I.V.-./··.
································~
.,.~ .
~~ · ,~,..... : .,.:.).\, ·•· :\')·1'~ fl
1

.

·. r,,J LIO\.
~ :.fo.~'1'.
~
.
m\m
.
:
1
J.
1if.l.. ./
~~

····················--···· ··· · ... ···· ....... ·· · ....... '" ...;-re ·
CAN B0 DANG K)'
(Ky. ghi ro h() 1e11)

-

~

~

-;1

~'huy
BO OANG

( Kf, gl11

K~

ru hQ ri'n)

,.tJ.:,-

_...,

R .. • i3 cCNG ~ \~.. :· .. · ............,

: . .': =:
( y. d'cM, •
(\ i'.\~ ., .
,, f.

.' . (•.

u)

•

,_, '·::·. , : .
~f~~~t:'f.''.:(A,
~
~. - ~

·:

,. f

Ly do x6a OK thvang tru: ................................................................... ..
CAN BO DANG K)'
Ngiiy ..... cluing ... .. nllm .. .........

Ly do x6a OK thtJOng tru:
CAN

I ,..

,'

Nf!CJ}

thang

nam

.........

(Ky, glri ro 111,> 1b1)

TRUONG CONG AN .. .. .. ............... ........... •
( KS,. dong dduJ

TRUONG CCNG AN . .......................... .
(Ky, dong df/u)

7
6

,
QUAN

Ho va rnn:

HE v61CHU HO:

11t-tttt 1 \I fttil

HQ va t~n go1 khac (nbu co)
1.. ~a \hang nAm sinh

Oli qwn
DAn tOc

( ,,.2 (l,r}
. .

1,g~ ngh1~p 001 lam viec. ·- .

CH2 HQ:

.l\l&U j El\f

C/'ltla

Co N&- . ~ I.iJ\I H

i

n g1ao: .................. ·········-···········-·
Ho chi€u s6: ..............! ........................ "

....................................................... .

Ngh~ nghiep. nc1i lam viec: ...................................................................... -..

7;

('-1.1.

Ho va ten:

Hty{j1

Ho va ten goi khac (ne'u co). · ·
.
... 0.
, than nam sinh: .dJ .A.I )9 9..f- G1C1i tinh(Nam/ nu)· (\ m
Ngay,
g,
I
~ -If,{" Cfti_ ( t/ if1/).
1
aue quan: ...it~··<
····b:C.Vfp ....t
·
·
Dan toe: ········X0.b....................Ton giao: ..... •················ ··········"····
CMND s6: ...O.):.S.5.t-t.4..
Ho chitu s6: ........................ ········ .....

™
dM->yt...
To ··

l--1/ ,.J

~ to

........ ..

C. l. ) ;~f G~i tfnh(Nam/ nO)

v. ~-L

Cf/t,D sO Q;lj

kO l\l 6=.......

QUAN

/

N.

ihJ- 11Ji1 ..

4.J.

································································· ········· ·······

,1
ff
'
2..
r I..,¢"'Y.
'fN\""'1
Ndi thtrdng tru tn!CJC khi
Chuyen
den
ngay
•-;k7·./•····0·······
.' !-~.
AsJ... •.•.. •• , ••.•, . ••••••...•.•••.••. •••••• ..•.•••.·•••••··••· ••••••••••••••••••• ...........
Chuyt:!an Uti

. ---=----

~

-,

.

•···················································.····· \··,r~· 6· - ·~··I . · .,.,.,, ,~ .... --.,.........~
~·::; ·~1hfl!
CAN BO DANG K~
')ijiil . ·~t/J£i{ •..;., mlm - ,· ........
t:1/
(Kj. ghi ro h9 ten)

~

;1

0

oo xoa OK thl!Ong tru
tArJ BO DANG ~
IJ,

hrbli()t,nJ

~n\·:~·,,

- ·::·········· ·············

CK,c·
.adi•tul)
d)
/
I

, ,

\·-..:,

.

-~~l:

Ly do x6a OK thuong tru: .............
............................ ·········
Ngay ..... thong ....... 11am •............
CAN BO DANG K~
· · • . ·•

nam

I Ky, ddnf< d&°uJ

tl

~

\'

•

.. ............
Ngcfr
rhting ..
TROONG CONG AN ...

.~ NG cOl'IG
- AN

·(t• .•ft~
.. •
. ·l•

~ Bfch TMy
Ly

~

(Ky , g/ri rii h9 tell)

,

TRVCJNG CONG AN ...... ... ................. ...
(Kj·. Jong JtfuJ

CA

/

QUAN
- Vvl
~ ~U' HQ:..........
a.l
~ He
....l
Ho va ten:

1)6

J

N(z-ll 9fl\/ . N6..t C ...8.i.tD.

Ho va ten QOI khac (neu co} . ..

. .... .. .. .. .. ................ .
Ngay, thang, nam sinh: .J.S· 5.1§.! 0 Gial tfn!l(l'Jam/ nu): .. fJ.i~:J

aue qwn: .............
Dan toe· . ...

.

........- ....... . ... ... _tliio6....... ,l/2.tf.a{'_

lM.?... .

CMNO s6· 0. 2.J..J

Ton giao: ..............................................

56J f.?. ?. HQ chieu so: ..........................................

Nghe nghiep. noi lam viec: .. ........................................................................
.• •••

.. • • •

•4

• •

-

.••

• ••••

,.

• •••••••

('ha/ . _ .
......Nfr.U.Y.8\1 ........ fl/trqc. . Cfl-/1 u

QUAN H~ Vdl CHp_,HQ: ......

d-J..(

Ho va ten: ...

Ho va ten goi khac (ne'u c6): ........................ • ...................... · · · ·· · · · ··
Ngay, thang, nam sinh: .. !...S..-..S.)!.f..o. Gioi tf~(Nam/ nil):

lHt;m

&inh. ...J!.)J.iJl

Que quan: ........................................................... ...

Dan tOc: ...........
CMND

JLJ/.lb..................Ton giao: ........................................ ·

s6: ...0...1...'1, ...f<:/..y... ff:oHo chieu so: .....................,....................

Nghe nghiep, noi lam viec: ................................................... ........................

• • • • • • • • • • . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . ••••••• • • • • • • • • • • • • • • • • • • • • • • ••

••••••• • ••• •• ooo ♦ O•o oF♦ OO O • O o 0 0 0 0 0 0 0 0 0 00 ♦ 0 ♦ 0 ♦

0 0 00 0

0 00 0 0 0000 0 000 0 .. 00000 0

00

0 00 ♦ 00 000 0 0000 0 0

0

,di thl.fOng tru trtfef~ khi

Chuyen den ngay ...,l,J;.. !...~....Tt. ...l&P}.....

.1.u.cw. ....tO.Uo.,.......k ..Kb.cW.....f-...¢f:N:a<. .......
,-... ~.:!:~./....... -·-'·~-· r.aYAP
~i~~. ~
-?. . . . .. .. . . . _ . .
w
ir;,\.1.~~/

chuyen den: ..

. . . .~A~. ~o.

r

( Ky, ghi ro hQ ten)

.

~

guyen Thi BI'ch Th'UJ
·

Ly do xoa 0K thLJong tru: ........
CAN

BO DANG K~

( Kj, g/11 rn h
......... ......... . . ...........................
Ngay

thang .... . ntim ............ .

TRVONG CONG AN . ........ ..................... ..

' ,, ~

·

.... ~-

~!. ~

:,'\1.,/ ·.:: '· . \. /
~.:'r
- ,,.,,,
~~· ,-: :F~:110~
,~ r1i'~..

, .) . · ,

'1

,,

-

_b_

.)

~

r

l~
\ _1,>1

nn ,J'Jl(iJ,P

Ly do x6a 0K thuong tru: ..........................................................................
CAN BO DANG KY
Ngay ....... thang ....... mim .............
(Ky, ghi ro /11;, ten )

TRVONG CONG AN ............................... ,... .

( Kf·, d(jng dlfu)

10

C

, .,
• «..; "

j

(Kj , J611g dduJ

11

/
QUAN H~ VOi CHU HO: ...Cl.t~l(

Ho va ten: r:I)

6_,

nJ{~u Yt,T\f

N 6. cc .

Ho va ten 901 khac (ne11 co)· . .. ... ....
Ngay, thang, nam sinh LS
Que qu.in: ....

Dan toe: .. ..

\

-J. iJ~ l

.. ·········-······ .

1 ~ 1 ..... .............

.. ..

1'- .. f?f_J
QUAN HE Vdl CHU HQ: ......Yr.l.J~
A

/

1

I

A

1 -ff u

Ho vA t@n: ..

.

Ho va ten goi khac (n!u co): .......'} ;.····.

··-···· .... .

N..~l'Y)
.&tlrlb........JJ..,,,_JJ..~

G101 tin~Nam/ nu): .....

T~n giao: ...........................................:

so C 'l.!-J .. b ffl-,...t..~ j Ho chieu s6: ........................................ .
Ngh~ ngh,ep, noi lam v1ec .......................................................................
CMND

,o.f( . . :. f) cl{ .. ...ft! ero--c.
. . .,......................
. ... . ... ..... .. . .. .... .

,«>.,.6.,.. ..'15..i.::: GiOi tlnh(~/ nil): ~l}.Q/Yl
au@ quan: ..........................................................__ ......... ti
lVwb
Ng~y. thAng, n~m sinh:

Dan toe: ............

J4!1D...................TOn giao: ....,........................................

CMND so: .P..Ud.ll../t..2./J........ Ho chieu so: .. .....................................

Nghe nghiep, noi lam viec: ............................................................................
··········································· ·····························································•···••·········· •• · •·

Ly do x6a OK thlfdng tru:
CAN BO OANG Kr'
( A ),

gl11 ro h() tin)

Ngay ..... rhang .... nam ........... ..

TRllbNG CONGAN .................................

Ly do x6a OK thuong tru: .................... ..........................................................
CAN BO OANG KY
Ngay ....... thdng ....... ndm ............ .
(Ky, glii ro11~ tlnJ
TRlJONG CONG AN .....................................
( K)l. dong dau)

(Kf, dongdllu)

12

13

W

QUAN

He VOi CHU HQ; ................

e1eu cH1N H THAY e61

Ho va ~n:

1 iii
rD/.C.l.;
."' ... fM.1
f ~ l1Jcym;... ·I "01.11,·tr'~
.t (~
. . Ct.j ~)
ph.o«L \.oa.... . V.llr!j .S N ... Ao. cs, 13/, ~

·

NQ1 dung . ..

Ho va t~n go, khac (n§u c6}:
GicJi trnh(Nam/ nil): ............

Ngay. thang, n~m sinh:

. . . . ·. . ..'. . . . . . . . . . . . . . . . . . . . . .( 16.~.. Jrf a,· ltti ...../.
-~A~-~o ~A~~ ;; ·. . · ·;~~y b;~~~;D.x;;d~·JciiJiil

Qoo quan:
Dan toe: . . ....................... Ton giao: ....................................... ..
CMNC' Sf' ~· .• . • . . . ..•..... Ho chieu s6: ........................................ ..
Nghe ngh1ep. noi lam viijc: ··-····•...................................................................

•ift{

(Ky. ghi ro h<> ren)

'
............. , ... ··~·-····························· ..··············································
......
.;, den
... ngay
· _.......... 1.............. /.................... No·1 th·u'ang tru, truac khi
Chuyen

chuyen llen: ··-········· .........................................................................................
CAN

BO BANG~

I K), gh1

ro hQ ren)

· Van
~

Ngay ....... tluing ....... nam .............

E>IEU CH1NH THAY E>OI

TRUONG CCNG AN ................................ ..
(Ky. 46ng dduJ

Noi dung: ...........................................................................................................

·····························································································•·························· ......
•••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••••• • •••••••••••••• ♦ •1•11•011otoo1111101011

10 I

························································•··•···••··•···························································
CAN BO DANG KY
Ngay ..... tlu111g ...... ndm .............

Ly do x6a OK tht.Jang tru: ........................................................................... ..
CAN B0 DANG KY'
Ngay ... ... thang ...... nitm ............ .
1
, Ki, ghi ro ho tt n)
TRUONG CONG AN .................................. ..

( Ky, ghi ri5 hQ ten)

TRUONG CCNG AN ........... . ..... .
I K), d,fog dtli,J

( K)\ dong ddu)

14

Ollt•lt•O

. I

,s

,

'

~

E>IEU CHINH THAY E>OI

N~i dung: ..

f ••• •• • ••

oo O

o 1 0 I

•

1'01'10

01' I 00 0 Ito • I o 10 o

Mliu HK08 b:111 hGOh
theO 0 0 &6 698/2007/00 BCA(C 1 1)
ngay O, 1 11 2007
I O l i e oo I · · • o t o

.. ........ ..

..... ·········...., .............············•·..,,
.... .. . .. .... ..... ......... ' .. .....
,

~

CANBOOANG KY

Ngay ..... tluing . ..... nam

TRlJONG CONG AN

(Kv. dong ddu)

.............
........... ..

f>IEU CHlNH THAY f)()I

Nol dung:_...•........ ···--······· ..····--·--·--··----·····--···--····--··········--·--··· ······················

--

...

.

···-··

.............. ..... ·········•·····..., ....................

.........

··················································•····
················ .
CAN BO DANG Kr'
(Ki. chi ro Ill)

I

I

"

,,

••

•••••••t i •••••

... ....................
,

NHUNG E>IEU CAN CHU

y

1- So ho khau dU~C cap cho hQ gia dlnh ho~c ca
nhan da d~·ng ky thUong tru va c6 gia tr! xac djnh noi
thUong tru cua cong dan.
2- So hQ khau bi hU hong thi dtJQC cap doi, bi mat
thl duc;,c cap !Qi.
3- So ho khau do B(> Cong an phat hanh va thong
nhat quan ly trong toan QUOC.
4- Khi c6 nhiJng thay dBi trong so hQ kh~u. chu ho
ho~c nguai trong h(l P.hai den co quan dang ky thuang
tru lam thu t1,1c thay doi theo quy djnh.

5- Qhu hQ ~o~c nguai trong hQ c6 trach nhiem xuat
tr!nh s5 hQ khau khi co quan, nguo1 c6 tham quyen y~u
cau.
6- Nghie~ c~m viec thue, cho thue , mVOn, cho
muon, lam g1a , sua ch □a , lam sai lech n¢i dung tv vi~t
them thong tin vao so ho khau.
.
I

. 7-..,Cong. dan can kiem tra lq cac thong tin
ky , d1eu ch1nh trvoc khi nh~n so.

li!n )

16

da

dang