MU HK01

MU HK01 (Ban hnh theo Q s 698/2007/Q-BCA(C11) ngy 01 thng 7 nm 2007)CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc

BN KHAI NHN KHU(Dng cho ngi t 14 tui tr ln)

1. H v tn khai sinh: ([1]) ...................................................................... 2. Gii tnh:..3. H v tn gi khc (nu c): ....................................................................................................

4. Sinh ngy ....... /...... / ............. 5. Ni sinh: .......................................................................

6. Qu qun: (2) .............................................................................................................................

7. Dn tc: 8. Tn gio: . 9. CMND/ H chiu s: .......................................

10. Ni thng tr: .......................................................................................................................

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

11. Ch hin nay: ......................................................................................................................

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

12. Trnh hc vn: (3)13. Trnh chuyn mn: (4) ...................................................................

14. Bit ting dn tc t ngi: 15. Bit ngoi ng: .............................................

16. Ngh nghip, chc v, ni lm vic hin nay: .......................................................................

17. T 14 tui tr ln n nay u, lm g:..........................................................................

T THNG, NM N THNG, NMCH

(Ghi r s nh, ng ph; xm, p, bn, x/ phng/ th trn; qun/ huyn; tnh/ thnh ph. Nu nc ngoi th ghi tn nc)NGH NGHIP, NI LM VIC

18. Tin n:

B BT NGYTI DANH, N PHT

19. Quan h gia nh: (B, m; anh, ch, em rut; v/ chng, con) (5[2])TTH V TNSINH NMQuan hNgh nghipCH HIN NAY (6[3])

NamN

................, ngy ....... thng ....... nm ...........

NGI KHAI HOC VIT H(Cam oan; k, ghi r h tn)