CONG HOA xA HOI CHU NGHIA VIET NAMDQc l~p-Tu do-Hanh phuc

-----000-----

HN, ngay .~thang ...G..namJ%.tp.

DON BAo MAT so CO DONG

Kinlt gui: -Bi)ph{in Qulin Ij c6 dong - Cty CP Chung khodn Thanh pha H6 Chi Minh

T6i ten: ~.:...~ ..tk~... . ..; . . . .Sinh ngay: D..L!./P3.J..J..9.6 ..Q Tai: H.{IJ:...AiliJ ..CMND s6: ~.g.®. (f/S.7J.~.~.,1.Lf Ngay dp: ..z.(.16.1.(.2.~.1..f...Tai: tUJ+..cJ.IJ.t..G-i:.,_.er:.0J~/).t...(JJtk"Ih

Mfl s6 cb dong: v.t.).A.:~.~q..t~..Gi~y clnrng nhan s6 .

r " , /) -"""'~So lUQ11gco phan sa hfru ghi tren so: ..z:..j u.J.U .., ." . 1 _ f I~ ?

Ten t6.Ch~Cp~at hanh: .. ~~. cP. pAa.w..{J.~ ...Pt lld-: 1Yu:..v.t.<J..t./w.n.... .Dia ChI hen he: .

s6 dien thoai: O'(f.d.g2.?:d:.G.J..1: Fax: .

Ly do m~t sb: ..(JJk~ ..~0:.L.;;;;o ~.{ ..~ _q~:..~ J£...~.e.N.&f)...:.6)1.(.2.4r3 0

Toi lam dan nay kinh dS nghi Quy cong ty dp lai sb cb dong moi, Toi xin cam doan ly doneu tren la dung sir th~t va hoan toan chiu hoan toan trach nhiem vS nhfrng v~n dS nay sinh doviec mat so gay ra.

xAc NHAN CUA Cd QUAN CO THAM QUYEN Ngm'yilam dan(Ky va ghi r5 hQ ten)

,

(Ban hanh kern theo Quy chi hoat a9ng dang kf; chung khoan)

M~u 13B/DKCKCQNGHoA xA H(H cnu NGHiA Vl¢T NAM

DQc l~p - Tl}'do - Hanh plnic

GIAy DE NGHI DIEU CHiNH THONG TIN

Kinh gfri: C,!:-CP D~i If h}mg hai Vi~t NamT~n toi/chung toi lit: fVJr ~ IrA-, , _S~ tho~g. :in n?~n dien': {J3to £oro :511y Ngay cap:,,!' (-1120/ fNai cap: CJ-L!- C ~ !Nd,-J.._(_)''J,tl:Dia ChI hen h~: .S6 di~n thoai: 01/)22 :;-:jj 1-H' At' t A' / ht A' d ? h - hi' khoa hien ai, 01C ung t01 ang sa uu c ung oan n u sau:Stt Mil chung khoan Lo~i CK2 S8Iugng S8 SB/Gifiy Ghi chu

CNSHCP

? , ,Sau khi kiem tra, doi chieu cac thong tin, toi/chung Wi phat hien co nhimg

thong tin khong chinh xac khi dang ky. DS dam bao quyen loi, toi/chung toi lam dannay dS nghi dicu chinh lai thong tin nhu sau:Thong tin ban dAu: I I

go rUfrlIJ' ()A! {l 1f? 0 ~aJ cr :;_(I (/) 6'02 fl/6)' cap. flo - Na.,'

Thong tin d~ ngh] di~u chinh:, ,. I(S 'acD' 03 00 too 0 ~ 4//4 fVf}oj o~ .z_6/0 4120,1f N~)'up: Ci!-'- c_fdJt&'-CXMtJt'-l~'p(

Toi/Chung toi cam kSt thong tin tren la chinh xac va chiu hoan toan chiu trachnhi~m vS vi~c dS nghi diSu chinh thong tin nay .

* Tili li~ugiri kem- 01 bim sao CMNDIGidy CNDKKDIGidy chUngnhtjn dang kY mii s6 giao djch chUng khoim;- 01 bim sao S61Gidy ChUng nhcjn sa hfiu chUngkhoan

... ..., ngay.1.2~thang...(.nam .J~((jNgU'(Yid~ ngh!

(Ky, ghi ro h9 ten, con d6u)

I Thollg till nltQIl di?ll:Ca nhiin trong nuac: S6 CMNDT6 ch(rc trong nuac: S6 Gi~y DKKDCa nhiin, t6 chtl'c nu6c ngoai: Ma s6 giao dich chung khoan (trading code)2 LOfJi CK: Lo~i I: Chuy€n nhUQ1lgt\l' do

Lo~i 2: Chuy€n nhu9'ng c6 di~u ki~n (h~n ch~ chuy€n nhu9'ng)

------ ---- - -