CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
H Ni, ngy . thng .nm 2011
N XIN CP LI CHNG CH HNH NGH
K S HOT NG XY DNG
Knh gi : S Xy dng H Ni
1. H v tn (ch in hoa): V TUN VINH.............................Nam/N: Nam........
2. Sinh ngy: 22 thng 11 nm 1975...............................................................
3. Ni sinh: Lo Cai....................................................................................................
4. Quc tch: Vit Nam...............................................................................................
5. S CMT/ H chiu: 011716755, Cp ngy 06 thng 05 nm 2002........................
Ni cp: Thnh ph H Ni........................................................................................
6. a ch thng tr: S 8 ng 191 Gip Bt, Hong Mai, H Ni ..........................
.....................................................................................................................................
7. Trnh chuyn mn:
- Vn bng, chng ch c cp (ghi r chuyn ngnh o to):
+ Thc s K thut Mi trng i hc Xy dng H Ni ...................................
+ K s Xy dng, chuyn ngnh Cp thot nc - Mi trng nc-i hc Xy
dng H Ni ...............................................................................................................
8. Ni dung c php hnh ngh hot ng xy dng ca chng ch c cp:
- Thit k Cp thot nc v Mi trng nc trong QH................................
.....................................................................................................................................
Ngy cp chng ch c: ngy 16 thng 11 nm 2006 ................................................
Ti xin chu trch nhim v ton b ni dung n ny. Trong qu trnh hot
ng xy dng khng vi phm cc quy nh ca php lut, khng gy ra s c
cng trnh v cam kt hnh ngh hot ng xy dng theo ng ni dung ghi trong
chng ch c cp v tun th cc quy nh ca php lut c lin quan.
Ngi lm n
(K v ghi r h, tn)

Ch : 2 n + 2 nh chp (khng dng nh in) + chng ch gc + 2 ph t chng minh th (nh

mang chng minh th gc)