Cng ty Lut Minh Gia www.luatminhgia.com.

vn

B CNG AN CNG HA X HI CH NGHA VIT NAM

------- c lp - T do - Hnh phc
---------------
S: 66/2015/TT-BCA H Ni, ngy 15 thng 12 nm 2015

THNG T
QUY NH V BIU MU S DNG TRONG CNG TC CP, QUN L TH CN CC
CNG DN, TNG TH CN CC CNG DN V C S D LIU QUC GIA V DN
C
Cn c Lut Cn cc cng dn ngy 20 thng 11 nm 2014;
Cn c Ngh nh s 106/2014/N-CP ngy 17 thng 11 nm 2014 quy nh chc nng, nhim
v, quyn hn v c cu t chc ca B Cng an;
Theo ngh ca Tng cc trng Tng cc Cnh st;
B trng B Cng an ban hnh Thng t quy nh v biu mu s dng trong cng tc cp,
qun l th Cn cc cng dn, tng th cn cc cng dn v C s d liu quc gia v dn
c.
Chng I
QUY NH CHUNG
iu 1. Phm vi iu chnh
Thng t ny quy nh biu mu, cch ghi biu mu; kinh ph in v qun l biu mu s dng
trong cng tc cp, qun l th Cn cc cng dn, tng th cn cc cng dn v C s d
liu quc gia v dn c.
iu 2. i tng p dng
1. Cng dn Vit Nam khi lm th tc cp, i, cp li th Cn cc cng dn, iu chnh cc
thay i v thng tin ca cng dn trong tng th cn cc cng dn. C s d liu cn cc
cng dn v cung cp thng tin, ti liu cho C s d liu quc gia v dn c.
2. Cng an cc n v, a phng.
3. Cc c quan, t chc, c nhn c lin quan n cp, qun l th Cn cc cng dn, tng th
cn cc cng dn v C s d liu quc gia v dn c.
iu 3. Cc biu mu c s dng trong cp, qun l th Cn cc cng dn, tng th
cn cc cng dn v C s d liu quc gia v dn c
1. Cc biu mu c s dng trong cp, qun l th Cn cc cng dn, tng th cn cc
cng dn (k hiu l CC), bao gm:
a) T khai cn cc cng dn (mu s CC01);
b) Phiu thu nhn thng tin cn cc cng dn (mu s CC02);
c) Giy hn tr th Cn cc cng dn (mu s CC03);
d) Danh sch xut duyt h s ngh cp, i, cp li cn cc cng dn (mu s CC04);
) Phiu giao nhn h s ngh cp, i, cp li cn cc cng dn cn tra cu (mu s
CC05);
e) xut ph duyt h s ngh cp, i, cp li th Cn cc cng dn (mu s CC06);
g) Giy xc nhn s Chng minh nhn dn (mu s CC07);

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h) Bo co cng tc cp, qun l cn cc cng dn (mu s CC08);

i) Phiu iu chnh thng tin cn cc cng dn (mu s CC09);
k) Phiu chuyn h s cn cc cng dn (mu s CC10);
l) Ti h s cn cc cng dn (mu s CC11).
2. Cc biu mu c s dng trong thu thp, cp nht thng tin C s d liu quc gia v dn
c (k hiu l DC), bao gm:
a) Phiu thu thp thng tin dn c (mu s DC01);
b) Phiu cp nht thng tin dn c (mu s DC02).
iu 4. Qun l cc biu mu
1. B Cng an thng nht qun l cc biu mu ban hnh km theo Thng t ny. In, pht hnh
biu mu CC11, cp giy in biu mu CC02 cho Cng an cc n v, a phng.
2. Cc Cnh st ng k, qun l c tr v d liu quc gia v dn c in, qun l v pht hnh
biu mu CC01 s dng ti Trung tm Cn cc cng dn quc gia.
3. Cng an tnh, thnh ph trc thuc Trung ng t chc in, qun l v pht hnh cc biu mu
CC01, CC08, DC01 v DC02 cho Cng an cc n v, a phng thuc quyn qun l.
4. Cc biu mu CC02, CC03, CC04, CC05, CC06, CC07, CC09 v CC10 c in trc tip t
my tnh khi lm th tc cp, i, cp li th Cn cc cng dn. Mu c in ra bao gm
cc thng tin c trch xut, thng k t C s d liu cn cc cng dn theo phm vi lu tr
ca tng n v.
5. Cc biu mu CC01, CC02, CC04, CC05, CC06, CC08, CC09, CC10, DC01 v DC02 c in
trn kh giy 210 mm x 297 mm (A4); trong , mu CC02 nh lng 120 g/m2. Mu CC03 v
CC07 c in trn kh giy 148 mm x 210 mm (A5). Mu CC01 v mu CC08 c in 02 mt.
Mu CC11 c kch thc 250 mm x 330 mm, c in trn giy Kraft nh lng 250 g/m2.
6. Cc biu mu quy nh ti Thng t ny c in bng mc en trn nn giy trng. Ring
mu CC11 c in bng mc en trn nn giy mu nu vng. Khi in khng c thay i ni
dung ca biu mu; Cng an cc n v, a phng c trch nhim qun l vic in, cp pht
biu mu v c s sch theo di.
iu 5. Kinh ph in, pht hnh biu mu
1. Kinh ph in, pht hnh biu mu s dng trong cng tc cp, qun l th Cn cc cng dn,
tng th cn cc cng dn v C s d liu quc gia v dn c c s dng t ngun kinh
ph thng xuyn ca B Cng an cp cho Cng an cc n v, a phng.
2. Tng cc Cnh st ch tr, phi hp vi Cc Ti chnh v cc n v c lin quan lp d tr
kinh ph in, pht hnh cc biu mu v giy in biu mu quy nh ti Khon 1, Khon 2 iu 4
Thng t ny.
Thng 9 hng nm, Cng an cc n v, a phng lp d tr nhu cu s dng biu mu CC02,
CC11 ca n v, a phng mnh cho nm tip theo gi Cc Cnh st ng k qun l c tr
v d liu quc gia v dn c tng hp, bo co Tng cc Cnh st.
3. Cng an cc n v, a phng lp d tr kinh ph in, pht hnh biu mu s dng trong
cng tc cp, qun l th Cn cc cng dn, tng th cn cc cng dn v C s d liu
quc gia v dn c quy nh ti Khon 3, Khon 4 iu 4 Thng t ny.
iu 6. Yu cu ghi biu mu
1. Ghi y , chnh xc, r rng ni dung trong tng biu mu, ch vit phi cng mt loi mc.
2. Ngi n lm th tc khng bit ch hoc khng th t k khai c th nh ngi khc k
khai h theo li khai ca mnh. Ngi k khai h phi ghi Ngi vit h, k khai trung thc, k,
ghi r h tn v chu trch nhim v vic k khai h .

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3. Cc ct, mc trong biu mu phi c ghi theo ng ch thch hng dn trong cc biu
mu (nu c) v quy nh ti Thng t ny. Trng hp thng tin ghi trong ct, mc ca biu
mu di th c vit tt nhng phi bo m r cc thng tin c bn.
4. Mu mc ghi biu mu, ch k ca ngi c thm quyn v cc ni dung trong biu mu
ch c dng mu mc xanh, tm than hoc en.
Chng II
CCH GHI CC BIU MU
iu 7. T khai Cn cc cng dn (CC01)
1. Mu CC01 c dng cng dn k khai thng tin v nhn thn ca mnh khi c yu cu
cp, i, cp li th Cn cc cng dn.
2. Cch ghi thng tin
a) Mc H, ch m v tn, H v tn gi khc: ghi y h, ch m v tn theo giy khai
sinh; ch in hoa du. Ch ghi h, tn gi khc nu trong giy khai sinh c h v tn gi khc;
b) Mc Ngy, thng, nm sinh: ghi ngy, thng, nm sinh ca cng dn c cp, i, cp li
th Cn cc cng dn. Ngy sinh ghi 02 ch s; nm sinh ghi bn ch s. i vi thng
sinh t thng 3 n thng 9 ghi 01 ch s, cc thng sinh cn li ghi 02 ch s;
c) Mc Gii tnh: nu gii tnh nam ghi l Nam, nu gii tnh n ghi l N;
d) Mc Dn tc, Tn gio: ghi dn tc, tn gio ca cng dn c cp, i, cp li th Cn
cc cng dn nh trong giy khai sinh hoc giy t chng nhn dn tc, tn gio ca c quan
c thm quyn;
) Mc Quc tch: ghi quc tch ca cng dn c cp, i, cp li th Cn cc cng dn
nh trong giy khai sinh hoc giy t chng minh c quc tch Vit Nam ca c quan c thm
quyn;
e) Mc Tnh trng hn nhn: ghi tnh trng hn nhn hin ti ca cng dn c cp, i, cp
li th Cn cc cng dn, gm: cha kt hn, kt hn hoc ly hn;
g) Mc Nhm mu (nu c): ghi theo bn kt lun v xt nghim xc nh nhm mu ca cng
dn ngh cp, i, cp li th Cn cc cng dn;
h) Mc Ni ng k khai sinh: ghi y a danh hnh chnh cp x, cp huyn, cp tnh ni
cp giy khai sinh cho cng dn. Trng hp a danh hnh chnh c s thay i ghi tn a
danh hnh chnh mi c thay i theo quy nh ca php lut;
i) Mc Qu qun: ghi y a danh hnh chnh cp x, cp huyn, cp tnh theo giy khai
sinh; nu khng c giy khai sinh th ghi theo s h khu. Trng hp a danh hnh chnh c
s thay i ghi tn a danh hnh chnh mi c thay i theo quy nh ca php lut;
k) Mc Ni thng tr: ghi y , chnh xc theo s h khu. Trng hp cng dn ngh
cp, i, cp li th Cn cc cng dn trong bin ch chnh thc ca Qun i nhn dn, Cng
an nhn dn ang tp trung trong doanh tri, nh tp th ghi theo giy gii thiu ca c
quan, n v cp cho cng dn;
l) Mc Ni hin ti: ghi y , r rng, chnh xc ni hin ti ca cng dn theo th t s
nh, ng ph; thn, xm, lng, p, bn, bun, phum, sc; x/phng/th trn; qun/huyn/th
x/thnh ph thuc tnh; tnh/thnh ph trc thuc Trung ng;
m) Mc Ngh nghip: ghi r ngh nghip ang lm, trng hp l qun nhn ang ti ng th
trng. Mc Trnh hc vn: ghi r trnh hc vn cao nht (tin s, thc s, i hc, cao
ng, trung cp, tt nghip trung hc ph thng, tt nghip trung hc c s...);
n) Cc mc 17, 18, 19, 20, 21: ghi y h, ch m, tn; quc tch; s Cn cc cng dn
hoc Chng minh nhn dn vo cc mc tng ng trong biu mu (nu c);

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o) Mc yu cu ca cng dn:
- Chuyn pht bng ng bu in n tn tay cng dn: trng hp cng dn cp, i, cp
li th Cn cc cng dn c yu cu chuyn pht tr bng ng bu in ghi c v ghi y
a ch, s in thoi ca cng dn, nu khng c yu cu th ghi khng;
- Cp, i, cp li th Cn cc cng dn: i vi cc trng hp cp ln u th ghi cp mi;
i vi cc trng hp h hng, ht thi hn hoc c s thay i thng tin trong th Cn cc
cng dn th ghi cp i; i vi cc trng hp mt th ghi cp li;
- Xc nhn s Chng minh nhn dn: trng hp cng dn cp, i, cp li th Cn cc cng
dn c yu cu xc nhn s Chng minh nhn dn 9 s th ghi c, nu khng c yu cu th ghi
khng;
p) Mc Ngy....thng..nm: ghi r ngy, thng, nm cng dn khai t khai cp, i,
cp li th Cn cc cng dn.
3. Mc "Kt qu xc minh: i vi trng hp h s ngh cp, i, cp li th Cn cc cng
dn cn xc minh qua tng th cn cc cng dn th n v tip nhn h s ngh i tng
th cn cc cng dn thuc Phng Cnh st qun l hnh chnh v trt t x hi i chiu, xc
minh vi h s gc v tr li kt qu cho n v yu cu.
iu 8. Phiu thu nhn thng tin cn cc cng dn (CC02)
1. Mu CC02, do Cng an ni tip nhn h s cp, i, cp li th Cn cc cng dn lp trn
c s i chiu thng tin ca cng dn trong C s d liu quc gia v dn c vi t khai cn
cc cng dn. Sau khi i chiu thng tin ca cng dn, mu CC02 c in trc tip t my in
cng dn k vo Phiu thu nhn thng tin.
2. M s, m vch mt chiu: mi h s ngh cp, i, cp li th Cn cc cng dn c
gn mt m s, m vch ring qun l v c in trn Phiu thu nhn thng tin Cn cc
cng dn.
3. S th Cn cc cng dn: ghi s Cn cc cng dn i vi trng hp cp th Cn cc
cng dn, c th nh sau:
Trung tm Cn cc cng dn quc gia khi tr th Cn cc cng dn c trch nhim gi km
danh sch ca cng dn c cp th Cn cc cng dn cho Phng Cnh st qun l hnh
chnh v trt t x hi Cng an cp tnh. Cn c vo danh sch, cn b qun l h s tng th
cn cc cng dn Cng an cp tnh c trch nhim ghi y 12 s Cn cc cng dn vo
Phiu thu nhn thng tin Cn cc cng dn. Trng hp cng dn c cp th Cn cc
cng dn ti Trung tm cn cc cng dn quc gia trc khi chuyn h s cn cc cng dn
cho c quan qun l cn cc cng dn Cng an cp tnh ni cng dn c h khu thng tr,
cn b chuyn giao h s c trch nhim ghi y s th Cn cc cng dn vo Phiu thu
nhn thng tin cn cc cng dn.
4. Cch ghi thng tin:
a) T mc 1 n mc 13: ghi cc thng tin ca cng dn theo hng dn ti khon 2 iu 7
Thng t ny;
b) T mc 14 n mc 16: ghi cc thng tin ca cng dn theo hng dn ti phn ghi ch biu
mu CC01;
c) Mc 17: nh chn dung ca cng dn c kch thc 4 cm x 6 cm, nn nh mu trng;
d) Mc 18: ghi c im nhn dng ca cng dn theo quy nh;
) Mc 19: ch ghi mt trong cc trng hp cp, i, cp li;
e) Mc 20: ghi s ln cp Chng minh nhn dn/Cn cc cng dn cho cng dn (tnh c
ln hin ti);
f) Mc 21: ghi tn c quan Cng an lp Phiu thu nhn thng tin cn cc cng dn;

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g) Mc 22: cn b kim tra Phiu thu nhn thng tin cn cc cng dn k v ghi r h tn sau
khi kim tra bo m thng tin y , ng theo quy nh;
h) Mc 23: cng dn ghi ngy, thng, nm lm th tc cp, i, cp li th Cn cc cng dn,
k v ghi r h tn.
iu 9. Giy hn tr th Cn cc cng dn (CC03)
1. Mu CC03 do c quan Cng an ni tip nhn h s ngh cp, i, cp li th Cn cc
cng dn ca cng dn lp, cp cho cng dn hn ngy n nhn th Cn cc cng dn.
2. Giy hn tr th Cn cc cng dn c in trc tip t my in sau khi thu nhn thng tin
nhn thn ca cng dn lm th tc cp, i, cp li th Cn cc cng dn theo quy nh.
iu 10. Danh sch xut duyt h s cp, i, cp li th Cn cc cng dn (CC04)
1. Mu CC04 do c quan Cng an tip nhn h s cp, i, cp li th Cn cc cng dn lp,
xut ch huy n v duyt h s ngh cp, i, cp li th Cn cc cng dn.
2. Cch ghi thng tin:
a) Mc (1): ghi tn c quan cp trn trc tip ca c quan ca ngi xut duyt h s cp,
i, cp li th Cn cc cng dn;
b) Mc (2): ghi tn c quan ca ngi xut duyt h s ngh cp, i, cp li th Cn cc
cng dn;
c) Mc (3): ghi chc danh ca ngi c thm quyn duyt h s ngh cp, i, cp li th Cn
cc cng dn;
d) Mc S: /: ghi s ca danh sch xut duyt h s ngh cp, i, cp li th
Cn cc cng dn;
) Mc M s danh sch: l m s chung ca cc h s trong danh sch xut duyt h s
ngh cp, i, cp li th Cn cc cng dn;
e) Ct STT: ghi s th t ca tng h s trong danh sch xut duyt h s ngh cp, i,
cp li th Cn cc cng dn;
f) Ct M s Phiu thu nhn thng tin cn cc cng dn ca cng dn: ghi m s trn Phiu
thu nhn thng tin cn cc cng dn ca cng dn;
g) Ct H, ch m v tn khai sinh, Gii tnh, Ngy sinh, Loi cp, S th Cn cc
cng dn c cp: ghi theo cc mc thng tin tng ng trn Phiu thu nhn thng tin cn
cc cng dn;
h) Mc kin ca ngi c thm quyn duyt h s: ngi c thm quyn duyt h s ngh
cp, i, cp li th Cn cc cng dn ghi r kin ca mnh l ng hoc khng ng ,
nu khng ng trng hp no th ghi r cc trng hp .
iu 11. Phiu giao nhn h s ngh cp, i, cp li th Cn cc cng dn cn tra
cu (CC05)
1. Mu CC05 do n v tip nhn h s ngh cp, i, cp li th Cn cc cng dn lp,
xut ch huy n v quyt nh chuyn cc h s ngh cp, i, cp li th Cn cc cng dn
cn tra cu qua tng th cn cc cng dn.
2. Cch ghi thng tin:
a) Mc (1): ghi tn c quan cp trn trc tip ca c quan ca ngi giao h s ngh cp, i,
cp li th Cn cc cng dn cn tra cu;
b) Mc (2): ghi tn c quan ca ngi giao h s ngh cp, i, cp li th Cn cc cng
dn cn tra cu;
c) Ct STT: ghi s th t ca tng h s ngh cp, i, cp li th Cn cc cng dn trong

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danh sch c gi;

d) Cc ct H, ch m v tn khai sinh, Gii tnh, Ngy, thng, nm sinh: ghi cc thng tin
ca cng dn theo h s ngh cp, i, cp li th Cn cc cng dn;
) Ct M s Phiu thu nhn thng tin cn cc cng dn: ghi m s trn Phiu thu nhn thng
tin cn cc cng dn ca cng dn;
e) Mc Tng s h s: ghi tng s h s ngh cp, i, cp li th Cn cc cng dn c
bn giao;
g) Mc Cn b lp phiu: cn b lp phiu k, ghi r h tn bo co ch huy duyt;
h) Mc Th trng n v: Th trng n v duyt, k v ghi r h tn;
i) Mc Giao h s: ghi r ngy, thng, nm giao h s. Bn giao v bn nhn k ghi r h v
tn;
k) Mc Nhn kt qu tra cu: ghi r ngy, thng, nm nhn kt qu. Bn giao v bn nhn k
ghi r h v tn.
iu 12. xut ph duyt h s ngh cp, i, cp li th Cn cc cng dn (CC06)
1. Mu CC06 do Trung tm Cn cc cng dn quc gia lp xut lnh o Cc Cnh st
ng k, qun l c tr v d liu quc gia v dn c ph duyt h s ngh cp, i, cp li
th Cn cc cng dn ca cng dn. Mu ny c lp theo danh sch h s ngh cp, i,
cp li th Cn cc cng dn ca Cng an cc tnh, thnh ph trc thuc Trung ng gi n.
2. Cch ghi thng tin:
a) Mc S:./: ghi s ca vn bn xut ph duyt h s ngh cp, i, cp li
th Cn cc cng dn;
b) Ct STT: ghi s th t ca tng m s danh sch trong xut ph duyt h s ngh
cp, i, cp li th Cn cc cng dn;
c) Ct n v: ghi tn ca n v tip nhn h s ngh cp, i, cp li th Cn cc cng
dn ca cng dn;
d) Ct M s cc danh sch: ghi m s ca tng danh sch xut duyt h s ngh cp,
i, cp li th Cn cc cng dn;
) Ct Tng s danh sch: ghi tng s cc danh sch trong ct m s cc danh sch;
e) Ct H s: ghi tng s h s trong danh sch c m s danh sch tng ng ct Tng s,
trong ghi r s lng h s hp l, iu kin cp, i, cp li th Cn cc cng dn vo
ct Hp l v s lng h s khng hp l, khng iu kin cp, i, cp li th Cn cc
cng dn vo ct Khng hp l.
iu 13. Giy xc nhn s Chng minh nhn dn (CC07)
1. Mu CC07 do c quan Cng an ni tip nhn h s ngh cp th Cn cc cng dn lp
xc nhn s Chng minh nhn dn (9 s) c cp ln gn nht khi cng dn c yu cu
xc nhn s Chng minh nhn dn c.
2. Th trng n v ni tip nhn h s ngh cp, i, cp li th Cn cc cng dn k giy
xc nhn s Chng minh nhn dn ca cng dn.
iu 14. Bo co cng tc cp, qun l cn cc cng dn (CC08)
1. Mu CC08 Cng an cp tnh, Cng an cp huyn thng k, bo co kt qu v cng tc
cp, qun l cn cc cng dn. nh k theo qu, 06 thng, 01 nm Cng an cp tnh phi gi
bo co v Tng cc Cnh st (qua Cc Cnh st ng k, qun l c tr v d liu quc gia v
dn c).
2. S liu, ni dung trong bo co phi chnh xc, r rng, y .

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iu 15. Phiu iu chnh thng tin cn cc cng dn (CC09)

1. Mu CC09 do c quan Cng an ni tip nhn h s cp, i, cp li th Cn cc cng dn
lp khi cng dn c thay i v ni thng tr, h tch v cc loi thay i khc iu chnh
thng tin ca cng dn trong h s tng th cn cc cng dn. C quan Cng an ni tip nhn
h s c trch nhim chuyn Phiu iu chnh thng tin cn cc cng dn cho c quan qun l
tng th cn cc cng dn Cng an cp tnh qun l, khai thc.
2. Cch ghi thng tin:
a) T mc 1 n mc 3: ghi cc thng tin ca cng dn theo hng dn ti khon 2 iu 7
Thng t ny;
b) Mc Ni dung iu chnh thng tin: ghi r ngy thng nm cng dn c thay i v ni ng
k thng tr hoc nhng thay i khc (lu : i vi ni ng k thng tr mi ghi y ,
chnh xc theo Phiu bo thay i v nhn khu, h khu; i vi nhng thay i khc ghi theo
quyt nh ca c quan c thm quyn cho php thay i cc thng tin ca cng dn);
c) Mc Ngy....thng.nm.: ghi r ngy, thng, nm cng dn ghi Phiu iu chnh
thng tin cn cc cng dn;
d) Mc Ph duyt ca Th trng n v: Th trng c quan qun l cn cc cng dn ni
iu chnh thng tin c trch nhim ph duyt cc thng tin c thu nhn trong Phiu iu chnh
thng tin cn cc cng dn ca cng dn;
) Mc Ngi c iu chnh: ngi c iu chnh thng tin cn cc cng dn c trch
nhim kim tra li cc thng tin c thu nhn trong Phiu iu chnh thng tin cn cc
cng dn, sau k, ghi r h tn.
iu 16. Phiu chuyn h s Cn cc cng dn (CC10)
1. Mu CC10 dng cho c quan ni tip nhn h s cp, i, cp li th Cn cc cng dn lp
chuyn giao h s cn cc cng dn trong trng hp cng dn chuyn ni ng k
thng tr i cc tnh, thnh ph khc v cc trng hp cng dn c cp th Cn cc
cng dn ngoi ni ng k thng tr, th h s s c chuyn v tng th cn cc cng
dn Cng an cp tnh ni ng k thng tr ca cng dn qun l.
2. Cch ghi thng tin:
a) Mc Knh gi: ghi r n v ni nhn h s cn cc cng dn;
b) T mc 1 n mc 4: ghi cc thng tin ca cng dn theo hng dn ti khon 2 iu 7
Thng t ny;
c) Mc kin xut: ghi ngn gn, c th kin trao i gia n v gi h s v n v nhn
h s cn cc cng dn;
d) Mc Xin tr li phiu ny cho: ghi y , c th tn n v gi h s cn cc cng dn;
) Mc Ngy....thng....nm..: ghi r ngy, thng, nm gi Phiu chuyn h s cn cc
cng dn v ngy, thng, nm nhn Phiu chuyn h s cn cc cng dn.
iu 17. Ti h s Cn cc cng dn (CC11)
1. Mu CC11 c dng cho c quan qun l h s tng th cn cc cng dn ng ti liu,
gm: T khai Cn cc cng dn, Phiu thu nhn thng tin Cn cc cng dn, Phiu chuyn
h s cn cc cng dn, Phiu iu chnh thng tin v cc ti liu khc lin quan n cng tc
cp, qun l th Cn cc cng dn.
2. Cch ghi thng tin:
a) Mc S th Cn cc: ghi y , c th 12 s Cn cc cng dn;
b) Mc H, ch m v tn; Gii tnh; Ngy, thng, nm sinh; Ni ng k thng tr;
Qu qun: ghi cc thng tin ca cng dn theo hng dn ti khon 2 iu 7 Thng t ny;

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c) Mc Ngy, thng, nm lp h s: ghi c th ngy, thng, nm lp h s cn cc cng dn;

d) Mc Cn b lp; n v lp: ghi y , c th tn cn b lp h s v n v lp h s cn
cc cng dn;
) Mc H s gm: ghi y , c th cc ti liu c lu gi trong h s cn cc cng dn.
iu 18. Phiu thu thp thng tin dn c (DC01)
1. Mu DC01 c dng cho cng dn k khai thng tin nhn thn ca mnh thu thp, cp
nht vo C s d liu quc gia v dn c.
2. Cch ghi thng tin:
a) Mc Tnh/thnh ph; Qun/huyn/th x; x/phng/th trn; Thn/p/bn/phum/sc/t;
Lng/ph; Xm/s nh: ghi y a danh hnh chnh theo giy khai sinh; nu khng c giy
khai sinh th ghi theo s h khu;
b) Mc H, ch m v tn khai sinh/H, ch m v tn cha/ H, ch m v tn m/H, ch
m v tn v (chng)/ H, ch m v tn ngi i din hp php/H, ch m v tn ch
h; S CMND/s DCN; Ni ng k khai sinh; Qu qun; Dn tc; Tn gio; Quc
tch; Ni thng tr/Ni hin ti: ghi nh hng dn ti phn ghi ch trong biu mu (nu
c);
c) Mc Ngy, thng, nm sinh; Gii tnh: ghi theo hng dn ti cc im a, b khon 2 iu 7
Thng t ny;
d) Mc Nhm mu: trng hp cng dn c yu cu cp nht v c bn kt lun v xt nghim
xc nh nhm mu ca ngi . Nhm mu no th nh du X vo nhm mu ;
) Mc Tnh trng hn nhn: trng hp cng dn cha kt hn, kt hn hoc ly hn th
nh du X vo tng ng;
e) Mc Ngy khai: ghi r ngy, thng, nm cng dn ghi Phiu thu thp thng tin dn c;
trng hp ngi khng bit ch hoc khng th t k khai c th thc hin theo quy nh ti
khon 2 iu 6 Thng t ny.
3. Mc Trng Cng an x/phng/th trn: Trng Cng an x, phng, th trn c trch
nhim xc nhn Phiu thu thp thng tin dn c ca cng dn ang c tr trn a bn qun l.
4. Mc Cnh st khu vc/Cng an vin: Cnh st khu vc, Cng an vin c trch nhim xc
nhn Phiu thu thp thng tin dn c ca cng dn trn a bn mnh ang qun l.
iu 19. Phiu cp nht, chnh sa thng tin dn c (DC02)
1. Mu DC02 dng cng dn k khai khi c s thay i cc thng tin v nhn thn quy nh ti
khon 1 iu 9 Lut Cn cc cng dn.
2. Cch ghi thng tin:
a) Mc H, ch m v tn; S DCN/s CMND; Ni thng tr: ghi nh hng dn ti
phn ghi ch trong biu mu;
b) Mc Ngy, thng, nm sinh: ghi thng tin ca cng dn theo hng dn ti im b khon 2
iu 7 Thng t ny;
c) Mc Gii tnh: nu gii tnh nam nh du X vo Nam, nu gii tnh n nh du X
vo N;
d) Mc Ni dung thng tin cp nht, chnh sa: ghi theo quyt nh c quan c thm quyn v
vic thay i thng tin ca cng dn;
) Mc H s, ti liu km theo: ghi y , r rng cc loi h s, ti liu km theo Phiu cp
nht, chnh sa thng tin dn c;
e) Mc Cn b xut: cn b i Cnh st qun l hnh chnh v trt t x hi Cng an cp

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huyn khi tip nhn h s kim tra, i chiu cc thng tin ca cng dn y , chnh xc c
trch nhim xut lnh o Cng an cp huyn;
g) Mc Ph duyt ca c quan qun l CSDLQG v DC: i din c quan qun l c s d liu
quc gia v dn c k, ghi r h tn v ng du.
Chng III
T CHC THC HIN
iu 20. Hiu lc thi hnh v quy nh chuyn tip
1. Thng t ny c hiu lc thi hnh k t ngy 02 thng 02 nm 2016 v thay th Thng t s
05/2014/TT-BCA ngy 22 thng 11 nm 2014 ca B trng B Cng an quy nh biu mu s
dng trong cng tc cp, qun l Chng minh nhn dn.
2. Nhng ni cha c iu kin trin khai cp th Cn cc cng dn theo Lut Cn cc cng
dn th tip tc s dng biu mu cp, qun l Chng minh nhn dn theo Quyt nh s
998/2001/Q-BCA(C11) ngy 10 thng 10 nm 2001 ca B trng B Cng an v vic ban
hnh cc biu mu s dng, trong cng tc qun l hnh chnh v trt t x hi, chm nht n
ngy 01 thng 01 nm 2020 phi thc hin thng nht theo Thng t ny.
iu 21. Trch nhim thi hnh
1. Tng cc trng Tng cc Cnh st c trch nhim hng dn, kim tra vic thc hin Thng
t ny.
2. Cc Tng cc trng, th trng n v trc thuc B Cng an, Gim c Cng an, Cnh st
phng chy v cha chy tnh, thnh ph trc thuc Trung ng v cc c quan, t chc, c
nhn c lin quan chu trch nhim thi hnh Thng t ny.
Trong qu trnh thc hin, nu c kh khn, vng mc, Cng an cc n v, a phng bo
co v B Cng an (qua Tng cc Cnh st) c hng dn kp thi./.

B TRNG
Ni nhn:
- Cc ng ch Th trng;
- Cc Tng cc, n v trc thuc B Cng an;
- Cng an, Cnh st PCCC cc tnh, thnh ph trc thuc
Trung ng; i tng Trn i Quang
- Cc Kim tra vn bn QPPL B T php;
- Cng bo, Cng TTT Chnh ph, Cng TTT B Cng
an;
- Cng bo ni b;
- Lu: VT, C72, V19.

Mu CC01 ban hnh km theo

Thng t s 66/2015/TT-BCA ngy 15/12/2015
CNG HA X HI CH NGHA VIT NAM
c lp - T do - Hnh phc
--------------

T KHAI CN CC CNG DN
1. H, ch m v tn(1): ....................................................................................................................
2. H, ch m v tn gi khc (nu c)(1): .......................................................................................
3. Ngy, thng, nm sinh:././..; 4. Gii tnh (Nam/n): ...............................

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5. S CMND/CCCD (2):
6. Dn tc:..7. Tn gio:...8. Quc tch: ................................
9. Tnh trng hn nhn: ......................................... 10. Nhm mu (nu c):.
11. Ni ng k khai sinh: ..................................................................................................................
12. Qu qun: .....................................................................................................................................
13. Ni thng tr: .............................................................................................................................
............................................................................................................................................................
14. Ni hin ti: ...............................................................................................................................
............................................................................................................................................................
15. Ngh nghip:..16.Trnh hc vn: .........................................................
17. H, ch m v tn ca cha(1): .................................................... Quc tch:..
S CCCD/CMND(*):
18. H, ch m v tn ca m(1): ..................................................... Quc tch:..
S CCCD/CMND(*):
19. H, ch m v tn ca v (chng)(1): ......................................... Quc tch:..
S CCCD/CMND(*):
20. H, ch m v tn ca ngi DHP(1):................................. Quc tch: ...................................
S CCCD/CMND(*):
21. H, ch m v tn ca ch h(1): ...............................................................................................
S CCCD/CMND(*):
Quan h vi ch h: ...........................................................................................................................
22. Yu cu ca cng dn:
- Cp, i, cp li th Cn cc cng dn: ........................................................................................
- Xc nhn s Chng minh nhn dn (c/khng): .............................................................................
- Chuyn pht bng ng Bu in n tn tay cng dn (c/khng):...........................................
a ch nhn: ................................................................................... S in thoi:....
Ti xin cam oan nhng thng tin k khai trn l ng s tht./.

.., ngythng..nm
NGI KHAI
(K, ghi r h tn)

KT QU XC MINH
i Tng th cn cc cng dn - Phng Cnh st QLHC v TTXH tr li kt qu i chiu, xc
minh vi h s gc (c hoc khng c h s gc, nu c h s gc th c ni dung g khc vi t
khai CCCD hoc Phiu thu nhn thng tin CCCD km theo?)
............................................................................................................................................................
............................................................................................................................................................

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

.., ngythng..nm Cn b tra cu

(3) (K, ghi r h tn)

Ghi ch:
- (1): Ghi ch in hoa du.
- (2): Ghi s CMND/CCCD c cp ln gn nht (nu l CMND c 9 s th 3 cui gch
cho).
- (3): i trng i Tng th cn cc cng dn Phng Cnh st QLHC v TTXH.
- (*): Khng bt buc cng dn phi k khai.
- CCCD l vit tt ca Cn cc cng dn; CMND l vit tt ca Chng minh nhn dn; DHP l
vit tt ca i din hp php./.

Mu CC02 ban hnh km theo

Thng t s 66/2015/TT-BCA ngy 15/12/2015
(M s, m vch mt PHIU THU NHN THNG TIN 17.
chiu) CN CC CNG DN
S th CCCD:.
nh chn
1. H, ch m v tn:........................................................................................ dung 4cm x
6cm
2. H, ch m v tn gi khc (nu c):...........................................................
3. Ngy, thng, nm sinh: 4. Gii tnh:..

5. S CMND/CCCD c cp:
Cp ngy:.//. Ni cp: ............................................................................................
6. Dn tc...7. Tn gio:..8. Quc tch ....................................................
9. Ni ng k khai sinh: ....................................................................................................................
10. Qu qun: .....................................................................................................................................
11. Ni thng tr ..............................................................................................................................

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12. Ngh nghip: ................................ 13. Trnh hc vn:.............................................................

14. H, ch m v tn ca cha: .......................................................................................................
15. H, ch m v tn ca m: ........................................................................................................
16. H, ch m v tn ca v (chng): ............................................................................................
18. c im nhn dng: ...................................................................................................................
19. Loi cp:..20. Cp ln th:.21. n v lp: ................................
Ci phi Tr phi Gia phi Nhn phi t phi

Ci tri Tr tri Gia tri Nhn tri t tri

4 ngn chm tay tri 4 ngn chm tay phi

22. Cn b kim tra 23.., ngythng..nm

(k, ghi r h tn) Ngi khai k, ghi r h tn

Mu CC03 ban hnh km theo

Thng t s 66/2015/TT-BCA ngy 15/12/2015
CNG HA X HI CH NGHA VIT NAM
c lp - T do - Hnh phc
--------------

GIY HN
Tr th Cn cc cng dn
Cng an ..............................................................................................................................................
tip nhn h s v lm th tc th Cn cc cng dn i vi cng dn:
H, ch m v tn: ...........................................................................................................................
Sinh ngy://
Gii tnh:
Ni thng tr: ...................................................................................................................................
............................................................................................................................................................
Thi gian hn tr th Cn cc cng dn i vi cng dn vogi
.pht, th. ngy:./............./

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Ti a ch: ..........................................................................................................................................
............................................................................................................................................................

.., ngythng..nm
NGI LP GIY HN
(K, ghi r h tn)

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Mu CC04 ban hnh km theo

Thng t s 66/2015/TT-BCA ngy 15/12/2015
(1) CNG HA X HI CH NGHA VIT NAM
..(2) c lp - T do - Hnh phc
---------- ---------------
S:./. , ngy thng nm ..

DANH SCH XUT DUYT H S NGH CP, I, CP LI TH CN CC CNG DN

Knh gi:..
..(2) ngh .(3) duyt h s ngh cp, i, cp li th Cn cc cng dn, danh sch c th sau y:
M s danh sch
M s Phiu thu nhn thng
STT H, ch m v tn khai sinh Gii tnh Ngy sinh Loi cp S CCCD c cp
tin CCCD

ngh ng ch xem xt, quyt nh.

CN B XUT CH HUY I kin ca ngi c thm quyn duyt h s:

(K, ghi r h tn) (K, ghi r h tn)

(3)
(K, ghi r h tn v ng du)

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Mu CC05 ban hnh km theo

Thng t s 66/2015/TT-BCA ngy 15/12/2015
(1) CNG HA X HI CH NGHA VIT NAM
..(2) c lp - T do - Hnh phc
---------- ---------------

PHIU GIAO NHN

H s ngh cp, i, cp li th Cn cc cng dn cn tra cu
H, ch m v tn khai Ngy, thng, nm M s Phiu thu nhn thng
STT Gii tnh
sinh sinh tin CCCD

Tng s h s: ...............................................................................................................................
Mi h s ngh cp, i, cp li th Cn cc cng dn cn tra cu bao gm: T khai Cn
cc cng dn v Phiu thu nhn thng tin Cn cc cng dn.
Phiu ny c lp thnh 02 bn, bn giao v bn nhn mi bn gi 01 bn.

Cn b lp phiu Th trng n v
(K, ghi r h tn) (K, ghi r h tn)

GIAO H S TRA CU NHN KT QU TRA CU

Ngythng..nm. Ngythng..nm.

Bn giao Bn nhn Bn giao Bn nhn

Ghi ch: Bn giao, bn nhn k, ghi r h tn, chc v, n v.

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Mu CC06 ban hnh km theo

Thng t s 66/2015/TT-BCA ngy 15/12/2015
CC CNH ST KQL C TR V DLQG V DN C CNG HA X HI CH NGHA VIT NAM
TRUNG TM CN CC CNG DN QUC GIA c lp - T do - Hnh phc
---------- ---------------
S:./. , ngy thng nm ..

XUT PH DUYT H S NGH CP, I, CP LI TH CN CC CNG DN

Knh gi: Lnh o Cc Cnh st ng k, qun l c tr v d liu quc gia v dn c
Trung tm Cn cc cng dn quc gia ngh lnh o Cc Cnh st ng k, qun l c tr v d liu quc gia v dn c ph duyt h s
ngh cp, i, cp li th Cn cc cng dn, danh sch c th sau y:

Tng s danh H s
STT n v M s cc danh sch
sch Tng s Hp l Khng hp l

CN B XUT LNH O TRUNG TM CCCD QUC GIA LNH O CC CNH ST KQL C TR

(K, ghi r h tn) (K, ghi r h tn) V DLQG V DN C
(K, ghi r h tn)

Ni nhn:
- Nh trn;
- Lu: Trung tm CCCD Quc gia

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Mu CC07 ban hnh km theo

Thng t s 66/2015/TT-BCA ngy 15/12/2015
(1) CNG HA X HI CH NGHA VIT NAM
---------- c lp - T do - Hnh phc
---------------
S:../GXN-CCCD

GIY XC NHN
S CHNG MINH NHN DN
........................................................................................................................ (1), xc nhn:
H v tn: .................................................................... ; Gii tnh:..(Nam/n).
Ngy, thng, nm sinh:./../..
Ni thng tr: ...................................................................................................................................
............................................................................................................................................................
S CMND c cp:
Do Cng an.................................................................. cp ngythngnm
Nay c cp th CCCD s:
Do Cc Cnh st ng k, qun l c tr v d liu quc gia v dn c cp
ngy..thngnm..

.., ngythng..nm
(2)
(K tn, ng du)
Ghi ch:
(1): Ghi tn n v cp giy xc nhn.
(2): Ghi chc danh ca ngi c thm quyn cp giy xc nhn.

CNG AN CNG HA X HI CH NGHA VIT NAM Mu CC08 ban hnh

km theo Thng t s
. c lp - T do - Hnh phc
66/2015/TT-BCA ngy
---------- --------------- 15/12/2015
S:.

BO CO
CNG TC CP V QUN L CN CC CNG DN
(T ngy.n ngy.)
Knh gi: .............................................................................................................................................
Phng Cnh st QLHC v TTXHbo co cng tc cp v qun l CCCD
nh sau:
I. CP TH CCCD
- Tng s h s lm th tc:..........................................................................................................
- Trong cp mi: ................................. , i th CCCD: ................................................................ ,

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cp li th CCCD ...............................................................................................................................
- tr th CCCD: .............................................................................................................................
- Cn tn: ............................................................................................................................................
- S Phiu thu nhn thng tin CCCD bn giao cho tng th CCCD:.., s
cha bn giao: ....................................................................................................................................
II. QUN L CCCD:
- T chc kim tra CCCD..t; s lt ngi kim tra ...........................................
- S ngi mang theo th CCCD: ......................................................................... (t l..%)
Qua kim tra pht hin:
- S th CCCD b hng: ....................................................
- S th CCCD nghi gi mo: ...........................................
- S ngi s dng th CCCD ca ngi - S ngi bo mt th CCCD: ........................................
khc:...
- Trng hp khc:...........................................................
Cc trng hp x l qua kim tra:
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
III. CN B, VT T:
1. Tng s cn b lm cng tc cp, qun l CCCD: ........................................................................
- Cn b Phng Cnh st QLHC v TTXH:........................................................................................
- Cn b Cng an qun/huyn/th x/thnh ph:................................................................................
2. Vt t, phng tin:
S lng
TT Vt t, phng tin Hot ng bnh Ghi ch
Tng s Hng
thng
1 My nh
2 My qut vn tay
3 My vi tnh
4 My in
Thit b xc minh di
5
ng
IV. KIN NHN XT NGH

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

.., ngythng..nm
TH TRNG N V
(K, ghi r h tn v ng du)

CNG AN CNG HA X HI CH NGHA VIT NAM Mu CC09 ban hnh

km theo Thng t s
. c lp - T do - Hnh phc
66/2015/TT-BCA ngy
---------- --------------- 15/12/2015

PHIU IU CHNH THNG TIN CN CC CNG DN

1. H, ch m v tn: .......................................................................................................................
2. Ngy, thng, nm sinh: .//..; Gii tnh (Nam/n): .....................
3. S th CCCD c cp:
Cp ngy: .//..Ni cp: .................................................................
4. Ni dung iu chnh thng tin:
NGY N NI NG K THNG TR MI
........................... ...........................................................................................................................
........................... ...........................................................................................................................
........................... ...........................................................................................................................
........................... ...........................................................................................................................
........................... ...........................................................................................................................
NGY NHNG THAY I KHC
........................... ...........................................................................................................................
........................... ...........................................................................................................................
........................... ...........................................................................................................................
........................... ...........................................................................................................................
........................... ...........................................................................................................................

LUT S T VN PHP LUT 24/7: 1900 6169

Cng ty Lut Minh Gia www.luatminhgia.com.vn

Ngythng.nm Ngythng.nm Ngythng.nm

TH TRNG C QUAN NGI C IU CHNH CN B THC HIN
QUN L CN CC CNG DN (K, ghi r h tn) (K, ghi r h tn)

CNG AN CNG HA X HI CH NGHA VIT NAM Mu CC10 ban hnh

km theo Thng t s
. c lp - T do - Hnh phc
66/2015/TT-BCA ngy
---------- --------------- 15/12/2015
S: .................

PHIU CHUYN H S CN CC CNG DN

Knh gi: ......................................
1. H, ch m v tn:............................................................................ Nam/n: ...........................
2. Ngy, thng, nm sinh: ..................................................................................................................
3. S th CCCD c cp:
Cp ngy: .//..Ni cp: .................................................................
4. Ni ng k thng tr: ................................................................................................................
5. kin xut: ...............................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
6. Xin tr li phiu ny cho: ................................................................................................................

.., ngythng..nm .., ngythng..nm

TH TRNG NI NHN TH TRNG NI GI
(K, ghi r h tn v ng du) (K, ghi r h tn v ng du)

CNG HA X HI CH NGHA VIT NAM Mu CC11 ban hnh km

theo Thng t s
c lp - T do - Hnh phc
66/2015/TT-BCA ngy
--------------- 15/12/2015

CNG AN TNH/TP
330
mm
H S CN CC CNG DN
S TH CN CC:..

H, ch m v tn: ................................................. Gii tnh (nam/n):.

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Ngy, thng, nm sinh: ......................................................................................................

Ni thng tr: ..................................................................................................................
............................................................................................................................................
Qu qun: ...........................................................................................................................

Ngy, thng, nm lp h s: ..............................................................................................

Cn b lp: ........................................................................................................................
n v lp: .........................................................................................................................
H s gm: ........................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................
............................................................................................................................................

250 mm

Mu DC01 ban hnh km theo

Thng t s 66/2015/TT-BCA ngy 15/12/2015
Tnh/thnh ph: ........................................... Thn/p/bn/phum/sc/t:....................................
Qun/huyn/th x: ..................................... Lng/ph:..............................................................
X/phng /th trn:.................................... Xm/s nh: .........................................................

PHIU THU THP THNG TIN DN C

1. H, ch m v tn khai sinh(1): .....................................................................................................
2. Ngy, thng, nm sinh: / / 9. Nhm mu: O A B AB
3. Gii tnh: Nam N 10. Tnh trng hn nhn: Cha kt hn kt hn Ly hn
4. Ni ng k khai sinh(2): .................................................................................................................
5. Qu qun(2): ....................................................................................................................................
6. Dn tc: ..................................................................... 7. Tn gio:
8. Quc tch(3): Vit Nam; Quc tch khc:.......................................................................................
11. Ni thng tr(4): .........................................................................................................................
............................................................................................................................................................
12. Ni hin ti(4): ............................................................................................................................

LUT S T VN PHP LUT 24/7: 1900 6169

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............................................................................................................................................................
13. H, ch m v tn cha(1): ...........................................................................................................
Quc tch:.. S CMND
S DCN(5)
H, ch m v tn m(1): ..................................................................................................................
Quc tch:.. S CMND
S DCN(5)
H, ch m v tn v/chng(1): ........................................................................................................
Quc tch:.. S CMND
S DCN(5)
H, ch m v tn ngi i din hp php (nu c)(1): .................................................................
Quc tch:.. S CMND
S DCN(5)
14. H, ch m v tn ch h(1): ......................................................................................................
S CMND
S DCN(5)
15. Quan h vi ch h:.................................. 16. S h khu: ........................................................

Ngy khai: / /
Trng Cng an Cnh st khu vc/ Ngi khai
x/phng/th trn Cng an vin (K, ghi r h tn)
(K, ghi r h tn v ng du) (K, ghi r h tn)

Ghi ch: (1) Vit IN HOA du. (2) Ghi y a danh hnh chnh cp: x, huyn, tnh. (3) Ghi
Quc tch khc v ghi r tn quc tch nu cng dn c 02 Quc tch. (4) Ghi r theo th t s
nh, ng ph, xm, lng, thn, p, bn, bun, phum, sc; x/phng/th trn; qun/huyn/th
x/thnh ph thuc tnh; tnh/thnh ph trc thuc Trung ng. (5) Ghi s nh danh c nhn
(DCN), trng hp cha c DCN th ghi s CMND.

Mu DC02 ban hnh km theo

Thng t s 66/2015/TT-BCA ngy 15/12/2015
.................................................... CNG HA X HI CH NGHA VIT NAM
................................................. (1) c lp - T do - Hnh phc
--------------

PHIU CP NHT, CHNH SA THNG TIN DN C

I. Thng tin v ngi khai(2)
1. H, ch m v tn(3): ....................................................................................................................
2. S DCN(4)
S CMND
3. Quan h vi ngi c cp nht, chnh sa thng tin: ..............................................................
II. Thng tin v ngi c cp nht, chnh sa thng tin(5)

LUT S T VN PHP LUT 24/7: 1900 6169

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1. H, ch m v tn khai sinh(3): .....................................................................................................

2. Ngy, thng, nm sinh: / /
3. Gii tnh: Nam N
4. S DCN(4)
S CMND
5. Ni thng tr(6): ...........................................................................................................................
............................................................................................................................................................
III. Ni dung thng tin cp nht, chnh sa
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
IV. H s, ti liu km theo
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................
............................................................................................................................................................

Ph duyt ca C quan qun l Cn b xut .., ngy thng nm

C s d liu quc gia v dn c (K, ghi r h tn) Ngi khai
(K, ghi r h tn v ng du) (K, ghi r h tn)

Ghi ch: (1) Ghi tn c quan cp trn trc tip v tn C quan qun l C s d liu quc gia v
dn c. (2) Ch phi ghi thng tin v ngi khai trong trng hp ngi khai khng phi l ngi
c cp nht, chnh sa thng tin. (3) Vit IN HOA du. (4) Ghi s nh danh c nhn, trng
hp cha c DCN th ghi s CMND. (5) Ghi thng tin ca cng dn trc khi c cp nht,
chnh sa. (6) Ghi y a danh hnh chnh 03 cp: x, huyn, tnh theo S h khu.

LUT S T VN PHP LUT 24/7: 1900 6169