UY BAN BAU DBHDND LONG HOA XA HOI CHU NGHiA VItT NAM THI X -A DIN BAN Doc lap - Ty. do - Hanh phtic

SO: 03 /TB-UBBC Di'n Ban, ngay 19 thang 02 nant 2021

THONG BAO Ve viec ni)p hO so• ting dai bleu 11(ii dOng nhan dan thi x5

khoa XII, nhiem kji 2021 - 2026

Can cir Lu4t B.au cir dai bieu Quoc hOi va dai bieu HOi dOng nhan dan so 85/2015/QH13;

Can cir Nghi quyet so 41/NQ-HDBCQG ngdy 18/01,/2021 .cua dOng bau cu Quoc gia hirang dan mau h6 so irngmau phial bau cir, not quy phong b6 phieu va cac mau van ban sir Ong trong cong tac Hu cir dai bieu QuOc hOi khoa XV va dai bieu Hoi d'ong nhan dan cac cap nhiem kST 2021-2026;

Uy ban . bau cir thi xa Dien Ban thong bdo ve viec nOp ht) so• irng cir dai bieu Hoi dOng nhan dan thi xa khoa XII, nhiem kS, 2021-2026 nhu sau:

Ve do tuOi va tie'u chuan ctia ngtroi (mg dai bieu•H(ii dOng nhan dan thi xa:

'1.: CE: Tinh den ngay cir dugc cong b6 (23/5/2021), cong dan Viet Nam du tuOi tra len (Dieu 2, Lu4t ball dai bieu Quoc hOi va dai bieu HOi dOng n s BAucC

M dan), c6 tieu chuan quy dinh tai Dieu 7 Luat To chirc chinh quyen dia phuo # IA D4N

khoan 3 Dieu 2 Lu4t sira doi, bo sung mot so, dieu LiCat chirc Chinh v )h/ QUANG'

Lu'a't chirc chinh quyen phuang c6 quyen irng cir dal bieu Hoi d'Ong nhan dan thi xa Dien Ban khoa XII, nhiem kSi 2021-2026.

2. HO so' ting

- Dan irng cir dai bieu HOi dOn.g nhan dan: thgc hien theo tau so 06/HDBC-HDND;

- So }feu ly lich c6 dong dau Oa') lai va xac nhan ciia ca quan, to chirc,.dan vi nai ngu6i irng cir cong tac hoac Uy ban nhan dan cap xa not ngued irng cir cu tru: thvc hien theo mau so 07/HDBC-HDND;

- Tieu sir tom tat: thuc hien theo mau so 08/HDBC-HDND; - Ban ke khai tai san, thu nhap cua ngtreYi irng cu: thgc hien theo matt s6

09/HDBC-HDND; - Moi bo hO so' img cir cua ngirgi „ irng cir gui kern theo 03 anh chan dung

mau, nen trang, 4cmx6cm (khong ke anh dan tren So yeu ly lic.h va Tieu sir torn tat).

Cric mau ho su nett teen (06/HDBC-HDND, 07/HDBC-HDND, 08/HDBC-HDND, 09/HDBC-HDND) &rue ban hanh kern theo Nghi quyJt sa 41/NQ-HDBCQG ngay 18/01/2021 ctia H.oi clang ball cfr Quoc gia.

c) Nguai irng cir thirc hien viec ke khai cac not dung day d4, chinh xac theo huong dan trong cac mau van ban thuOc ho so img cir ban hanh kern theo Nghi

-r

TM. UY BAN BAU CU CHU TICH

guy& so 41/NQ-HDBCQG ngay 18/01/2021 dm H6i ding bAu cir QuOc gia. Viec ke khai c6 the thgc hien bAng cach sviet tay hoc danh may nhung phai bao dam dung theo cdc mau van ban thu6c h6 so irng cir do H6i (Ring bau cir quoc gia ban hanh. Nguai img cir 1(3'i vaa tirng trang van ban cila ho so irng cir. Nguai irng cir c6 th4 lien he Uy ban bau Cir thi xa Dien Ban (co' quan thwong tn:rc: Phong AT.C5i vu thi xa Dien.Ban, cilia chi: 22 Hoang Dieu, phuong Vinh Dien, thi xa" Dien Ban) de nh'dn ho so irng cir hoc c6 the tai file dien tix cdc mat' van ban trong ho so irng cir tir Trang thong tin din tir cila Dien Ban: http://www.dienban.gov.vn.

d) Anh chan dung cita nguai img cir la anh dugc chup trong that gian 06 thang tinh den ngay nip h6 so irng Cu. Trong So yeti 1)", lich, Tieu sir torn tat, anh cita nguai img cir phai dan dung vi tri quy dinh va ding dAu giap lai dm co quan, to chirc, don vi nai nguai irng Cu cong tac ho;dc Uy ban nhan dan cap xa not nguai irng Cu cu

3. Nip hO so. frng a) Viec nip 116 so img cir ddi bieu H6i ding nhan dan thi xa Dien Ban khoa

XII, nhiem kST 2021-2026 &rag thu.c hien nhu. sau: - Nguai Ung cir duac co quan, to chirc, don vi gieri thieu img cir va nguai tax

irng cir dui bieu Hoi ding nhan dan thi )(a Dien Ban kh6a XII, nhiem kSi 2021-2026 nip 01 b6 ho so (mg cir tai Uy ban bAu cir thi xa Dien Ban.

b) Thai hdri nip hO so img cir ddi bieu H6i ding nhan dan thi xa Dien Ban. kit& XII, nhiem kSi 2021-2026 la trong gia hanh chinh cdc ngay trong tuAn, bAt dAu tir ngay 22/02/2021 va ket thiic vao 17 gib. 00 phtit ngay 14/3/2021 (Rieng thir Bay, ngay 13/3/2021 va Chu nhlat, ngay 14/3/2021, Uy ban bAu cir thi xa van nh'dn ho so tang cir).

c) Dia diem nip 116 so img cir ddi bieu H6i ding nhan dan thi xa Dien Ban kit& XII, nhiem kST 2021-2026:

Tdi Uy ban bAu cir thi xa Dien Ban, dia chi: Phong N6i vu thi xa Dien Ban, dia. chi: 22 Hoang Dieu, phtarng VTnh Dien, thi xa Di0 Ban.

tJ' y ban bAu cir thi xa Dien Ban tran trong thong bao de cdc ca nhan, to chirc

•

duvc

41 Noi nhe)fi: - UBBC tinh; Ncii vu; - TTTU, HDND, UBND thi xa; - UBMTTQVN thi xa; doan the CT-XH tinh; - Cac Ban Dang, Dang Cly thu(ic Thi Ciy; - Thanh vien UBBC thi ?Ca; - Cac ban, nganh ctIa thi xa; - Dang ay cac xa, phu*ng; - UBND, UBBC ode xa, *rang; - TT VH-TT&TT-TH thi xa (de. dim tin); - Lull: VT, GNV.

Milu sa 06/HDBC-HDND

CONG HOA XA. H91 CHU NGHiA VIVI' NAM DO 14p - Ty' do - H4nh phtic

DON UNG CIS DAI BIEU HOI DONG NHAN DAN (1) NHIEM KY 2021-2026

Kinh Oy ban bau cir (1)

1. HQ va ten thuOng dung: (2) 2. Ho va ten khai sinh: (3)

Cac bi danh/ten g9i khac (n6u co): 3. Ngay, thong, nom sinh• 4. Giai tinh: 5. Que)c tich: (4) 6. Noi clang ky khai sinh: (5) 7. Que quail: (6). 8. Noi clang ky/ thuttng trii: (7)

Noi a hien nay: (8)

9. Se) CMND/HO chi6u/Can cuot cong dan: (9) Ngdy cdp• Cu quan cap:

10. Dan tic: (10) 11. Ton gido: (11) 12. Trinh dO:

- Gido clvc phO thong: (12) - Chuyen mon, nghiep vu: (13) - HQC vi: (14) Hoc ham: (15) - Ly luan chinh tri: (16) - Ngoai ngir: (17)

13. Nghe nghiep hien nay: (18) 14. Chirc vu (19):

- Chirc vu trong ca quan, to chirc, don vi clang cong tac: - Chirc vu trong Dang, doan the:

15. Noi cong tac: (20) 16. Dia chi lien he: SO dien thoai ca quan/nai lam viec: So dien thoai nha rieng•

SO dien thoai di Ong. .E-mail:

•

, Can cir vao cac, dieu 2, 3, 37 cip Luat Bau cir dai Neu Qu6c hoi long nhan dan va Die 7,cua Luat To chinh quyen dia phuong, toi CO du dieu kien, tieu cpuan irng cir dai bieu Hii 'Jong nhan dan Vay toi irng cir dai bi'eu HOi (long nhan clan (1) nhiem

va dai nhan thay minh, lam don nay de Icy 2021-2026.

, ngay thcing /lam 2021

1q ten (4, ghi hp va ten)

Mau so 07/HDBC-HDND

CONG HOA XA H91 CHU NGHiA VItT NAM Di)c lap - Tu• do - Hanh phuc

Anh

4cm x 6cm SO YEU LY LICH CUA NGU'OI eNG CU'DAI BIEU HO BONG NHAN

DAN (1) NaltM KY 2021-2026

1. H9 va ten thu9ng dung: (2) 2. Ho va ten khai sinh• (3)

Cac bi danh/ten g9i khac (rieu c6):

3. Ngdy, thong, nom sinh• 4. Giai tinh: 5. Qu6c tich: (4) 6. Nai darigk)', khai sinh: (5) 7. Que quan: (6) 8. Nai dang Ic)", thu•ang tru: (7)

Nai a hien nay: (8) 9. S6 CMND/H9 chieu/Can cuac ding dan: (9)

Ngdy cap• Co quan cap: 10. Dan t9c: (10) 11. Ton giao: (11) 12. Trinh d9: - Giao duc ph6 thong: (12)

- Chuyen mon, nghiep vu: (13)

Hoc vi: (14) H9c ham: (15) - Ly luan chinh tri: (16) - Ngoai ngir: (17) 13. Nghe nghiep hien nay: (18) Truang hap Id can b9, cOng chdc, vien chirc, thi ghi rO: - Ngach. Ma ngach - Bac Krung (n6u co). He so luang: Ngay hLrang: - Phu Cap chic vu (n6u co): 14. Chdc vu trong ca quan, t6chdc, dart vi dang cOng tac: (19) 15. Nai cong tac: (20) 16. Twang hap la Dang vien Dang C9ng san Viet Nam, thi ghi rO: (21) Ngdy vac) Dang. / /

- Ngay chinh ../ / S6 the dang vien: - Chuc vu trong Dang. - Ngdy ra kh6i Dang (net' co)•

LY do ra khai Dang: 17. Tham gia lam thanh vien cua cac to chirc doan the khac: (22)

- Ten to chirc doan the: - Chirc vu trong tong to chirc doan the: 18. Tinh trong sirc khoe: (23) 19. Cac hinh thirc khen thuang nha ntrac da dugc trao tang: (24)

20. Cac hinh thin ky luat, xir ly vi pham da bi ap dung (Dang, chinh quyen, doan the): (25) ...

21. La dai bieu Qu'Sc hal khod (nett co): 22. La dal bieu Hai d6ng nhan dan(neu có): nhiem ky

23. TOM TAT QUA TRINH CONG TAC

Thai gian Cong viec, chirc danh, chirc vu, noi cong tac (Chinh quyen, Dang, doan the)

Tir thang den thang

nam nam

QUAN HE GIA DiNH (26)

24. Ho va ten cha: Sinh ngay thang...... nam

+ Que quart: + Noi a hien nay: + Nghe nghiep, chirc vu- + No i cong tac: + La thanh vien cua to chirc chinh tri, to chirc chinh tri - xa hOi (n6u co):

25. HQ va ten me: Sinh ngdy thang nam

+ Que quart-

+ Nori a hien nay: + Nghe nghiep, chirc + Nai cong + La thanh vien cua to chirc chinh tri, to chirc chinh tri - xa hOi (nett c(5):

26. Ho va ten vg (chtmg): Sinh ngay thong .nam

+ Que van. + Nai or hien nay: + Nghe nghiep, chirc vv. + Nai ding tac: + La thanh vien cua to chirc chinh tri, to chirc chinh tri - xa hoi (neu co):

27. HQ va ten con dill. nhdt. Sinh ngay thong nam

+ Nai a hien nay: + Nghe nghiep, chirc vu (neu co). + Nai cong tac/hgc t'Op. + La thanh vien cua to chirc chinh tri, to chirc chinh tri - xa" hOi (neu co):

28. Con thir hai (tra len): khai nhu con thir nhAt.

Toi xin cam doan nhirng not dung neu tren hi deb, dii va dimg sif thOt, neu sai tdi xin holm toem chiu trdch nhiem truyk phrip lufn.

Xac nhan ctia co' quan, to chin, , ngay thcing n m 2021 dun vi no'i lam viec hoc Ky ten

US7 ban nhan dan cap la ncri mfr.(' (KY, ghi r5 hp va ten)

Mju so 08/HDBC-HEIND

Anh

4cm x 6cm

TIEU se TOM TAT CUA NGU'61 tiNG CIY DA' BIEU Ho BONG NHAN DAN

(1) NHIEM KY 2021-2026

1. H9 \id ten thuong dimg: (2) 2. HQ va ten khai sinh: (3)

Cac bi danh/ten g9i khac (neu co): 3. Ngay, thang, nam sinh. 4. Giai 5. Quo'c tich: (4) 6. Novi dang 14 khai sinh: (5)

7. Que quan: (6) 8. Noi clang 14 among tn:i: (7)

Nair a hien nay: (8)

9. S6 CMND/HO chieu/Can cuerc cong dan: (9) Ngay cap. Ca quan cap:

10. Dan tOc: (10) 11. Ton gido: (11) 12. Trinh dO: - Gido dpc ph9' thong: (12)

- Chuyen mon, nghiep Nip: (13) - HQC vi: (14) FIN ham: (15) - 14T luan chinh tri: (16) - Ngoai ngtr: (17)

13. Nghe nghiep hien nay: (18) 14. Chtc vu trong ca quan, to chtc, dan vi dang cong tac: (19)

15. Noi cong tac: (20) 16. Ngdy vao Dang: (21) / / - Ngdy chinh thtc: ./ / ; S6 the clang vien

- Chirc vu trong Dang: - Ngay ra khai Dang (neu co)

1_,)", do ra khOi 'Tang.

17. Tham gia lam thanh vier' cua cac t'9 chirc doan the: (22)

- Ten to chirc doan the: - Chirc vu trong tUng to chirc doan the. 18. Tinh tang sire khoe: (23) 19. Cac hinh thirc khen thuang nha nuac da duac trao tang: (24)

20. Cac hinh thdc ky 1uat, xir 1y vi pham da bi ap dung (bang, chinh quyen, down the): (25) ...

21. La dai bieu Qu6c hei khod (neu có): 22. La dai bieu HOi ckmg nhan dan (neu c(5): nhiem kST

TOM TAT QUA TRINH CONG TAC

Thai gian Cong viec, chirc danh, chirc vu, noi cong tac (Chinh quyen, Dang, doan the)

Tir thang nam den thang ... nam

, ngay thang nam 2021 Ky ten

(Ky, ghi ró ho va ten)

Mciu so 09/HDBC-HDND

LONG HOA XA HO CHU NGHIA VIVI' NAM floc 14p - Tu• do - 114nh phtic

BAN KE KHAI TAI SAN, THU NHAP (27) CUA NGU'OI IJNG DAI BIEU HQ! BONG NHAN DAN

(1) NHIEM KY 2021-2026

(Ngdy thang nam 202 1)(27.2)

I. THONG TIN CHUNG 1. Nguo•i Ice khai tai san, thu nhap - HQ Ira ten• Ngdy thang nam sinh: - Chirc vp/chirc danh cong tac: - Co quan/clan vi cong tac: - No•i thu6ng triu - S6 can cuo•c cong dan hoac giay chimg minh nhan clan(' 3) '

Ngay cap• ncri cap• 2. Vq hoac chong ctia nguo•i ke khai tai san, thu nhap - HQ va ten• Ngdy thang nam sinh: - Nghe nghiep• - No•i lam viec(27•4). - Novi thu6ng - S6 can cuo•c cong dan hoac giay chimg minh nhan dan• Ngay cap• not cap•

3. Con chua thanh nien (con de, con nuoi theo quy dinh ctia phap luAt) 3.1. Con thir nhAt: - HQ Ira ten• Ngdy thang nam sinh: - thu6ng - So can cuo•c cong dan hoac giAy chirng minh nhan dan:

Ngay cap• nui cap• 3.2. Con thir hai (tro• len): Ke khai Wang ttr nhu con thir nhat. II. THONG TIN MO TA VE TAI SAN(27 5) 1. Quyen sir dpng thtrc to d6i Vai 6t(27.6): 1.1. Dat 6(27.7): 1.1.1. Thira thir nhAt: - Dia chi 27.8): - Dien tich(27'9). - Gia tri(271°). - Giay chimg nhan quyen sir dung(27.11).

- Thong tin khac (nett co)( 2712) * 1.1.2. Thira thir 2 (tro• len): Ke khai Wang ttr nhu• thira thir nhAt. 1.2. Cac loci dAt khaC(27 13): 1.2.1. Thira thir nhAt: - Loai dAt• Dia chi: - Dien tich: - Gia tri(271°).

- Giay chirng nhan quyen sir dung: - Th6ng tin khac (neu co) 1.2.2. Thira thir 2 (tro. len): Ke khai along to nhu thira thir nhdt. 2. Nha er, cong trinh xay dung: 2.1. Nha 2.1.1. Nha thir nhdt: - Dia chi: - Loai nha(27•14). - Dien tich sir dung (27.15).

- Gia tri(2710). - Gidy chirng nhan quyen hau: - Thong tin khac (neu co): 2.1.2. Nha thir 2 (trO. len): Ke khai tuang to nhu nha thir nhAt. 2.2. Cong trinh xay dung khac(27• 16): 2.2.1. Cong trinh thir nhat: - Ten ding trinh. Dia chi: - Loai cong trinh. Cap cong trinh: - Dien tich: - Gia tri (27.10). - Gidy chirng nhan quyen him: - Th6ng tin khac (neu c6): 2.2.2. Cong trinh thir 2 (tr .& len): Ke khai Wong to nhu cong trinh thir nhdt. 3. Tai san khac gan lien vari ddt(2717): 3.1. Cay lau nam(27•18): - Loa" cay. So luting- Gia tri(27•1°). - Loai cay. SO ltromg. Gia tri(27•1°). 3.2. Rimg san xudt(27• 19): - Loai ring. Dien tich. Gia tri(27• 1°). - Loai rirng. Dien tich• Gia tri(271°). 3.3. Vat kien tritc khac gan lien veri dat: - Ten goi• So luting- Gia tri(27•'°). - Ten goi• SO luvng• Gia tri(27'1°). 4. yang, kim cuong, bach kim va cac kim loci quy, da quy khac co tong gia tri to 50 trieu &Ong trO• 1el-1(27.2C°.

5. Tien (tien Viet Nam, ngoai te) gom tien mat, tien cho vay, tien tra truarc, tien giri ca nhan, to chirc trong ntrac, to chirc ntrerc ngoai tai Viet Nam ma tong gia tri quy doi tir 50 trieu &Mg to. 161(27.21). , 6., CO phieu, trai phieu, von Op, cac loci gidy ter c6 gia khac ma tong gia tri to 50 trieu dong ter len (khai theo tong Loai): 6.1. CO phieu: - Ten co phial. SO luvng• Gia tri: - Ten co phieu. SO luting. Gia tri: 6.2. Trai phieu: - Ten trai phieu. SO luting. Gia tri: - Ten trai phieu. So ltrong. Gia tri: 6.3. V& g6p(27.22):

- Hinh tilde g6p von. Gia tri• - Hinh thirc gop von. Gia tri• 6.4. Cac,loai giay to co gia khac(2723): - Ten giay ter co gia: Gia tri•

- Ten giAy to co gia• Gia tri• 7. Tai san khac ma rai tai san co gia tri tir 50 trieu dOng tro• len, bao g'om: 7.1. Tai san theo quy dinh ciia phap lu;at phai clang ky sir dung va duvc cap? giAy clang ky (tau bay, tau thily, thuyen, may iii, may xiic, 6 to, mo to, xe gan may...)( 27.4):

- Ten tai san- So clang ky• Gia tri: - Ten tai san• So clang ky• Gia tri: 7.2. Tai san khac (dO my nghe, do the• ding, ban ghe, cay canh, tranh, anh, cac 14 tai san khac)( 27.25): - Ten tai saw Nam bat dAu so( hiru• Gia tri: - Ten tai saw Nam bat dau sa hiru• Gia tri: 8. Tai san a mrac ngoai(27• 26); 9. Tai khoan a ntrac ngoai(27•27): - Ten chu tai khoan: , so tai khoan: - Ten ngan hang, chi nhanh ngan hang, 6' chirc not ma tai khoaw

Toi xin cam loan nhirng not dung neu tren la dig dii va thing sy. that, neu sal toi xin hocin loan chiu (rich nhiem fru& phdp

NGUbl KE KHAI TAI SAN (K.V, ghi ro hip va ten)

HI5(NG DAN KE KHAI HO SO trNG cU DAI BIEU HO BONG NHAN DAN NHItM K1' 2021-2026

(Kern theo cac mju sa 06, 07, 08, 09/HDBC-HDND)

(1) Ghi ten don vi hanh chinh cap tinh, cap huy'en, cap xa nai minh irng cu dai bleu HOi Tong nhan dan.

(2) Ho va ten thuang Ghi ho, chit dem (neu co) va ten thuang dung bang chit in hoa, doi vai ngtrai hoot dOng ton giao thi ghi theo chi:re danh ton giao (vi HOA THIXONG THICH THANH A...).

(3) H9 va ten khai sinh: Ghi clung 119, chit dem va ten ghi trong Giay khai sinh, bang chit in hoa (Vi du: NGUYEN THI A).

(4) Quoc tich: Ghi di "Chi al 01 qutic tich la qmic tich Vi0 Nam va khong trong thei gian thtrc hiCe'n tha tyc xin gia nh4p qu6c tich colic gia khac"; throng hop clang co ca quoc tich ntrac khac hoac clang lam tha tpc xin gia nhap quoc tich nu& khac thi ghi ro thong tin ve cac quOc tich clang co hoac clang xin gia nhap.

(5) Nai clang ky khai sinh: Ghi ten dan vi hanh chinh cap xa, huy'en, tinh hoac tuang ducmg nai da cap Giay khai sinh hoac nai minh duac sinh ra trong treeing hop khong co Giay khai sinh.

, (6) Que quan: Ghi nai sinh Ong not hay nai sinh cha; treeing hop ca bit co the ghi theo nai sinh cua me hoac ngtrai nuoi &rang minh tit nho (neu khong biet rO cha, mg); ghi rO ten hi'en nay dm xa (phtrerng, thi tan), huy'en (quan, thi xa, thanh pho thuOc tinh, thanh pho thuOc thanh pho true thucic trung uang), tinh (thanh pho true thuOc trung trong).

, (7) Nai clang 14 thuang Ghi theo dia chi clang thuang tru ghi tren 110 khau;

(8) Nai O hi.'0 nay: Ghi nai cu tru thuang xuyen, neu tang vai nai clang 1c)", thuang tit thi ghi "Nhtr tren". Ghi r`O so nha, clueing pH), to dan pho (lang, x6m, th6n, ban, ap ...), xa (Outing, thi tran), huy'en (quan, thi xa, thanh phi) thuOc tinh, thanh pica thuOc thanh pho true thuOc trung trong), tinh (thanh pho true thuOc trung uang).

(9) So CMND/HO chieu/Can cu.& ding dan: Ghi mot trong cac so gidy chimg minh nhan dan, so h0 chieu hoac so can cu.& cong dan; trung hop la Cong an nhan dan, si quan Quan dOi nhan dan thi ghi so giay chi:mg minh Cong an nhan dan hoac giay chimg minh si quan Quan dOi nhan dan Vist Nam.

(10) Dan tOc: Ghi ten dan tOc gOc dm ban than theo Gidy khai sinh nhu: Kinh, Thai, Tay, Muang, Khmer....

(11) Ton giao: Ghi rO ten ton giao (nhu C6ng giao, Phat giao, Tin Lanh, Cao Dai, Phat giao HOa hao, fled giao...) va chUc sac, chirc vies trong ton giao (neu co) (nhu Giam mpc, Linh nwc, Muc str, Hoa thuang, Dai dirc, Ni six ...). Treeing hop khong theo ton giao nao thi ghi "Khong".

(12) Trinh dO giao dtic 016 thong: Ghi rO lop cao nhat da h9c xong trong h dao too 10 nom hay 12 nom, hoc phO thong hay bo tfic hoac cap hoc da tot nghi0 (Vi cht: da h9c het lap 9 phi') thong he 10 nom thi ghi la "9/10 phi" thong", da hoc xong lop 12 libel thong he 12 nom thi du da tot nghiep hoac chua tot nghiep trung hoc phO thong thi deu ghi la "12/12/phii thong",...).

(13) Trinh c/0 chuyen mon, nghiep Ghi rO dai h9c, cao clang hoac trung cap..., chuyen nganh gi thi viet theo chirng chi, van bang da cltrac cap.

(14) HQC vi: Ghi rO hoc vi (neu co) la Tien si khoa h9c, TiL si, Thac si hoac tuong throng va chuyen nganh dao tao.

(15) HQC ham: Ghi rO danh hieu dugc Nha nuac phong tang nhu: Gido six, Pho gido Vin

, (16) I41 luan chinh tri: Ghi trinh dO cao nhAt theo chirng chi, van bang da dugc cap nhu: so cap, trung cap, cao cap, cir nhan.

, (17) Ngogi ngir: Ghi rO bit tieng nuerc rid() va, kha nang sir dung ngon ngit. Vi neu tot nghiep dai hgc ngoai ngir thi ghi obi hoc tieng Anh, tieng Phap..; neu hoc theo N bed duOng thi viet la: Anh, Phap... trinh dO A, B, C, D theo van bang hoac chirng nhan da dugc cap. Twang hop c6 chirng chi ngoai ngir do cac to chirc quoc to cap con thai han nhu: IELTS; TOEFL... hoac khung Bl, B2 chau Au thi khai theo chimg chi dirge cap. Truang hap da h9c dai hge, thac si, tien si o nuac ngodi hoac hge bang tieng nuac ngodi thi khai theo van bang dugc cap va ngon ngir theo hoc (Vi Thac si luSt — Tieng Anh...). N6i dugc tieng dan tOc thieu so nao thi ghi rO ten dan tOc d6.

(18) Nghe nghiep hien nay: Ghi ro nghe nghiep dang lam.

(19) Chirc Ghi rO chirc vu chinh quyen, ham cap (luc lugng vu trang, ngoai giao...); chirc vu trong Dang, doan the dang dam nhiem.

,(20) Noi cong tac: Ghi 1'6 nai dang cong tac hoac lam viec (neu co). Truang hap CO nhieu nai cong tac hoac noi lam viec thi ghi noi cong tac hoac lam viec thuang xuyen (noi lam viec chinh).

(21) Neu la Dang vien thi ghi ro ngay, thang, nam dugc ket nap vao Dang, ngdy chinh thirc (nhu trong 1)% lich Dang vien). Neu da ra kh6i Dang thi ghi ro thang, nam nao va 1)% do ra kh6i Dang.

(22) Ghi rO la thanh vien cua cac to chirc chinh tri - xa hOi, to chirc xa hOi nao; dang gift chirc vu gi trong to chirc (neu co).

(23) Ghi tinh hinh sire khge ban than hien nay: tot, trung binh, kern.

(24) Chi khai nhcing hinh thirc khen thuang, danh hieu thi dua cao nhAt trong timg loai doi vai ca nhan va viet Id ten, hang, dugc tang nam nao (Vi dugc tang Han chuong lao dOng hang 2, 3 thi chi ghi Huan chuong lao dOng hang 2; dugc tang Huan chuong dloc lap hang 1, 2, 3 thi chi ghi dirge Huan chuong dOc lap hang 1... hoac danh hieu dugc phong tang: Anh hung lao dOng,,Anh hung lire luting trang, Nha gido nhan dan, Nghe,si nhan dan, Nha gido uu Thay thuoc nhan dan, Thay thuoc uuNghe si uu Chien si thi dua toan quoc...).

, (25) Cac hinh thirc luSt, xir vi pham da bi tip dung (Dang, chinh quyen, doan the) gom co:

- KS/ luat ve Dang: khai trir, each chirc, canh cao, khien trach theo quy dinh cua Dang.

- KS/ luat hanh chinh: cac bien phap xir l)% kSTluat theo quy dinh cua Luat Can bO, cong chirc, Lust Vien chirc.

- Xir 17 vi pham hanh chinh: cac bin phap xir ly hanh chinh theo quy dinh cua LuSt Xir 1)% vi pham hanh chinh.

- XS/ 1)% hinh cac hinh phat chinh va hinh phat b6 sung theo quy dinh cua BO luat Hinh str.

Twang hap da bi kST luSt ve Dang, 1()% luSt hanh chinh, xir 1)% hanh chinh trong thai gian 01 nam tinh den ngdy lam ho so' irng cir thi ghi rO ten co quan ra quyet dinh, thai gian ra quyet dinh, 1)% do bi ky luat, xir 1)% va hinh thirc, thai han xir

Tnreng hop bi k'et an ve hinh str ma chua dugc xoa an tich thi ghi ro s6 ban an, quyet dinh dm Tea an da c6 hieu lgc phap lust, thai gian ra ban an, quyet dinh, tai dank, hinh phst bi ap dung.

Neu khong co hoac da bi xir ly nhung khong thu6c cac truang hop ke tren thi ghi "Khong bi ky luOt, kitting co an tich".

(26) Ghi day du thong tin ve nhang ngueri than thich (g6m cha me de, cha me nuoi, vg/chong, con de, con nu8i theo quy dinh cua phap 10'0. Twang hop, nhang nguei than thich da nghi huu hoac khong con cong tac, lam viec thi ghi r8 nghe nghiep, chirc vg, not ding tac, lam viec cued ding truck khi nghi him hoac th6i cong tac, lam viec; truang hop da mat thi ghi r6 mat nam nao, nghe nghiep, chirc vg, not cong tac, lam viec, nai a cu6i ding trtrac khi mat. Truang hop nhang ngueri than thich da tong la dang ,vien nhtmg bi khai trir, b6 sinh host hoac xin ra khOi Dang thi phai ghi r8 trong So. yeu ly lich.

(27) Viec ke khai doi vai Ban ke khai tai san, thu nhap cua ngtrai ung dai bieu H6i clang nhan dan nhiem ky 2021-2026 thirc hien theo Huang dan tai Nghi dinh so 130/2020/ND-CP ngay 30/10/2020 dm Chinh pho ye Kiem soat tai san, thu nhap cua ngueri co chirc vu, quyen hsn trong co. quan, to chdc, don vi. Cu the nhu sau:

(27.2) Ghi ngay hoan thanh viec ke khai. (27.3) Ghi s6 can mac cong dan; truang hop chua dugc cap the can Gude Ong dan

thi ghi so giay chimg minh nhan dan, giay chimg minh Cong ,an nhan dan hoac giay chimg minh sir quan Quan dei nhan dan Viet Nam; ghi r8 ngay cap va co. quan cap.

(27.4) Neu vg hoac ch6ng cua ngueri ke khai lam viec thuang xuyen trong co. quan, to chgc, doanh nghiep thi ghi ro ten ca quan/to chirc/doanh nghiep do; neu lam viec to do, nghi him hoac lam viec not trq thi ghi rO.

(27.5) Tai san phai ke khai la tai san hien co thu6c quyen sa hfru, quyen sir dung cua ngued ke khai, cua vg hoac chong va con de, con nuOi (neu co) chua thanh nien theo quy dinh cua phap lust.

(27.6) Quyen sir dung thirc t6,d6i vai dat la tren thirc to nguai ke khai co quyen sir dun* dOi vai thira dat bao gem dat da dugc cap hoac chua dugc cap giay chimg nhan quyen sir dung dat.

, (27.7) Hat a la dat dugc sir dung vao mgc dich de theo quy dinh phap lust ve dat dai. Truang hqp thira dat dugc sir dung cho nhieu mgc dich khac nhau ma trong do co data thi ke khai vao mgc dat a.

(27.8) Ghi cu the s6 nha (neu co),,ngO, ngach, khu ph& than, x6m, ban; xa, phuang, thi tran; quan, huyen, thi xa, thanh pito thu6c tinh, thanh pito thu6c thanh pito tr%rc thu6c trung trong; tinh, thanh pho trgc thu6c trung uang.

(27.9) Ghi dien tich dat (m2) theo gidy chimg nhan quyen sir dung dat hoac dien tich do thgc to (neu chua c6 giay chirng nhan quyen sir dung dat).

(27.10) Gia tri la gia g6c tinh bang tien Viet Nam, cg the: Truang hop tai san co dugc do mua, chuyen nhugng thi ghi so tien thgc to phai tra khi mua hoac nhan chuyen nhuong cong vai cac khoan thue, phi khac (neu co); truang hop tai san c6 dugc do to xay Ong, che tao, ton tso thi ghi tong chi phi da chi tra de hoan thanh viec xay dkmg, the tao, ton tao cong vai phi, re phi (neu co) tai thai diem hinh thanh tai san; truang hop tai san dugc cho, tang, thira ke thi ghi theo gia thi tai theri diem dugc cho, tang, thira ke cong vat cac khoan thue, phi khac (neu co) va ghi "gia tri trac tinh"; truang hgp khOng the trey tinh gia tri tai san vi cac 15f do nhu tai san sir dung da qua lau hoac khong co giao dich doi vai tai san tuang tU thi ghi "khong xac dinh dugc gia tri" va ghi r8 1T

do. , (27.11) Ndu thira dAt TA dugc cap giAy chung nhan quydn sir dung dAt thi ghi so

giay chimg nhan quyen sir dung dat va ten nguai dugc cap hoac ten nguai dai din (neu la giay chimg nhan quyen sir dung dat ,chung dm nhieu nguai); neu thira dat chua dugc cap giay chung nhan quyen sir dung dat thi ghi "chua dupc cap giay chimg nhan quyen sir dung dat".

(27.12) Ghi cu thd vd tinh trang thuc t6 quan li, sir dung (Vi du nhu ngoai ke khai dimg ten dang lcf quyen sir dung, quyen sa him nhung thuc to la dm nguai khac); tinh tang chuyen nhuomg, sang ten va hidn tang sir dung nhu cho thue, cho mugn,...

(27.13) Ke khai cac loai dat co muc dich sir dung khong phai la dat a theo quy dinh dm Luat Dat dai.

, (27.14) Ghi "can he" neu la can he trong nha tap the, chung Cu; ghi "nha a rieng Id" neu la nha dugc xay dung tren thira dat rieng bidt.

(27.15) Ghi tong din tich (m2) san xay dung dm tat ca cac tang cila nha a rieng le, bit thu bao gem ca cac tang ham, tang tura ham, tang ky- thuat, tang,ap mai va tang mai turn. Neu la can he thi din tich dugc ghi theo giay chimg nhan quyen sa hiru hoac hop &Ong mua, hop dong thue ciia Nha nuac.

(27.16) C6ng trinh xay dung khac la cong trinh xay dung khong phai nha a.

(27.17) Ke khai nhung tai san gan lidn vai dat ma c6 ding gia tri m8i loai trac tinh tir 50 tridu &mg tra len.

(27.18) Cay lau nam la cay trong met lan, sinh twang va cho thu hoach trong nhidu nam gem: cay cong nghidp lau nam, cay an qua lau nam, cay lau nam lay go, cay tao canh, b6ng mat. Cay ma thuc rirng san xuat thi khong ghi vao muc nay.

(27.19) Rimg san xuat la ring trong. (27.20) Ghi cac loai yang, kim cuang, bach kim va cac kim loai quy, cid q4 khac

co tong gia tri tir 50 tridu dong tra len. , (27.21) Tidn (tidn Vidt Nam, ngoai td) Om tien mat, tien cho vay, tien tra tnrac,

tien giri ca nhan, to chirc trong nuac, to chirc nuac ngoai tai Vidt Nam ma tong gia tri quy doi tir 50 tridu (long tra len. Neu ngoai td thi ghi so lugng va so tien quy doi ra tien Vidt Nam.

(27.22) Ghi tirng hinh thfrc g6p von dau to kinh doanh, ca trtrc ti6p va gian tidp. (27.23) Cac loai giay ter co gia khac nhu chimg chi quy, 1(5/ phidu, sec,...

, (27.24) O to, mo to, xe gan may, xe may (may iii, may ?die, cac loai xe may khac), tau thily, tau bay, thuyen va nhilng dong san khac ma theo quy dinh phai dang 14 sir dung va dugc cap giay dang 14 co gia tri m6i loai tir 50 tridu dong tra len.

(27.25) Cac loai tai san khac nhu cay canh, ban ghd, tranh anh va cac loai tai san khac ma gia tri quy doi m6i loai tir 50 tridu dong tra len.

, (27.26) Ke khai tai san a nuac ngoai phai ke khai tat ca loai tai san nam ngoai l'anh tho Vidt Nam, tucmg tir muc 1 den muc 7 cila Phan II va neu ro tai san dang a nuac nao.

(27.27) Ke khai cac tai khoan ma tai ngan hang a nuac ngoai; cac tai khoan khac ma a nude ngoai kh6ng phai la tai khoan ngan hang nhung co the thuc hidn cac giao dich bang tien, tai san (nhu tai khoan ma a cac cong ty chung khoan nuac ngoai, san giao dich yang nuac ngoai, vi din tir a nuac ngoai...).