Mu 19-KN

NG B TRNG HCT NG Y/CHI Y...................... S: - GT/

NG CNG SN VIT NAMCn Th, ngythng nm 20.

GIY GII THIU(C gi tr n ht ngy thng nm 20)

Knh gi: ng y/Chi y c s .

ng y/Chi y c s: ...................................................................................................................................... Gii thiu ng ch:.......................................................l ................................................................................................ ........................................................................................ ................................................................................................ n ly kin nhn xt ca cc ng ch v l lch ca ngi xin vo ng l: . Ni dung cn c cc ng ch thm nh, nhn xt vo l lch ca ngi xin vo ng nh sau: ...................................................................................................................................... ...................................................................................................................................... ...................................................................................................................................... ...................................................................................................................................... ...................................................................................................................................... ...................................................................................................................................... ...................................................................................................................................... ...................................................................................................................................... Mong cc ng ch quan tm gip .

Ni nhn:- Nh trn, - Lu: ng y/Chi y.

T/M NG Y/CHI Y B TH(K, ng du, ghi r h v tn)