SA I MU S 32 NH SAU:

(ban hnh km theo Quyt nh s 1131/2008/Q-TTCP ngy 18 thng 6 nm 2008 ca Tng thanh tra)
CNG HA X HI CH NGHA VIT NAM
c lp T do Hnh phc
-------------......., ngy . thng . nm .
N KHIU NI
Knh gi: ................................................................................................................................. (1)
H v tn: . (2); M s h s: ............................................... (3)
a ch:
Khiu ni ................................................................................................................................. (4)
Ni dung khiu ni................................................................................................................... (5)
Ni dung 1.
Ni dung 2.
Ni dung n..
(Ti liu, chng t km theo nu c)
NGI KHIU NI
(K v ghi r h tn)
(1) Tn c quan, t chc, c nhn c thm quyn gii quyt khiu ni.
(2) H tn ca ngi khiu ni,
- Nu l i din khiu ni cho c quan, t chc th ghi r chc danh, tn c quan, t chc m mnh i
din.
- Nu l ngi c y quyn khiu ni th ghi r theo y quyn ca c quan, t chc, c nhn no.
(3) Ni dung ny do c quan gii quyt khiu ni ghi.
(4) Khiu ni ln u (hoc ln hai) i vi quyt nh, hnh vi hnh chnh ca ai?
(5) Ni dung khiu ni
- Ghi tm tt s vic dn n khiu ni;
- Yu cu ( ngh) ca ngi khiu ni ;
MU S 46
(ban hnh km theo Quyt nh s 1131/2008/Q-TTCP ngy 18 thng 6 nm 2008 ca Tng thanh tra)
CNG HA X HI CH NGHA VIT NAM
c lp T do Hnh phc
-------------., ngy . thng .nm
N T CO
Knh gi: . (1)
Tn ti l:

a ch:
Ti lm n ny t co hnh vi vi phm php lut ca: ( Ngi b t co) (2)
Nay ti ngh: Ni dung sau (3)
Ni dung 1.
Ni dung 2.
Ni dung n..
Ti xin cam oan nhng ni dung t co trn l ng s tht v chu trch nhim trc php lut nu c tnh
t co sai.
NGI T CO
(K, ghi r h tn)
(1) Tn c quan tip nhn t co.
(2) H tn, chc v v hnh vi vi phm php lut ca ngi b t co.
(3) Ngi, c quan c thm quyn gii quyt t co xc minh, kt lun v x l ngi c hnh vi vi phm
theo quy nh ca php lut.