TN T CHC/C NHN

CNG HO X HI CH NGHA VIT NAM

c lp - T do Hnh phc

S:...

..., ngy ... thng ... nm ...

Mu s: 01/NHT
(Ban hnh km theo TT s
28/2011/T-BTC ngy
28/02/2011 ca B Ti chnh)

GIY NGH
HON TR KHON THU NGN SCH NH NC
[01] Trng hp hon thu trc, kim tra sau:
Trng hp kim tra trc, hon thu sau:
Knh gi: .......(tn c quan thu, c quan c thm quyn hon tr)........
I- Thng tin v t chc, c nhn ngh hon tr:
[02] Tn ngi np thu:................................................................................................................................................
[03] M s thu:
[04] CMND/HC :......................................................................................... Quc tch : ..................................................
[05] a ch :.....................................................................................................................................................................
[06] Qun/huyn: ............................................................... [07] Tnh/thnh ph: ...........................................................
[08] in thoi: ...................................... [09] Fax: ............................................. [10] Email: .......................................
[11] Tn i l thu (nu c):.........................................................................................................................................
[12] M s thu:
[13] a ch :.....................................................................................................................................................................
[14] Qun/huyn: ............................................................... [15] Tnh/thnh ph: ...........................................................
[16] in thoi: ...................................... [17] Fax: ............................................. [18] Email: .......................................
[19] Hp ng i l thu s:...................................................ngy ................................................................................
II- Ni dung ngh hon tr khon thu ngn sch nh nc (NSNN):
1. Thng tin v khon thu ngh hon tr :
S
TT
(1)

Khon thu
ngh
hon tr
(2)

S tin phi np
(hoc s tin
thu u ra)
(3)

S tin thu u
vo c khu
tr (nu c)
(4)

S tin
np
(a)
(5)

S tin
ngh
hon
(6)

n v tin: ng Vit Nam

Thi gian pht L do
sinh khon
ngh
ngh hon (b)
hon tr
(7)
(8)

Tng cng
Gii trnh v vic iu chnh thu GTGT u vo, u ra so vi s thu ti T khai thu np cho c quan thu
(trng hp ngh hon thu GTGT; nu c):.........
2. Hnh thc ngh hon tr:
2.1. B tr cho khon phi np NSNN :
S
TT
(1)

Khon phi
np NSNN
(2)

C quan
thu (c)
(3)

Quyt nh thu/
T khai hi quan (d)
(4)

Thi gian pht sinh

khon phi np (e)
(5)

n v tin: ng Vit Nam

Np vo ti khon (g)
S
Thu NSNN Tm thu tin
(6)
(7)
(8)

Tng cng
Tng s tin np NSNN ghi bng ch:.............................................................................................................................
...........................................................................................................................................................................................
2.2. Hon tr trc tip :
S tin hon tr: Bng s: ................................................. Bng ch:.............................................................................

...........................................................................................................................................................................................
Hon tr bng : Tin mt :

Chuyn khon :

Chuyn tin vo ti khon s : .......................................... Ti Ngn hng (KBNN):......................................................

(hoc) Ngi nhn tin : .................................................... S CMND/HC : ................cp ngy............. ti.................
III- Ti liu gi km: (ghi r tn ti liu, bn chnh, bn sao)
1 ........................................................................................................................................................................................
2 ........................................................................................................................................................................................
Ti cam oan s liu khai trn l ng v chu trch nhim trc php lut v nhng s liu khai./.

NHN VIN I L THU

H v tn:.......................................
Chng ch hnh ngh s:...............................

NGI NP THU hoc

I DIN HP PHP CA NGI NP THU
K, ghi r h tn; chc v v ng du (nu c)

Ghi ch:
- (a) i vi thu GTGT: chi ghi s thu np trong trng hp ngh hon tr do np nhm, np
tha; (b) v (e): K thu, t k n k; (c) C quan qun l thu ni ngi np thu cn n thu; (d) Quyt nh
hnh chnh ca c quan c thm quyn hoc t khai hi quan; (g) i vi khon phi np NSNN theo t khai, quyt
nh ca c quan thu th nh du du V vo ct ti khon Thu NSNN, i vi khon thu xut nhp khu do
c quan hi quan qun l th nh du du V vo ct ti khon Tm thu, ng thi ghi s tin tng ng theo
dng ti ct (8) S tin.
- Trng hp ngh hon thu i thit b, my mc, phng tin vn ti chuyn dng nm trong dy
chuyn cng ngh v vt t xy dng thuc loi trong nc cha sn xut c cn nhp khu to ti sn c
nh ca doanh nghip: Ch tiu S thu u vo c khu tr (nu c) v S thu ngh hon ghi s thu
GTGT pht sinh; Ch tiu S tin phi np (hoc s tin thu u ra) khng ghi v gch cho; Ch tiu S tin
np ghi n chng t np thu GTGT khu nhp khu; Ch tiu L do ngh hon tr ghi r vn bn quy
phm php lut c lin quan n s thu ngh hon./.