TN T CHC/C NHN

CNG HO X HI CH NGHA VIT NAM

.
c lp - T do Hnh phc
S:...
..., ngy ... thng ... nm ...
GIY NGHHON 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 :
n v tin: ng Vit Nam
S
TTKhon thu nghhon trS tin phi np(hoc s tinthu u ra)S tin thu uvo
c khutr (nu c)S tin np
(a)
S tin nghhonThi gian phtsinh khon ngh hon
(b)
L do nghhon tr
(
1
)
(
2
)
(
3
)
(
4
)
(
5
)
(
6
)
(
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 :n v tin: ng Vit Nam
STTKhon phinp NSNNC quanthu
(c)
Quyt nh thu/T khai hi quan

(d)
Thi gian pht sinhkhon phi np
(e)
Np vo ti khon
(g)
StinT h u N S N N T m t h u
(
1
)
(
2
)
(
3
)
(
4
)
(
5
)
(
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:.............................................................................
1
Mu s:
01/NHT
(Ban hnh km theo TT s28/2011/T-BTC ngy28/02/2011 ca B Ti chnh)