MU 02

BH Theo TT s 01/2007/TT-BCA(C11)
Ngy 02 thng 01 nm 2007

CNG HA X HI CH NGHA VIT NAM

c lp T do Hnh phc

GIY KHAI SANG TN, DI CHUYN

XE: .............................. BIN S: .................................
1- H tn ch xe: .......................................................................................................................
2- Ni thng tr:.......................................................................................................................

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3- S CMND: ..............................cp ngy ............................ti ..............................................
4- C chic xe vi c im sau:
Nhn hiu:...........................S loi: ......................................Loi xe: .................................
Mu sn:..............................S my:......................................S khung: ..............................
5- Nay sang tn cho ng/ b: ......................................................................................................
6- Ni thng tr: .......................................................................................................................
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7- L do sang tn di chuyn (iu ng hoc cho, tng, tha k, mua li): ................................
.....................................................................................................................................................
DN BN C S MY, S KHUNG

Ni dn bn c s my

Ni dn bn c s khung

8- Km theo giy t ny c: ........................................................................................................

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9- Ti xin hon ton chu trch nhim trc php lut v cc chng t trong h s xe.
10- ngh cng an qun, huyn: ..............................................................................................
xt v lm th tc sang tn, di chuyn chic xe ni trn.
CN B LM TH TC
(K, ghi r h tn)

, ngy . thng nm .
CH XE
(K, ghi r h tn, ng du nu l xe c quan)

TRNG CNG AN QUN, HUYN

(K, ghi r h tn, ng du)