Mu TP/QT-2010-TKKGQT - T khai ng k quc tch Vit Nam

Mu TP/QT-2010-TKKGQTMu TP/QT-2010-TKKGQT

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc

T KHAI NG K GI QUC TCH VIT NAM

Knh gi: C quan i din Vit Nam ti ..................................................H v tn (1):.................................................................................................................................Gii tnh : Nam: N:

Ngy, thng, nm sinh:...................................................................................................................Ni sinh (2): ...................................................................................................................................Ni ng k khai sinh (3): .............................................................................................................Quc tch hin nay (4):...................................................................................................................H chiu/Giy t hp l thay th (5): .............................................. S:........................................Cp ngy, thng, nm:........................................., C quan cp: ................................................... a ch thng tr: ..........................................................................................................................................................................................................................................................................................................................................................................................................................................Ngh nghip:............................................................................................................................................................................................................................................................................................Ni lm vic : ........................................................ .................................................................................................................................................................................................................................Thi gian xut cnh khi Vit Nam (nu c):.................................................................................a ch c tr Vit Nam trc khi xut cnh (nu c):................ Sau khi tm hiu cc quy nh ca php lut Vit Nam v quc tch, ti nhn thy bn thn ang c quc tch Vit Nam. Vy ti lm T khai ny xin c ng k gi quc tch Vit Nam. Ti cng xin ng k gi quc tch Vit Nam cho con cha thnh nin hin ang sinh sng cng ti c tn sau y (nu c):STTH v tnGii tnhNgy, thng, nm sinhNi sinh

Ni ng k khai sinh Quc tch hin nay

Ti xin cam oan nhng li khai trn y l ng s tht v xin chu trch nhim trc php lut Vit Nam v li khai ca mnh.

............, ngy ...... thng ..... nm .........Giy t km theo chng minh quc tch Vit Nam Ngi khai

-................................................................ (k v ghi r h tn)

-............................................................... -............................................................... - .............................................................

Ch thch:

(1) Vit ch in hoa theo H chiu/giy t hp l thay th;(2) Ghi a danh hnh chnh hoc tn c s y t;(3) Ghi tn c quan ng k khai sinh;(4) Trng hp c t hai quc tch tr ln th ghi r tng quc tch;(5) Ghi r loi giy t g;

nh 4x6

(chp cha

qu 6 thng)

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