ada TaLT8 (anc to 09959500 10C4 . Tes 101 ee DVN) BAO HIEMXA HOI VIETNAM CONG HOA XA HOICHU NGHIA VIET NAM ‘D§e lip - Ty do- Hanh phic TO KHAI ‘THAM GIA, DIRU CHINH THONG TIN BAO HIEM XA HOI, BAO HIEM Y TE inh gii: Bao hiém Huygn Béng Anh Phin ké kai bit buge [01]. Ho va tén (dct nox): NGUYEN VAN DUYEN {02}. Nefy, thing, nim sinh: 08/08/1971 [03]. Gigi tinh: Nam [04]. Qué tich: Vigt Nam [05]. Dan tgc: Kink {06}. Noi dang ky gidy Khai sinh: [06.1]. Xa (phudne, tito): Be Hg [06.2]. Huyén (auén, tia, Tp tude tinny: Dong Anh [06.3]. Tinh (Tpy: HA nGi [07]. Dia chi nhgn ho so: [07.1]. $6 nha, dung phé, thén xém:Thugng Phiie 072}. Xa (phuimg, th win): Bie HOng [07.3] Huyén (quén, th x8, Tp thude tinh): Bong Anh [07.4):Tinh (rp): HA NG [08]. Ho tén cha/ mel ngurdi gi h6 (iw re em di 6 TL. Phan ké Khai chung, [09]. Ma sé BHXH (da fp). [09.1]. $6 dign thogi ign he: [09.2]. $6 CMNDY H6 ehiéw Thé can cude: 012462334 [10}. Ma s6 ho gia dinh (48 ep): . Ctrig hc cb mi ain B88 ng Ph ni [11]. Mate tién déng: .. . [12]. Phuong thite déng: Hang thing céng ty chuyén khoan. [13]. Noi dang ky kh bénh, chia bénh ban déu: Bénh vign Da khoa Déng Anh [14]. Néi dung thay d@i, yéu clu: [15]. H8 so kém theo (réu c6): Mau TKI-TS, XACNHAN CUS BON VI “Toi cam doan nh nd dang ké kai ing vi cia (chip cng dBi vi gue io ng thay i ho, eich nhigen tebe php Tuk v nhOng i dng 6k Khai ten dtm: md, thing, nd sin) Ding Anh nga 15 théng 11 nde 2017 [Nguoi ké Khai (8, ghir ho ten) Ghi cha: Phin Ma sé BHXH, Mite tién dong, Ma s6 hé gia dinh dé P. TCHC dién.(1004 04 18 69) re 24 NBN 102 mp 11 Bupyn st 8a uy Buog so 24 wp Samp Gu Bun 9 ny dy ognn dogs gop niga es Bunya eH Bump 1a Fuge wep wD 03 (us808 yoyoscwaqyoog/-day :340 Pip 1s yup P18 oy BA B& HXHE 98 BAC Nato bas 24a 90 DHE 2Y LON 249 HD) paw [mv sme =aopoe| wv | soon may quy windy |” nwo | muy sup@'= apn Sea | wn | oo0etOMt een ups | © 036269210 an |aoy sma—eorn| oN | — wov90e ssyertun ou. | © ee ee Oe ; a 1 —r veo] ona em | ewpunée| wusren psd in | Hm | gtmemms || HE | quo |g SNL /GNWO 9s_| weed 9h “ON uy, - ey Bugg (oun 9p dx wD) "pings - Bugey 9¢q (pa Ho Foanas) ex anya BuAMNL (ged UEP or-HP) Bla - 6R6r9L (oa wr gs afew) nyU OY 9S OS es “(gongs womp UBIp 9S ~ 9nd WEA UAKMBN :04 NUP UN WA OH ow ei Oy uate yuegy 98 A