col\rc HoA xA sor

clrt Ncr{a vrEr uau

Tudo - Hanh phfc
----o0o-----

DQc lep -

crAv

uf quviN

THAM DUDAr nor Cd DoNG THUdNG NrEN NAM 2017
Kinh

eiti:

coNc ry cd nuAN v4r rrEu xAy nUNc suu orEN

Hdm nay, ngdy ........thdng ..... ndm2017 tai Hd N6i, ch ng t6i gdnt:
1. Bdn

ui quyin:

Tdn Cd

dong:

Ma Cd dong:



Dia chi thudng trri/Tru s& chinh: ........................
56 diOn

thoai:

......." Fax:

chidu:
56 cd phdn sd htu: .............
Se'

DKKD/CMND/[{6

......."..Nghy ca'p: ..................
Bdng chit:..........

Ngttli dai di6n vdn (d6i v6i c6c td chrlc) : ........................

Chrlc vU:

N@lduue ui,qsyde

I

'

Theo giiy u1i quydn nly, B€n duoc uli quydn c6 toln quydn thay rnar tscn u1| quy€n rham dtr, thio luAn, bidu
qtryet vir thtrc hi€n crio quydn vh nghia ,ru khdc cfra Cd clong ffieo quy ainh crii pidu lo C6ng ty tai dai iroi
Cri d6ng Cong ry Cd phin Var licu Xay Dung tsutr Dien ng51, ..."..."thang ....... ndm 20I7.