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c0xc rY cO PrrAN 6 r0 rMr
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CO DONG TFIU,ONG NIEN NAHa 2016

TMT,I
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uc Dai hQi d6ng co d6ng thuong ni6n nam 2016
ong ty cd ph6n 6 16 TMI'.

TOn c6 d6ng
SO

:

CMND,iFI6 chiCu/DKKD

Ngdy cAp : ...../.. ...1.............

Dia chi
Ei6n thoai

:

Tdi ddng ky tham dU Dai hQi d6ng c6 d6ng thuong ni6n ndm 2016 cira C6ng ty co
phdn 6 tO TMT duoc td chri'c ngay . ......1 ......12016.
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So c6 phAn ddng ky biOu quy6t :

...............

c6 phdn.

(Bing chir ;
Trong d6

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:

htu

phAn sd
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T6ng s6 cd ph6n duo. c uy quyOn :
SO cO

(Cd ...

Tdi cam k6t todn b0

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....."..........................

....co phdn.

...............

....c6 phdn.

Giiiy iry quyin

lcdm theo)

cd ph6n ddng ky bi6u quyOt n6u trOn ld ho-p lQ, phu hop vcii

c5c quy dinh hiqn hdnh cria Phap luat vd Didu l0 Cdng ty.
sO

....., ngdy... ... ...thang ...... niim 2016
Ngu'd'i ding ky
(Ky, ghi rd ho tAn, d6ng ctdLt nAu tir to , hin')