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sAx cuxc cAP TH6NG TIN
Kinh
gu'i: - Uy ban Chung kho6n Nhd nuivc
- So Giao dich chirng kho6n
3/Ngdy th6ng nrm sinh:.
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s/ s6 CMND (hoac ,6 r,o .r,io,
9/
SO
l1/
),
dien thoai:.
Chrirc vu hi€n nay
121 Cdcchirc
tait6 ch(r'c
l2r
d6itLLorg cong bo thong tin.'......
vg hiQn dang ndm giir tai t6 chirc kh6c:"'
l3l56 Cpnimgiir:
..
......
chiem
....t'u
+ Dai di6n (t6n t6 chfi'c ldNhd nu
+ C6 nhdn so hiru:.
l4l
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4
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15/ Danh s6ch ngudi c6 liOn quan cita ngudi khai-
CVNO'flo clridLrtdoi vOi ca
nh6n) hoac SO CCX d5ng kY
SO
TOn c6 nhAn/t6 chric
doanh nghiQp. Gi6Y PheP ho4t
d6ng hoac gi6y to PhAP 11" tuong
dLtong (doi voi to ch[r'c t. ngAv cAp.
.^
nol cap
56 lu'o-ng CP/CCQ
nim gifr'. tj,' lQ so'
hi'u trdn vdn dieu I0
MOi quan
cira cong t1' d4i
hq
chfrng.
qu!
l
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dai
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t)^/
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nam glu, ty le so
CMNDI{Q chii5u ldOi vOi ca
nh6n) hoic 56 GCN dAng ky
SO
STT
TEn c6 nhdn/t6 chri'c
hiru tr6n v6n di6u
cira c6ng ty d4i
chring, qu! dai
chring (ntlu c6)
doanh nghiQp, GiSy ph6p hoat
dQng hoflc gi0y to p\up tV
tuong duong (d6i v6i tO chric),
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ngay cap, nol cap
lQ
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h0
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l7l
Quy6n loi m6u thuAn v6'i c6ng ty dqi ch0ng,
TOi cam doan nhfl'ng
qu! dqi chfng (ntiu
c6).
loi khai tr6n dAy ld dirng su thdt, n6u sai tdi xin hodn todn chiu tr6ch nhi6m
tru6c ph6p ludt
NGI,fi KHAI
(K!,, ghi rd hp t€n)
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ceNG HoA xA ugl cHU Ncnia vrET NAM
DQc lip - Tg do - Hpnh Phric
L6.i.\;,.. ,sur./.4
tltung
Ll
tiltrt
JC/7
sAx cuxc cAP THONG TIN
gu'i:
Kinh
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3/ Ngdy th6ng
4i Noi sinh:..
- Uy ban Chirng kho6n Nhd nr-L6c
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nrm sinh: ... .
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Chfc vu hiQn nay tai t6 chf'c ld d6i tugng cdng b6 th0ng tin.'....'.
l2l
Cdcchric vp hiQn dang nim gifr tpi t6 chric kh6c:
13/56 Cp nam giir:
..
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chi6m
....% v6n di6u
+ Dai diOn (ten t6 chirc ld Nhd nLLtic/c5 OOng chi6n luo. c/t6 chilc l
+ C6 nhdn so hfr'u.'
l4l
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I
F.
le
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SO
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nh6n) hodc SO GCN dang k!
doanh nghi€p. Gi6y phdP ho4t
dQng ho4c giAy to'Ph6P lY tuo'ng
duong (d6i v6i t6 chirc). ngdy cAp,
nol cap
ei"h
Vd^ Tl^ed,
Sd luo.'ng CP/CCQ
n6m gifi'. t1,
16
so
hii'u tr6n v6n di0u le
MOi qu"n
cua cdng ty dai
he
chLlng.
qu!
dai
ch[rng (n6u c6)
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nh6n) ho4c SO GCN d[ng ki
doanh nghiQp, Gi6y phdp hopt
d6ng hoSc gidy td ph6p lf
tuong cluong 1d6i vOi tO chric),
ngay cap, nu cap
S5 luong CP/CCQ
,nam glu, t) le so
hfr'Lr tren vdn di0u lQ
cira cong ty dai
chring. qu! dAi
ch[rng (n€u co)
:
M6i quan
16l Lqiich li€n quan d6i v6i c6ng ty dai chirng, qlri dai chirng (n5u c6)i.'
l7l
Quyen
loi m6u thuSn vdi c6ng ty dai ch[rng, qu.i dai chirng (n6u coi.
T6i cam doan nhfr'ng lo'i khai tr6n ddy ld dring su thdt. nOu sai t6i xin hoirn toirn chiu tr6ch nhi6m
tru6c ph6p luAt
NGUOI KHAI
(Ky, ghi rd hp ftn)
Di"l^
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* Ngudi c6 li6n quan thqo quy dinh tpi kho6n 34 Di€u 6 Lupt Chirng kho6n ngdy 29 th6ng 6 ndm
2006
he
ceNG HoA xA ugI cHU Ncnia vIEr NAM
DQc lfp - Tq do - H4nh Phric
hF.
sAN
cuxc
NA.t
., n giry,lJ
th
an g
H
cAP TtrONG TIN
Kinh gu'i: - Uy ban Chung kl-ro6n Nha nr-16'c
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r/Hova,ur'
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Mrr,.....
3/ Ngdy th6ng nrm sinh:
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2t G\oitinh:.....
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l2l
Cdc chilc vu hi6n dang n6m
l3l
SO CP
n[rn gi[':
..
tin.'..'...."'.'
giu'tai to chirc kh6c..........
.......
chi6m
...".% v6n
+ Dai {iQn (tQn t6 chirc ldNha nu6'c/c6 d6ng chi6n lu'o-c/t6 chLi'c kh6c) so I.riru:/.
+ C6 nhdn s0 htu:.
fi
di6Lr l0'
n
am
J A?
I
l5/ Danh
s6ch nguoi co li6n cluan
cta
rrgu'cri khai-:
So
CMNu llo
T€n c6 nhAn/t6 chric
roi ea
CCx dang ky
chi6Lr 1.loi
nhAn) hopc S6
^.: phep ho4t
doanlr nghiQp. CidS
d6ng hopc gi6y td'ph6p 11,' tuo'ng
ducrng lOOi vO; t6 chri'c), ngd-v c6p.
nor cap
Sd lr-ro-ng CP/CCQ
j
.nam glu'. t\ lr'so
tr6n v6n di0u l0
cua cdng ty dai
ch[ng, qu! dai
.;
chung (neLl co
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he
)
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T€n c6 nhin/t6 chric
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Ho clrieu tdoi voi ca
nh6n) ho[c 56 GCN clang ky
doanh nghi0p. GiAl,phdP ho4t
d6ng hoic gi6y to ph6P l1f
tuong du'o"ng (ddi vcri td ch0'c),
ngdy c6p. noi cAP
56 luong CP/CCQ
j
.narn glu. t) lr- s()
hi'r-r tr0r, v6n di6u 16
cua cong ty dai
chfng. qu! d4i
ch[rng (n6u c6)
16/Lo.iich lien quan d6i v6i c6ngty d4i chirng,
qu1,
dqi chirng (n6Lr c6)i.'
17l Quyen lo-i mau thuran v6i cdng ty dai chfng,
qu!
dAi chirng (ntiu c6/.
MOi
he
T6i cam doan nhfr'ng loi khai tren dAy ld dring su'thAt. n6u sai t0i xin hoan toan chiLr trdch nhiern
tru6c ph6p lu6t
NGIId KHAI
tKi, ehi
-/ rAho rin)
(l--I
z--.=---
/t1tr"6; rl',.u,\,
qr.ran
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* Nguo'i c6 li6n quan theo quy dinh rai khoirn 34 DiAu 6 LuAt Chirng kho6n ngirl'29 thang 6 ndrr
2006