M u s :ẫ ố 04 - 2/TNCN
(Ban hành kèm theo Thông t s 60/2007/TT-BTC ngày 14/06/2007 c a B Tài chínhư ố ủ ộ
C NG HOÀ XÃ H I CH NGHĨA VI T NAMỘ Ộ Ủ Ệ
Đc l p - T do - H nh phúcộ ậ ự ạ
GI Y U QUY N QUY T TOÁNẤ Ỷ Ề Ế
THU THU NH P CÁ NHÂNẾ Ậ
Năm ..........
Tên tôi là: ………………………….. Qu c t chố ị :…………………….
Mã s thu : ……………………………………………………..…….ố ế
Năm ............... tôi ch có thu nh p ch u thu t i m t n i là Công ty/đnỉ ậ ị ế ạ ộ ơ ơ
v ................ Đ ngh Công ty/đn v (mã s thu ) ....................thay m t tôi th cị ề ị ơ ị ố ế ặ ự
hi n quy t toán thu thu nh p cá nhân năm ........... v i c quan thu .ệ ế ế ậ ớ ơ ế
Tr ng h p c quan thu ki m tra phát hi n tôi có thu nh p ch u thu ườ ợ ơ ế ể ệ ậ ị ế ở
n i khác thì tôi hoàn toàn ch u trách nhi m tr c pháp lu t./.ơ ị ệ ướ ậ
.................., ngày ....... tháng ....... năm .......
NG I U QUY N ƯỜ Ỷ Ề
(Ký, ghi rõ h tên)ọ
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