BAa HIEM XA H<)I VII;:T NAM CQNG HOA XA. HQI CHU NGHiA VI$T NAM
BAo HIEM xA HQI TP.HO CHi MINH DQc l~p - Tv do - H~nh phuc
S6:0)Oq /TB-BHXH TP.H6 Chi Minh, ngay Dt thang 12 niim 2013
THONGBAo
V~ vi~c di~u chinh, b6 sung nQi dung Phi~u giao nh~n h8 sO'
Can c(r Quy~t dinh s6 2103 / QD - BHXH ngay 6/6/2012 cua Giam d6c Bao hi~m xa h<)i Thanh ph6 v€ vi~c ban hanh quy dinh ti~p nh?n h6 sa va tra k~t qua theo cO'ch~ m<)tcua t~i Bao hi~m xa h<)iThanh ph6 H6 Chi Minh.
Theo d€ nghi cua Twang phong Thu; Bao hi~m xa h<)i Thanh ph6 H6 Chi Minh di€u chinh, b6 sung Phi~u giao nh?n h6 sa (PGNHS) nhu sau:
1. Phi~u giao nh~n h8 sO':
1.1. DiJu chinh, b6 sung PGNHS 202/ .../THU
2.2. N<5idung aiJu chinh, b6 sung:
Them n<)idung cho nghi~p Vl,lti~p nh?n h6 sa va thanh toan thti lao cho d~i ly thu (Ml;lC III: Thanh toan thit laD cho &;liIf; thu ").
2. Ngay ap d1}ng:
Bao hi~m xa h<)iThanh ph6 H6 Chi Minh th6ng nhftt ap dl,lng PGNHS n6i a
tren, k~ tu ngay 02/01/2014.
3. T6 chfrc th1}'c hi~n:
- Phong Cong ngh~ thong tin chiu trach nhi~m ph6i hQ'Pv6i nha cung cftp phc1nm€m ti~p nh?n h6 sa (Cong ty CP TS24), d~ di€u chinh, b6 sung PGNHS n6i a tren phl,lc Vl,lcho vi~c giao dich ti~p nh?n h6 sa tren toan h~ th6ng.
- Cac Phong nghi~p Vl,l,Bao hi~m xa h<)i qu?n / huy~n , t6 ch(rc, dO'n vi va bao nay./ "f'
ca nhan nguai lao d<)ng t6 ch(rc tri~n khai va thlJc hi~n theo n<)i dung cua thong
No'i nh{in:
- BGB BHXH TP.HCM;
- Tmong phong nghi~p vv;
- Giam d6c BHXH qu~n, huy~n;
- Trang web BHXH TP.HCM;
- LU'u: VT, TCCB(2bht,1
'--
*Cao Van Sang
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I'hiiu giao nh4n h6 sO' nay ap dl.mg ke tit· ngay (}2/(}]/2(}]4
s6 H6 sO': 202/ ./THU CQNG HOA XA HQI cuD NGHiA VI'.E:TNAM
s6 H6 sO': 202/ . / THU - GH DQc l~p - Tl}' do - H~nh phiic
PHIEU GIAO NH~N HO SO
Lo~i ha sO': cAp the BHYT Tv nguy~n
(ThO; h~n giai quy~t lo~i h6 sO' nay: 10 ngay lam vi~c;
rH~ng h6 sO' gia h~n the BHYT: 05 ngay lam vi~c)
1. Ten d011 vi: Mff d011 vi: .
2. Di~n tho?i: Email: .
STT Lo~i gi~y to', bi~u m~u s6
hrQ11g
I. HB so' dang ky IAn dAu hoi,ic dang ky l~i sau th(ri gian diJ'ng dong:
1. TO' khai tham gia BHYT (m:iu A03-TS, 01 ban / bQ)
2. Oanh sach nguO'i tham gia BHYT T\1 nguy~n - d6i tugng tang m6'i (m:iu 003-TS, 03 ban)
3. UNC - n~u cC>(Ban sao, 0 I ban)
Tru'itng h(J'pgidm muc dong BHYT, h6 sO'b6 sung:
I. s6 hQ kh~u ho~c s6 t?m tru (Ban sao, 01 ban / hQ)
2. The BHYT con gia trj SLrdVng cua nhiing nguO'i trong hQ thuQc di~n bat bUQc khac - neu cC>(Ban sao, 01 ban / nguO'i)
II. HB so' gia h~n the BHYT:
1. Oanh sach nguO'i tham gia BHYT T\1 nguy~n - d6i tugng gia h?n (m:iu 003- TS, 03 ban)
2. UNC - n~u cC>(Ban sao, 01 ban)
Tmitng h(J'pgidm muc dong BHYT, h6 sO'b6 sung:
1. s6 hQ kh~u ho~c s6 t?m tru (Ban sao, 01 ban / hQ)
2. The BHYT con gia trj SLrdVng cua nhiing nguO'i trong hQ thuQc di~n bat bUQc khac - neu CC>(Ban sao, 01 ban / nguO'i)
Ill. HB so' d~ nghj thanh toan thiJ lao cho d~i Iy thu:
1. (Ji~y thanh toan thu lao cho t6 chLrc ca nhiin hlm d?i ly thu (m:iu C66-HD).
IV. File dii'li~u: Chuy~n b~ng IMS 0 b~ng USB 0 b~ng email 0
Ngay tra k~t qua: ./. ./ (Qua h<;lntra h6 sO' 30 ngay, cae dun vi ehua d~n nh~n, CO' quan BHXH se ehuy~n h6 So' van kho luu tru) .
............... , ngay thang nam .
Can be}ti~p nh~n h6 sO' NgU'o; ne}p h6 sO'
(Ky. ghi h9 ten) (Ky, ghi h9 ten)
DO'n vi: ..••............•...... Mftu s6: C66-HD
BQ ph~n .•................ (Ban h<'mhtheo Thong tU' s6 178/TT-BTC ngay 23/10/2012 cua B(>Tai chinh)
GIAy THANH ToAN THU LAO
CHO TO CHUC, cA NHAN LAM D~I LY THU
- Can Cll HQ'P d6ng thu BHXH, BHYT tv nguy~n s6 ngay . thang nam gifra 8<io hiem xa h9i va .
- Can Cll Danh sach d6i tm;mg tham gia BHXH, BHYT tv nguy~n I~p ngay '" thang . nam .
- Can Cll Danh sach tre em du6'i 6 tu6i tham gia BHYT I~p ngay thang nam .
- Can Cll s6 ti~n thu BHXH, BHYT tv nguy~n da n9P cho cO' quan BHXH t~i Phi~u thu
, ,
s6 ngay thang nam cua Bao hiem xa h9i .
(Ho~~c G·J.lay b'ao C'0 soJ. ngay......, th'ang na~'m cua .)
D~ nghi cO' quan Bao hi~m xa h9i chi thli lao lam d~i Iy thu
cho Dia chi: .
S6 tai khoan: Ma t~i: .
nhu sau:
+ T;(ong soJ.. tIenj, d-a nQP~ coco'h quan BHXH :. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. dj,ong
+ SoJ. tre, em tham gIa• BHYT duO'!,.;(. 6 tuOl .
+ T;(ong soJ..j,tIen th'u 1ao duQ'c h'uang: .. .. .. .. .. .. . .. di,ong
Vi~t b6ng chfi:: d6ng
Ngay thimg nom .
D~ILYTHU
(Ky, hr ten)
;( J..j, CO QUAN BAo HIEM xA HQI DUY~T i,
T~~g s:otIen:~.. . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .. d~ng
Vzet bang chu dong
Ngay thang nom .
Ngm'ri d~ ngh! thanh toan PhI} trach bQ ph~n K~ toan tnro-ng Thii tnrO'ng dO'n vi
(Ky, hr ten) (Ky, hr ten) (Ky, hr ten) (Ky, hr ten)
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