0330-136735 - thông Tư 08 Bộ Tttt Về Vtci

B THNG TIN V
TRUYN THNG
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CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc
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S: 08/2016/TT-BTTTT
H Ni, ngy 30 thng 3 nm 2016
THNG T
HNG DN THC HIN CHNG TRNH CUNG CP DCH V VIN THNG
CNG CH N NM 2020
Cn c Lut Vin thng ngy 23/11/2009;
Cn c Ngh nh s 25/2011/N-CP ngy 06/4/2011 ca Chnh ph quy nh chi tit v
hng dn thi hnh mt s iu ca Lut Vin thng;
Cn c Ngh nh s 132/2013/N-CP ngy 16/10/2013 ca Chnh ph quy nh chc
nng, nhim v, quyn hn v c cu t chc ca B Thng tin v Truyn thng;
Cn c Quyt nh s 11/2014/Q-TTg ngy 27/01/2014 ca Th tng Chnh ph v t
chc v hot ng ca Qu Dch v vin thng cng ch Vit Nam;
Cn c Quyt nh s 1168/Q-TTg ngy 24/7/2015 ca Th tng Chnh ph ph duyt
Chng trnh cung cp dch v vin thng cng ch n nm 2020;
Theo ngh ca V trng V Qun l doanh nghip,
B trng B Thng tin v Truyn thng ban hnh Thng t Hng dn thc hin
Chng trnh cung cp dch v vin thng cng ch n nm 2020.
MC LC
Chng I. QUY NH CHUNG........................................................................................ 2
iu 1. Phm vi iu chnh...........................................................................................2
iu 2. i tng p dng............................................................................................2
Chng II. QUY NH C TH...................................................................................... 2
iu 3. Cc nhim v v ni dung h tr thit lp h tng vin thng.........................2
iu 4. Lp Danh mc d n u t thit lp h tng vin thng................................ 3
iu 5. Lp k hoch u t......................................................................................... 3
iu 6. La chn Ch u t........................................................................................ 4
iu 7. T chc thc hin, qun l d n..................................................................... 4
iu 8. Dch v vin thng cng ch............................................................................ 5
iu 9. i tng th hng........................................................................................ 6
iu 10. Nguyn tc h tr........................................................................................... 7
iu 11. Lp v xc nhn danh sch i tng th hng...........................................7
iu 12. Lp K hoch v D ton kinh ph hng nm................................................9
iu 13. Hp ng t hng......................................................................................... 9
iu 14. Nghim thu, quyt ton v thanh l hp ng t hng.................................9
iu 15. i tng, iu kin, phng thc, ni dung, vng v thi gian thc hin
h tr........................................................................................................................... 10
iu 16. Lp k hoch v d ton kinh ph h tr......................................................11
iu 17. T chc thc hin d n mua sm, lp t u thu truyn hnh s.............. 11
iu 18. Cc nhim v khc....................................................................................... 12
iu 19.Trnh t thc hin..........................................................................................12
Chng III. KIM TRA, GIM ST, BO CO V T CHC THC HIN......... 12
iu 20. Kim tra, gim st v bo co...................................................................... 12
iu 21. T chc thc hin.........................................................................................13
Chng I
QUY NH CHUNG
iu 1. Phm vi iu chnh
Thng t ny hng dn t chc thc hin Chng trnh cung cp dch v vin thng
cng ch n nm 2020 c ph duyt ti Quyt nh s 1168/Q-TTg ngy 24/7/2015
ca Th tng Chnh ph (sau y gi tt l Chng trnh).
iu 2. i tng p dng
1. C quan, t chc, doanh nghip vin thng tham gia thc hin Chng trnh;
2. i tng c th hng ca Chng trnh.
Chng II
QUY NH C TH
Mc 1. H TR THIT LP H TNG VIN THNG
iu 3. Cc nhim v v ni dung h tr thit lp h tng vin thng
Cc nhim v v ni dung h tr thit lp h tng vin thng bao gm:
1. H tr u t xy dng mng cp quang ti a 24 si thit lp h thng truyn dn
bng rng n cc x cha c kt ni truyn dn bng rng;
2. H tr u t xy dng mng cp quang ti a 64 si, ti a 5 tuyn cp thit lp
mng truy nhp bng rng c nh ti mi x cha c mng truy nhp bng rng c nh;
3. H tr u t xy dng ti mi x min ni, hi o ti a 03 trm v mi x ng
bng ti a 02 trm thu pht sng thng tin di ng 3G thit lp mng truy nhp bng
rng di ng ti cc x cha c mng truy nhp bng rng di ng;
4. H tr u t 03 my tnh, 03 b lu in, 01 my in hoc my scan, 01 b chuyn
mch LAN, bn gh v cc lp t ban u ti mi im thit lp 500 im cung cp
dch v truy nhp Internet cng cng ti cc x c t l h gia nh l thu bao s dng
dch v truy nhp Internet bng rng c nh thp v cha c im truy nhp Internet
cng cng.
iu 4. Lp Danh mc d n u t thit lp h tng vin thng
1. Cn c hng dn ca B Thng tin v Truyn thng v Mu 01/HT Ph lc ban hnh
theo Thng t ny:
a) y ban nhn dn cp tnh ch tr, phi hp vi doanh nghip vin thng lp Danh mc,
s b Tng mc u t v thuyt minh cc d n ti a phng thc hin cc nhim v
ti cc Khon 1, 2, 3 iu 3 Thng t ny;
b) Doanh nghip vin thng lp Danh mc, s b Tng mc u t v thuyt minh cc
d n thc hin nhim v ti Khon 4 iu 3 Thng t ny.
2. Trn c s Danh mc, s b Tng mc u t v thuyt minh cc d n ca y ban
nhn dn cp tnh v doanh nghip xut, Ban Qun l Chng trnh cung cp dch v
vin thng cng ch (sau y gi tt l Ban Qun l Chng trnh) tng hp v xc nh
cc d n theo cc tiu ch ch yu sau y:
a) Ph hp vi cc quy hoch, k hoch pht trin ca ngnh, a phng, doanh nghip
vin thng;
b) Quy m d n ph hp vi tin trin khai v kinh ph Chng trnh;
c) c im v iu kin a phng;
d) V tr a l ca cc a im cn trin khai nhim v;
) Thc trng h tng mng vin thng;
e) c lp trong t chc thc hin d n v qun l, vn hnh, khai thc sau u t.
3. Ban Qun l Chng trnh trnh B Thng tin v Truyn thng ph duyt Danh mc
v s b Tng mc u t cc d n cho ton b Chng trnh.
iu 5. Lp k hoch u t
Cn c Danh mc v s b Tng mc u t cc d n c ph duyt, kinh ph thc
hin Chng trnh, Ban Qun l Chng trnh trnh B Thng tin v Truyn thng ph
duyt K hoch u t cc d n v mc vn cc d n nh sau:
1. Nm 2016, ph duyt K hoch u t cc d n khi cng trong giai on t nm
2016 n nm 2018.
2. Nm 2018 ph duyt K hoch u t cc d n khi cng trong nm 2019 v nm
2020.
iu 6. La chn Ch u t
1. Tiu ch v iu kin la chn Ch u t:
a) Kinh ph xut h tr v Tng mc u t ca d n;
b) D kin thi gian thc hin d n;
c) Yu cu v cng ngh, k thut, tiu chun, cht lng cng trnh d n;
d) T trng h tng mng vin thng ti a phng;
) Kinh ph h tr mt doanh nghip thit lp h tng vin thng trong ton b
Chng trnh khng vt qu 70% tng kinh ph dnh cho u t thit lp h tng vin
thng ca Chng trnh.
2. Cn c K hoch u t c ph duyt, Ban Qun l Chng trnh lp v gi H
s mi ng k tham gia n doanh nghip theo Mu 02/HT Ph lc ban hnh km theo
Thng t ny.
3. Doanh nghip gi Ban Qun l Chng trnh H s ng k tham gia theo Mu 03/HT
Ph lc ban hnh km theo Thng t ny.
4. Cn c cc tiu ch la chn Ch u t v H s ng k tham gia, Ban Qun l

Chng trnh trnh B Thng tin v Truyn thng ph duyt Ch u t i vi tng d
n.
5. Trng hp ch c duy nht mt doanh nghip tham gia v p ng yu cu ca H s
ng k tham gia, B Thng tin v Truyn thng ch nh doanh nghip lm Ch u
t thc hin d n.
6. Trong trng hp khng la chn c doanh nghip theo Khon 4, 5 iu ny, B
Thng tin v Truyn thng giao mt doanh nghip lm Ch u t da trn mt s tiu
ch ch yu: Nng lc mng li v ti chnh ca doanh nghip, thc trng h tng vin
thng ti a phng.
iu 7. T chc thc hin, qun l d n
1. Ch u t lp d n v trnh B Thng tin v Truyn thng ph duyt.
2. Ch u t thc hin v qun l d n u t theo quy nh ca php lut v u t,
u thu, xy dng v cc quy nh khc ca php lut c lin quan.
3. Tm ng, thanh ton, quyt ton
a) Vic tm ng, thanh ton, quyt ton theo cc quy nh ca php lut;
b) Qu dch v vin thng cng ch Vit Nam hoc n v c y thc vic cp pht
kinh ph ca Chng trnh thc hin tm ng v thanh ton kinh ph h tr theo quy nh
ca php lut v quy nh v qun l ti chnh ca Qu.
4. Ch u t thc hin tip nhn ti sn, qun l ti sn theo cc quy nh ca php lut.
5. Hng nm, doanh nghip (Ch u t) xy dng k hoch sa cha ln/nng cp ti
sn nu ti Khon 4 iu ny gi B Thng tin v Truyn thng xem xt, b tr kinh
ph t Chng trnh thc hin theo quy nh.
Mc 2. H TR CUNG CP DCH V VIN THNG CNG CH
iu 8. Dch v vin thng cng ch
1. Dch v vin thng cng ch bt buc bao gm:
a) Dch v vin thng cng ch khn cp (dch v gi n cc s dch v khn cp, bao
gm s dch v gi Cng an 113, s dch v gi Cu ha 114, s dch v gi Cp cu y
t 115);
b) Dch v vin thng cng ch di ng hng hi phc v hot ng tm kim, cu nn
trn bin qua h thng i thng tin duyn hi;
c) Dch v vin thng cng ch v tinh phc v hot ng ch o, iu hnh phng,

chng thin tai.
2. Dch v vin thng cng ch ph cp bao gm:
a) Dch v vin thng cng ch tr gip tra cu s thu bao in thoi c nh (dch v
gi n s tr gip tra cu s thu bao in thoi mng vin thng c nh mt t 116);
b) Dch v vin thng cng ch in thoi c nh mt t tr sau;
c) Dch v vin thng cng ch thng tin di ng mt t tr sau;
d) Dch v vin thng cng ch di ng hng hi cho tu, thuyn nh bt hi sn trn
bin qua h thng i thng tin duyn hi;
) Dch v vin thng cng ch truy nhp Internet bng rng c nh tr sau;
e) Dch v vin thng cng ch knh thu ring c nh mt t;
g) Dch v vin thng cng ch truyn dn tn hiu truyn hnh s qua v tinh VINASAT;
h) Dch v vin thng cng ch thu knh truyn dn cp quang trn c s h tng cp
quang ca Tp on in lc Vit Nam.
iu 9. i tng th hng
1. i tng c hng gi cc dch v vin thng cng ch:
a) Ngi s dng dch v in thoi c nh mt t ni ht gi n cc s dch v khn
cp trong phm vi ni ht;
b) Ng dn Vit Nam trn tu, thuyn nh bt hi sn trn bin s dng dch v vin
thng cng ch di ng hng hi qua h thng i thng tin duyn hi phc v hot ng
trong cc s kin tm kim, cu nn trn bin;
c) Thnh vin thuc Ban Ch o Trung ng v phng chng thin tai s dng dch v
vin thng cng ch v tinh phc v hot ng ch o, iu hnh, phng, chng thin tai;
d) Ngi s dng dch v vin thng cng ch in thoi c nh mt t ni ht gi
n s dch v tr gip tra cu s thu bao in thoi c nh mt t;
) H ngho hoc h cn ngho theo quy nh chun ngho quc gia, chun cn ngho
quc gia s dng dch v vin thng cng ch in thoi c nh mt t tr sau hoc dch
v thng tin di ng mt t tr sau;
e) Ng dn Vit Nam trn tu, thuyn nh bt hi sn trn bin s dng dch v vin
thng cng ch di ng hng hi qua h thng i thng tin duyn hi;
g) Trng hc, bnh vin, y ban nhn dn cp x theo quy nh s dng dch v vin
thng cng ch truy nhp Internet bng rng c nh mt t tr sau;
h) Bnh vin v tinh, bnh vin ht nhn trong n bnh vin v tinh giai on 20132020 theo Quyt nh s 774/Q-BYT ngy 11/3/2013 ca B trng B Y t s dng
dch v vin thng cng ch knh thu ring c nh mt t tc 2Mbps c d phng
kt ni bnh vin v tinh vi bnh vin ht nhn ca nhm;
i) i pht thanh, truyn hnh cp tnh cha t ch v ti chnh s dng dch v vin
thng cng ch truyn dn qung b cho mt knh chng trnh truyn hnh a phng
s dng bng tn Ku ca v tinh VINASAT pht chng trnh truyn hnh phc v
nhim v chnh tr, thng tin tuyn truyn thit yu ca a phng cho cc khu vc min
ni, bin gii, hi o, cc vng lm kh thu c tn hiu truyn hnh s mt t.
2. i tng c hng mc h tr cung cp dch v vin thng cng ch:
a) Doanh nghip vin thng cung cp dch v cho cc i tng th hng nu ti Khon
1 iu ny;
b) Doanh nghip vin thng cung cp dch v truy nhp Internet cng cng thuc phm
vi Chng trnh cung cp dch v vin thng cng ch n nm 2020 theo Quyt nh s
1168/Q-TTg ngy 24/7/2015 ca Th tng Chnh ph;
c) Doanh nghip vin thng thu si cp quang ca n v thuc Tp on in lc Vit
Nam kt ni t t lin ti trung tm hnh chnh ca cc huyn o Ct Hi, C T,
L Sn, Ph Quc, Vn n.
iu 10. Nguyn tc h tr
1. Danh mc, i tng th hng, phm vi, gi cc s dng, mc v thi im h tr
thc hin theo quy nh ca B Thng tin v Truyn thng v danh mc, i tng th
hng, phm vi, cht lng, gi cc, khung gi cc s dng v mc h tr cung cp
dch v vin thng cng ch n nm 2020.
2. i tng th hng quy nh ti cc im a, b, c, d Khon 1 iu 9 Thng t ny
khng phi lp danh sch i tng th hng.
3. i tng th hng quy nh ti cc im , e, g, h, i Khon 1 iu 9 v cc im
truy nhp Internet cng cng nu ti im b Khon 2 iu 9 Thng t ny c lp
thnh danh sch i tng th hng v danh sch ny c S Thng tin v Truyn
thng xc nhn.
a) i tng pht sinh trong qu ngoi danh sch i tng th hng c xc nhn,
doanh nghip tng hp, bo co S Thng tin v Truyn thng xc nhn h tr i
tng t qu tip theo;
b) i tng th hng trong danh sch i tng th hng ng k ngng h tr,
doanh nghip tng hp, bo co S Thng tin v Truyn thng v ngng h tr cho i
tng.
c) Kinh ph h tr cho S Thng tin v Truyn thng thc hin vic xc nhn i tng
th hng thc hin theo quy nh ca B Ti chnh.
4. Cc i tng th hng c h tr kinh ph trn thc t, khng ph thuc k hoch
cung cp v d ton kinh ph h tr dch v vin thng cng ch hng nm (sau y gi
tt l K hoch v D ton kinh ph).
iu 11. Lp v xc nhn danh sch i tng th hng
1. ng k h tr
a) i tng th hng quy nh ti cc im , g, h, i Khon 1 iu 9 Thng t ny
thc hin ng k h tr vi doanh nghip vin thng hoc n v thnh vin, n v trc
thuc ca doanh nghip vin thng theo cc Ph biu ti Mu 01/DV Ph lc ban hnh
km theo Thng t ny;
b) i tng th hng quy nh ti im e Khon 1, im b Khon 2 iu 9 Thng t
ny khng phi ng k h tr, doanh nghip lp v gi S Thng tin v Truyn thng
danh sch i tng th hng theo cc Ph biu ti Mu 02/DV Ph lc ban hnh km
theo Thng t ny.
2. Lp danh sch i tng th hng ng k h tr
a) Doanh nghip vin thng lp v gi v S Thng tin v Truyn thng danh sch i
tng th hng ng k h tr theo cc Ph biu ti Mu 02/DV Ph lc ban hnh km
theo Thng t ny;
b) Doanh nghip vin thng la chn ch mt thu bao hoc mt gi cc hoc mt knh
thu ring hoc mt knh chng trnh c ng k sau cng cho mt i tng th
hng khi i tng th hng ng k h tr nhiu hn mt thu bao hoc mt gi
cc hoc mt knh thu ring hoc mt knh chng trnh truyn hnh.
3. Xc nhn danh sch i tng th hng
a) S Thng tin v Truyn thng kim tra v xc nhn cc danh sch i tng th hng,
m bo ng i tng h tr theo quy nh ca B Thng tin v Truyn thng v danh
mc, i tng th hng, phm vi, gi cc s dng v mc h tr cung cp dch v

vin thng cng ch n nm 2020;
b) Trng hp i tng th hng ng k h tr vi nhiu doanh nghip, S Thng tin
v Truyn thng xc nh doanh nghip c ng k sau cng l doanh nghip h tr
cho i tng ;
c) S Thng tin v Truyn thng gi doanh nghip v Ban Qun l Chng trnh danh
sch i tng th hng c xc nhn theo cc Ph biu ti Mu 02/DV Ph lc
ban hnh km theo Thng t ny.
4. Cp nht i tng pht sinh
a) Hng qu, doanh nghip lp danh sch i tng th hng pht sinh trong qu v gi
S Thng tin v Truyn thng trc ngy th 15 ca qu tip theo;
b) Trong thi hn 10 ngy k t ngy nhn c danh sch i tng pht sinh, S
Thng tin v Truyn thng xc nhn, gi doanh nghip v Ban Qun l Chng trnh
danh sch ny.
iu 12. Lp K hoch v D ton kinh ph hng nm
1. Trc ngy 30 thng 9 hng nm, cn c hng dn ca B Thng tin v Truyn
thng, danh sch i tng th hng c xc nhn v tnh hnh cung cp dch v
vin thng cng ch nm thc hin, doanh nghip lp K hoch v D ton kinh ph gi
Ban Qun l Chng trnh theo cc Ph biu ti Mu 03/DV Ph lc ban hnh km theo
Thng t ny.
2. Trc ngy 31 thng 10 hng nm, Ban Qun l Chng trnh trnh B Thng tin v
Truyn thng ph duyt K hoch v D ton kinh ph ca cc doanh nghip.
3. i vi nm 2016, doanh nghip lp K hoch v D ton kinh ph sau thi im
Thng t ny c ban hnh.
iu 13. Hp ng t hng
1. Trc ngy 01 thng 01 hng nm, cn c K hoch v D ton kinh ph c ph
duyt, Ban Qun l Chng trnh v doanh nghip thng tho, k kt hp ng t hng
cung cp dch v vin thng cng ch (sau y gi tt l Hp ng) theo Mu 04/DV Ph
lc ban hnh km theo Thng t ny.
2. Doanh nghip thc hin cung cp dch v vin thng cng ch theo ni dung Hp ng
k kt.
iu 14. Nghim thu, quyt ton v thanh l hp ng t hng
1. Trong thi gian 20 ngy u mi qu, doanh nghip lp Bo co thc hin cung cp
dch v vin thng cng ch qu trc theo cc Ph biu ti Mu 05/DV Ph lc ban
hnh km theo Thng t ny v gi Ban Qun l Chng trnh.
2. Trong thi gian 30 ngy k t khi nhn c Bo co thc hin cung cp dch v vin
thng cng ch qu trc, Ban Qun l Chng trnh t chc lp bin bn xc nh sn
lng v kinh ph h tr theo cc Ph biu ti Mu 06/DV Ph lc ban hnh km theo
Thng t ny v gi Qu Dch v vin thng cng ch Vit Nam hoc n v c y
thc vic cp pht kinh ph ca Chng trnh thc hin tm ng, thanh ton kinh ph
h tr.
3. Trc ngy 31 thng 3 hng nm, Ban Qun l Chng trnh v doanh nghip t chc
v lp bin bn nghim thu v bin bn thanh l Hp ng nm trc theo cc Ph biu
ti Mu 07/DV Ph lc ban hnh km theo Thng t ny.
4. Vic quyt ton kinh ph h tr theo cc quy nh ca php lut.
Mc 3. THC HIN H TR U THU TRUYN HNH S
iu 15. i tng, iu kin, phng thc, ni dung, vng v thi gian thc hin
h tr
1. i tng h tr: Cc h ngho v h cn ngho theo tiu chun ngho, cn ngho
quc gia c cp c thm quyn ph duyt ti thi im thc hin h tr u thu truyn
hnh s v thuc vng h tr.
2. iu kin nhn h tr
a) H ngho, h cn ngho ang s dng my thu hnh cng ngh tng t cha tch hp
tnh nng thu truyn hnh s theo chun DVB-T2, cha c u thu truyn hnh s DVBT2, cha s dng bt k mt trong cc phng thc truyn hnh tr tin nh truyn hnh
cp, truyn hnh v tinh, truyn hnh Internet (IPTV) trong thi gian trin khai h tr ti
a phng;
b) n ngh nhn h tr u thu truyn hnh s c xc nhn l h ngho, h cn ngho
ca x, phng, th trn theo Mu 01/THS Ph lc ban hnh km theo Thng t ny.
3. Phng thc v ni dung h tr
Mi h ngho, h cn ngho c nhn mt ln gm 01 u thu truyn hnh s mt t
hoc v tinh km theo ng-ten thu ph hp cng vi dy cp ni c di ti a 15 mt
(i vi ch thu ngoi tri), c lp t hon chnh v bo hnh t nht 12 thng tnh
t ngy h gia nh nhn bn giao u thu truyn hnh s.
4. Vng h tr
Vng h tr l vng m cc h dn thu tn hiu truyn hnh b nh hng khi cc
i truyn hnh ngng pht sng truyn hnh tng t mt t chuyn sang pht sng
truyn hnh s mt t hoc v tinh theo tng giai on do B Thng tin v Truyn thng
cng b.
5. Thi gian thc hin h tr
Thi gian thc hin h tr theo l trnh ca n s ha truyn dn, pht sng truyn
hnh mt t n nm 2020 c quy nh ti Quyt nh s 2451/Q-TTg ngy
27/12/2011 ca Th tng Chnh ph v k hoch thc hin ca Ban Ch o n s
ha truyn hnh Vit Nam theo tng giai on.
iu 16. Lp k hoch v d ton kinh ph h tr
1. Trc ngy 30 thng 9 hng nm, cn c Hng dn ca B Thng tin v Truyn
thng, y ban nhn dn cp tnh lp v gi v B Thng tin v Truyn thng K hoch
v d ton kinh ph h tr u thu truyn hnh s theo Mu 02/THS, 03/THS, 04/THS,
05/THS Ph lc ban hnh km theo Thng t ny.
2. Trc ngy 31 thng 10 hng nm, Ban Qun l Chng trnh tng hp, trnh B
Thng tin v Truyn thng ph duyt K hoch v d ton kinh ph h tr u thu truyn
hnh s.
iu 17. T chc thc hin d n mua sm, lp t u thu truyn hnh s
1. Trn c s K hoch v d ton kinh ph h tr u thu truyn hnh s c ph
duyt, B Thng tin v Truyn thng la chn n v trc thuc B lm ch u t
thc hin v qun l d n mua sm u thu truyn hnh s.
2. n v c chn lm ch u t xy dng, trnh B Thng tin v Truyn thng ph
duyt d n, t chc u thu mua sm u thu truyn hnh s theo quy nh ca php
lut v u t, u thu sau khi d n c ph duyt v quyt ton d n u t theo
quy nh.
3. y ban nhn dn cp tnh ch o, t chc v phi hp vi ch u t, nh thu phn
phi u thu truyn hnh s ng, kp thi v trc tip cho cc i tng c th hng
theo quy nh.
4. y ban nhn dn cp tnh t chc thc hin xc nhn danh sch i tng nhn u
thu truyn hnh s ti a phng theo Mu 06/THS, 07/THS Ph lc ban hnh km theo
Thng t ny.
5. Qu dch v vin thng cng ch Vit Nam hoc n v c y thc vic cp pht
kinh ph ca Chng trnh thc hin tm ng, thanh ton y , kp thi kinh ph h tr
u thu truyn hnh s theo cc quy nh ca php lut v quy nh v qun l ti chnh
ca Qu.
6. Kinh ph t chc, trin khai, kim tra, gim st v xc nhn h tr u thu truyn hnh
s thuc nhim v ca a phng c trch t ngun ngn sch a phng v cc
ngun hp php khc.
7. Cn c kh nng ngn sch a phng v cc ngun hp php khc, y ban nhn dn
cp tnh quyt nh h tr u thu truyn hnh s mt t i vi h ngho, h cn ngho
theo tiu chun h ngho, cn ngho ca a phng v cc i tng chnh sch x hi.
Mc 4. THC HIN CC NHIM V KHC
iu 18. Cc nhim v khc
1. H tr trin khai cc gii php tng cng bo m lin lc an ton, tin cy trong vic
thit lp mng v cung cp dch v vin thng cho cng ng v cho ch o iu hnh
ca chnh quyn cc cp.
2. H tr thit lp cng thng tin in t ca y ban nhn dn cc cp v dch v cng
trc tuyn trn cng phc v ngi dn, tp trung cho vng su, vng xa, vng kh khn,
vng bin gii, hi o.
3. H tr u t trang b my pht truyn hnh s mt t pht cc knh chng trnh
phc v nhim v chnh tr, thng tin tuyn truyn thit yu ti vng su, vng xa, vng
kh khn, vng bin gii, hi o.
4. H tr thit lp cng thng tin in t v tng i h tr, t vn gii p thng tin v
s ha truyn hnh.
5. H tr kinh ph thc hin iu tra phng thc thu xem v tuyn truyn v s ha
truyn dn, pht sng truyn hnh mt t n nm 2020.
iu 19.Trnh t thc hin
1. B Thng tin v Truyn thng hng dn lp, ph duyt K hoch v d ton kinh ph
h tr thc hin cc nhim v.
2. n v c la chn, giao thc hin nhim v thc hin theo quy nh ca php lut.
Chng III
KIM TRA, GIM ST, BO CO V T CHC THC HIN
iu 20. Kim tra, gim st v bo co

1. Kim tra, gim st
a) Hng nm, Ban Qun l Chng trnh lp k hoch, ni dung kim tra nh k, t
xut, trnh B Thng tin v Truyn thng ph duyt; phi hp vi cc B, y ban nhn
dn cp tnh, doanh nghip v cc n v lin quan ca B Thng tin v Truyn thng t
chc vic kim tra thc hin cc d n, hp ng.
b) Hng nm, y ban nhn dn cc tnh, thnh ph trc thuc Trung ng ch o t
chc, phi hp kim tra nh k, t xut theo k hoch kim tra ca B Thng tin v
Truyn thng hoc theo yu cu qun l ca a phng.
c) S Thng tin v Truyn thng ch tr xut k hoch, ni dung kim tra, gip y ban
nhn dn tnh ch o cc S, ban, ngnh, n v lin quan t chc hoc phi hp kim
tra nh k, t xut cc d n, hp ng.
d) Cc t chc, doanh nghip tham gia Chng trnh t chc v phi hp kim tra nh
k, t xut v gim st thng xuyn cc ni dung trin khai ca Chng trnh theo quy
nh hin hnh.
2. Bo co
a) y ban nhn dn cp tnh, thnh ph trc thuc Trung ng quy nh ch bo co
thc hin Chng trnh trn a bn.
b) S Thng tin v Truyn thng, Qu Dch v vin thng cng ch Vit Nam, Ban qun
l Chng trnh, cc t chc, doanh nghip tham gia Chng trnh thc hin bo co
nh k v t xut theo quy nh.
c) Cc biu mu bo co nh k c quy nh ti Mu 01/BC, 02/BC, 03/BC Ph lc
ban hnh km theo Thng t ny. Cc bo co t xut c B Thng tin v Truyn
thng hng dn trong qu trnh thc hin trin khai Chng trnh.
d) Cc t chc, doanh nghip tham gia Chng trnh thc hin bo co nh k theo cc
mu biu quy nh ti im c Khon 2 iu 20 Thng t ny v cc bo co t xut do
B Thng tin v Truyn thng hng dn trong qu trnh thc hin.
3. B Thng tin v Truyn thng thc hin s kt, tng kt Chng trnh, bo co Th
tng Chnh ph v cc B, Ngnh lin quan.
iu 21. T chc thc hin
1. Thng t ny c hiu lc thi hnh k t ngy 15 thng 5 nm 2016.
2. Ch tch U ban nhn dn cc tnh, thnh ph trc thuc Trung ng, Chnh Vn
phng B, Th trng cc c quan c lin quan thuc B, cc c quan, t chc, doanh
nghip c lin quan chu trch nhim thi hnh Thng t ny.
3. Trong qu trnh thc hin, nu c vng mc, ngh phn nh kp thi v B Thng
tin v Truyn thng nghin cu, gii quyt./.
B TRNG
Ni nhn:
- Th tng,cc Ph Th tng Chnh ph;
- Vn phng Trung ng v cc Ban ca ng;
- Vn phng Quc hi;
- Vn phng Chnh ph;
- Vn phng Ch tch nc;
- Vn phng Tng B th;
- Vin Kim st nhn dn ti cao;
- Ta n nhn dn ti cao;
- Kim ton nh nc;
- Cc B, c quan ngang B, c quan thuc
Chnh ph;
- UBND cc tnh, thnh ph trc thuc TW;
- S TT&TT cc tnh, TP trc thuc TW;
- Cc Kim tra vn bn - B T php;
- Cc doanh nghip vin thng;
- Cng bo; Cng thng tin in t CP;
- B TTTT: B trng, cc Th trng, cc n
v thuc B, Cng thng tin in t;
- Lu: VT,QLDN.
Nguyn Bc Son
PH LC
BIU MU CHNG TRNH
(Ban hnh km theo Thng t s 08/2016/TT-BTTTT ngy 30 thng 03 nm 2016 ca B
Thng tin v Truyn thng)
Stt
Tn biu mu
Ni lp
Ni nhn
Tn sut
UBND cp tnh
phi hp vi
doanh nghip
B TTTT
01 ln/giai
on
B TTTT
Doanh
nghip
01 ln/giai
on
Doanh nghip
B TTTT
01 ln/giai
on
i tng th
hng
Doanh
nghip
01 ln
I H tr thit lp h tng
Mu 01/HT Danh mc d n v s b
tng mc u t , thuyt minh d n
1
trin khai nhim v thit lp h tng
vin thng
2
Mu 02/HT H s mi ng k tham
gia la chn ch u t
Mu 03/HT ng k tham gia la

chn ch u t
II H tr dch v
4 Mu 01/DV n ng k thu bao
Mu 02/DV Danh sch i tng th

hng
Doanh nghip
S TTTT
01 ln
Mu 03/DV K hoch sn lng v d

ton kinh ph h tr
Doanh nghip
B TTTT
01 ln/nm
B TTTT,
doanh
01 ln/nm
7 Mu 04/DV Mu hp ng t hng
cung cp dch v vin thng cng ch
8
Mu 05/DV Bo co sn lng, kinh

ph h tr hng qu
9 Mu 06/DV Bin bn nghim thu sn

lng, kinh ph h tr hng qu
10
Mu 07/DV Bin bn thanh l hp

ng t hng
B TTTT, doanh
nghip
nghip
Doanh nghip
B TTTT
01 ln/qu
B TTTT, doanh
nghip
B TTTT,
doanh
nghip
01 ln/qu
B TTTT, doanh
nghip
B TTTT,
doanh
01 ln/nm
nghip
III H tr u thu truyn hnh s
H ngho, h cn
ngho
S TTTT
Mu 02/THS Danh sch tng hp i

12 tng c h tr u thu truyn hnh
s
S TTTT
B TTTT
Mu 03/THS Danh sch h ngho

13 c hng h tr u thu truyn
hnh s
S TTTT
Mu 04/THS Danh sch h cn ngho

14 c hng h tr u thu truyn
hnh s
S TTTT
Mu 05/THS K hoch v d ton

kinh ph h tr u thu truyn hnh s
S TTTT
B TTTT
Doanh nghip
UBND cp
tnh
11
15
Mu 01/THS n ngh h tr u
thu truyn hnh s
Mu 06/THS Bng k chi tit i

16 tng nhn h tr u thu truyn
hnh s
17
Mu 07/THS Bo co s lng v
kinh ph h tr u thu truyn hnh s
01 ln/d n
01 ln/d n
B TTTT
01 ln/d n
B TTTT
01 ln/d n
Ch u t
B TTTT
01 ln/d n
01 ln/d n
01 ln/d n
IV Bo co
Mu 01/BC Bo co ngun vn hot
18 ng ca Qu dch v vin thng cng
ch Vit Nam
Qu DVVTCIVN
19
Mu 02A/BC Bo co tnh hnh s

dng kinh ph ca Chng trnh
Ban QLCTVTCI
20 Mu 02B/BC Bo co sn lng c Ban QLCTVTCI
B TTTT
01
ln/6thng
B TTTT
01
ln/6thng
B TTTT
01
h tr ca Chng trnh
ln/6thng
21
Mu 03A/BC Bo co tnh hnh s

dng kinh ph ca Chng trnh
Doanh nghip
B TTTT
01
ln/6thng
22
Mu 03B/BC Bo co sn lng c
h tr ca Chng trnh
Doanh nghip
B TTTT
01
ln/6thng
Mu 01/HT/Ph biu 01
[H TR THIT LP H THNG TRUYN DN V MNG TRUY NHP
BNG RNG]1)
[H TR TRANG THIT B THIT LP 500 IM TRUY NHP
INTERNET CNG CNG]2)
Chng trnh cung cp dch v vin thng cng ch n nm 2020
[Tn tnh/thnh ph]3)
[Tn doanh nghip khai thc im cung cp dch v truy nhp internet cng cng]4)
DANH MC D N V S B TNG MC U T
D kin thi gian
thc hin d n
S b tng mcu t
(VN)
[Tn d n 1]
[t thng/nm n
thng /nm]
[s b tng mc u t
ca d n]5)
[Tn d n m]
[t thng/nm n
thng /nm]
[s b tng mc u t
ca d n m]
STT
Tn d n
2
3
Tng
[s b tng mc u t
cc d n]
Mu 01/HT/Ph biu 02
DANH SCH CC X TRIN KHAI NHIM V THEO MI D N
STT
Tn x
[Tn d n 1]6)
M tnh/ tp9)
M huyn9)
M x9)
Tn x
[Tn x A]
[Tn x B]
n1..
[Tn d n 2]6)
M tnh/ tp9)
M huyn9)
M x9)
Tn x
[Tn x A]
[Tn x B]
n2..
..
Ngy thng nm ..
[TM. Y BAN NHN DN
CH TCH]7)
[I DIN DOANH NGHIP]8)
(K tn ng du)
Ghi ch:
1 ) 3) 7)
S dng trong trng hp lp Danh mc v s b Tng mc u t cc d n thc

hin cc nhim v ti cc Khon 1, 2, 3 iu 3 Thng t ny.
2) 4) 8)
S dng trong trng hp lp Danh mc v s b Tng mc u t cc d n thc

hin nhim v ti Khon 4 iu 3 Thng t ny.
5)
Kinh ph d kin l kinh ph xut h tr t ngun kinh ph Chng trnh.
6)
Mi d n trong Ph biu 02 tng ng vi mt d n lit k ti Ph biu 01.
9)
M tnh/thnh ph, huyn, x c quy nh ti Quyt nh s 124/2004/Q-TTg ngy

08/7/2004 v vic ban hnh bng danh mc v m s cc n v hnh chnh Vit Nam.
Mu 01/HT/Ph biu 03
NI DUNG C BN THUYT MINH D N [Tn d n ]1)
TNH/TP [tn tnh,tp]2)
1) Nghin cu s cn thit u t, cc iu kin thun li kh khn;
2) Ph hp vi quy hoch, k hoch pht trin ngnh, vng v k hoch pht trin kinh t
- x hi ca a phng;
3) D kin mc tiu, quy m, a im thc hin d n;
4)3) Thuyt minh s b v phng n thit lp h tng vin thng bng rng v lp cc
bng cung cp thng tin theo Mu 01/HT/Ph biu 03/bng 1, Mu 01/HT/Ph biu
03/bng 2, Mu 01/HT/Ph biu 03/bng 3, Mu 01/HT/Ph biu 03/bng 4, Mu
01/HT/Ph biu 03/bng 5 di y;
5)4) Thuyt minh s b v phng n h tr trang thit b thit lp im internet cng
cng v lp Danh sch trang thit b cn h tr ti cc x thuc d n theo Mu
01/HT/Ph biu 03/bng 6 di y;
6) Phn tch s b cc yu cu v k thut, tiu chun, cht lng ca cng trnh d n,
sn phm hoc dch v cung cp;
7) D kin thi hn thc hin d n;
8) Phn tch s b phng n ti chnh ca d n: s b tng mc u t ca d n; d
kin vn u t ca Chng trnh tham gia thc hin d n;
9) Nu s b hiu qu u t v kinh t - x hi ca d n;
10) Nhng ni dung cn thit khc (nu c);
Ghi ch:
1)
Mi d n ny tng ng vi mt d n lit k ti Ph biu 01.
2) 3)
Ni dung ny ch dng cho cc d n thc hin cc nhim v ti cc khon 1, 2, 3

iu 3 Thng t ny;
4)
Ni dung ny ch dng cho cc d n thc hin nhim v ti khon 4 iu 3 Thng t

ny.
Mu 01/HT/Ph biu 03/bng 1

DANH SCH CC X V CC NHIM V CN THC HIN THIT LP
H TNG VIN THNG BNG RNG THUC D N1)
TT Danh sch cc x cn thit lp Cc nhim v cn thc hin ti mi x Ghi ch
h tng vin thng bng rng
M
huyn
6)
6)
(2)
(3)
[M
[M
[Tn
X Thit lp h Thit lp
Thit lp
ng
thng
mng truy mng truy
2
bng ) truyn dn nhp bng nhp bng
bng rng 3) rng c nh rng di ng
4)
5)
(4)
(5)
(6)
(7)
huyn A] x A] x A]
[M
[M [Tn
huyn B] x B] x B]
6)
(1)
M x Tn x
[M
[M [Tn
huyn n] x n] x n]
(8)
Ghi ch:
1)
Mi d n ny tng ng vi mt d n lit k ti Ph biu 01;
Bng ny ch dng cho cc d n thc hin cc nhim v ti cc khon 1, 2, 3 iu 3

Thng t ny.
2)
Ct (4) ny ng vi mi x ti ct (3), nu x l x ng bng, in k t x, ngc

li trng.
3)
Ct (5) ny in k t x nu x c tn ti ct (3) c nhim v thit lp h thng

truyn dn bng rng, ngc li trng.
4)
Ct (6) ny in k t x nu x c tn ti ct (3) c nhim v thit lp mng truy

nhp bng rng c nh, ngc li trng.
5)
Ct (7) ny in k t x nu x c tn ti ct (3) c nhim v thit lp mng truy

nhp bng rng di ng, ngc li trng.
6)


DANH SCH CC IM KT NI THUC D N1)
TT
Tn im kt ni
a im im kt ni
M M x Tn x
4)
huyn 4) 4)
(1)
I
(2)
(3)
(4)
a im
(5)
Danh sch cc im kt ni cn thit lp2) ti x thuc d n
[Tn im kt ni 1]
[M
huyn]
[M
x]
[Tn
x]
[a im im kt
ni 1]
[Tn im kt ni 2]
[M
huyn]
[M
x]
[Tn
x]
[a im im kt
ni 2]
Ghi ch
II
[Tn im kt ni n]
[M
huyn]
[M
x]
[Tn
x]
[a im im kt
ni n]
Danh sch cc im kt ni sn c 3) c la chn cho d n
[Tn im kt ni 1]
[M
huyn]
[M
x]
[Tn
x]
[a im im kt
ni 1]
[Tn im kt ni 2]
[M
huyn]
[M
x]
[Tn
x]
[a im im kt
ni 2]
[Tn im kt ni m]
[M
huyn]
[M
x]
[Tn
x]
[a im im kt
ni m]
Ghi ch:
1)

Thng t ny
2)
im kt ni cn thit lp l im m ti v tr c d tnh t tp trung cc thit

b truyn dn ca x cha c mng truyn dn.
3)
im kt ni sn c l im kt cui ca h thng truyn dn bng rng ang hot

ng m ti v tr c th cho php mng truyn dn bng rng cn thit lp kt ni
vo;
im kt ni sn c c la chn cho d n l im kt ni sn c c s dng trong
phng n thit lp h tng vin thng bng rng ca d n.
4)


DANH SCH CC TUYN KT NI C LA CHN THUC D N1)
TT
Tn tuyn kt ni
Tn
Tn im
Chiu di
Mi trng Ghi ch
im kt kt ni
ni u cui 2)
2
)
(1)
(2)
(3)
tuyn (km)
truyn dn
bng rng 3)
(4)
(5)
[Tn tuyn kt ni
c la chn 1]
[Tn [Tn im [chiu di

im kt kt ni tuyn kt ni
ni u cui 1] c la chn
1]
1]
[Tn tuyn kt ni
c la chn 2]
[Tn [Tn im [chiu di

ni u cui 2] c la chn
2]
2]
[Tn tuyn kt ni
c la chn n]
[Tn [Tn im [chiu di

ni u cui n] c la chn
n]
n]
Tng chiu di cc
tuyn kt ni ca h
thng truyn dn
thuc d n
[Tng chiu
di cc tuyn
c la chn]
Ghi ch:
1)

Thng t ny.
2)
Mi tn im kt ni u hoc cui tng ng vi mt tn im kt ni cn thit lp

hoc tn im kt cui sn c ti ct (1) Mu 01/HT/Ph biu 03/bng 2 trn.
3)
in ct (5) vi cc gi tr quang hoc viba hoc hn hp.

DANH SCH CC MNG TRUY NHP BNG RNG C NH TI CC X
THUC D N1)
TT Tn mng truy nhp c nh
Tng chiu di cc
tuyn cp (m)
X ng
bng 2)
(1)
(2)
(3)
Mng truy nhp c nh x

[M huyn, m x, tn x 1]3)
[Tng chiu di mng

truy nhp ca x 1]
Mng truy nhp c nh x

[M huyn, m x, tn x 2]3)
[Tng chiu di mng

truy nhp ca x 2]
Mng truy nhp c nh x

[M huyn, m x, tn x n]3)
[Tng chiu di mng

truy nhp ca x n]
Ghi ch
Tng chiu di cc tuyn cp [Tng chiu di cc tuyn

ca cc mng truy nhp ca cp ca cc mng truy
cc x ng bng
nhp ca cc x ng
bng]
Tng chiu di cc tuyn cp [Tng chiu di cc tuyn
ca cc mng truy nhp ca cp ca cc mng truy
cc x min ni, hi o nhp ca cc x min ni,
hi o]
Ghi ch:
1)

Thng t ny.
2)
Ct (3) ny ng vi mi x c tn ti ct (1), nu x l x ng bng in k t x,

ngc li trng.
3)


DANH SCH CC TRM THU PHT THNG TIN DI NG 3G THUC D
N1)
TT Tn trm thu pht
thng tin di ng
3G
a im t trm 3G
M M x Tn x
huyn
Ghi ch
a im
[Tn trm 3G 1]
[M
huyn]
[M [Tn x] [a im ca [ta t trm]

x]
trm 3G 1]
(nu c)
[Tn trm 3G 2]
[M
huyn]

x]
trm 3G 2]
(nu c)
[Tn trm 3G n]
[M
huyn]

x]
trm 3G n]
(nu c)
Tng s trm thu

pht thng tin di
ng 3G
[Tng s trm thu pht 3G]
Ghi ch:
1)

Thng t ny.

DANH SCH TRANG THIT B TI CC X THUC D N1)
STT
1
Trang thit b cn h tr
n v
S lng
Ghi ch
IM ICC TI X [M tnh/tp, m huyn, m x, tn x]

My tnh
...
Thit b lu in
Switch 5 cng
...
My in
ci
Bn gh
...
Ph kin tai nghe
cc lp t internet
ln
Windows 7
B Office 2007
...
Phn mm dit Virut

My tnh
..
.
n
...
Ghi ch:
1)
Bng ny ch dng cho cc d n thc hin nhim v ti khon 4 iu 3 Thng t ny.
Mu 02/HT
H S MI NG K THAM GIA LA CHN CH U T
H S MI NG K THAM GIA LA CHN CH U T
D n: _____________ (ghi tn d n)
H ni, ngy ___thng ___ nm ____

i din hp php ca B Thng tin v Truyn thng
[Ghi tn, chc danh, k tn v ng du]
MC LC
Chng I. Yu cu v th tc mi la chn Ch u t
A. Tng qut
B. Chun b h s ng k tham gia
C. Np h s ng k tham gia
D. Kt qu ng k tham gia
Chng II. Cc thng tin c bn v d n
T NG VIT TT
HSMKTG
H s mi ng k tham gia
HSKTG
H s ng k tham gia
TCG
Tiu chun nh gi h s ng k tham gia

Chng I
YU CU V TH TC MI NG K THAM GIA
A. TNG QUT
Mc 1. Ni dung mi ng k tham gia

1. B Thng tin v Truyn thng, 18 Nguyn Du H Ni mi doanh nghip np
HSKTG la chn Ch u t d n _________ [Tn d n hoc d ton mua sm c
duyt].
2. Ni dung cng vic ch yu: _______ [Ghi ni dung yu cu].
3. Ngun vn thc hin d n: Ngun vn ca Chng trnh cung cp dch v vin
thng cng ch n 2020.
Mc 2. HSMKTG v pht hnh HSMKTG
1. HSMKTG bao gm cc ni dung c lit k ti Mc lc ca HSMKTG ny.
2. B Thng tin v Truyn thng (sau y gi tt l B) pht hnh min ph HSMKTG
cho cc doanh nghip c nhu cu tham gia.
Mc 3. Gii thch lm r HSMKTG
Trng hp doanh nghip mun c gii thch lm r HSMKTG th phi gi vn bn
ngh n B trc thi im ht hn np HSKTG xem xt, x l (doanh nghip
c th thng bo trc cho B qua fax, e-mail...). Sau khi nhn c vn bn yu cu lm
r HSMKTG ca doanh nghip theo thi gian quy nh, B s c vn bn tr li, trong
c m t ni dung yu cu lm r nhng khng nu tn doanh nghip ngh lm r
v gi cho tt c doanh nghip nhn HSMKTG t B. Trng hp vic lm r dn
n phi sa i HSMKTG th B tin hnh sa i HSMKTG theo quy nh ti Mc
4 Chng ny.
Mc 4. Sa i HSMKTG
Trng hp cn thit, B s tin hnh sa i HSMKTG (bao gm c vic gia hn thi

hn np HSKTG nu cn thit) bng cch gi vn bn sa i HSMKTG n tt c
cc doanh nghip nhn HSMKTG trc thi im ht hn np HSKTG ti
thiu 20 ngy. Ti liu ny l mt phn ca HSMKTG. Doanh nghip phi thng bo
cho B l nhn c cc ti liu sa i bng mt trong nhng cch sau: gi vn
bn trc tip, theo ng bu in, fax hoc e-mail.
Mc 5. Chi ph tham gia la chn Ch u t
Doanh nghip chu mi chi ph lin quan n qu trnh tham gia la chn Ch u t, k
t khi nhn HSMKTG cho n khi c thng bo kt qu ng k tham gia la chn
Ch u t.
B. CHUN B H S NG K THAM GIA
Mc 6. Ngn ng s dng
HSKTG cng nh tt c vn bn, ti liu trao i gia B v doanh nghip lin quan
n vic mi ng k tham gia phi c vit bng ngn ng ting Vit.
Mc 7. Ni dung HSKTG
HSKTG do doanh nghip chun b phi bao gm nhng ni dung sau:
1. Ti liu chng minh t cch hp l;
2. Ti liu k khai theo Bng 01 Mu 03/HT Ph lc ban hnh km theo Thng t ny.
Mc 8. Th ng k tham gia la chn Ch u t
Th ng k tham gia la chn Ch u t d n do doanh nghip chun b v phi c
ghi y theo Ph biu 01 Mu 03/HTPh lc ban hnh km theo Thng t ny, c ch
k ca ngi i din hp php ca doanh nghip.
Mc 9. Ti liu chng minh t cch hp l, nng lc v kinh nghim, xut thc
hin d n ca doanh nghip
1. Ti liu chng minh t cch hp l ca doanh nghip
a) Doanh nghip phi cung cp cc ti liu chng minh t cch hp l ca mnh: Bn
chp Giy chng nhn ng k doanh nghip c chng thc.
2. Ti liu chng minh nng lc v kinh nghim ca doanh nghip
a) Nng lc v kinh nghim ca doanh nghip c k khai theo Ph biu 02, 03 Mu
03/HT Ph lc ban hnh km theo Thng t ny.
3. xut thc hin d n

Doanh nghip phi xut phng n thc hin d n vi cc ni dung c bn quy nh
ti Ph biu 04 Mu 03/HT Ph lc ban hnh km theo Thng t ny.
Mc 10. Quy cch ca HSKTG
1. Doanh nghip phi chun b mt bn gc v hai bn chp HSKTG, ghi r bn gc
v bn chp tng ng.
2. Doanh nghip phi chu trch nhim v tnh chnh xc v ph hp gia bn chp v
bn gc.
3. HSKTG phi c nh my, in bng mc khng ty c, nh s trang theo th t
lin tc. Th ng k tham gia; cc vn bn b sung, lm r HSKTG v cc biu khc
phi c i din hp php ca doanh nghip k theo hng dn ti Mu 03/HT Ph lc
ban hnh km theo Thng t ny.
C. NP H S NG K THAM GIA
Mc 11. Nim phong v cch ghi trn ti ng HSKTG
1. HSKTG bao gm cc ni dung nu ti Mc 7 Chng ny. HSKTG phi c
ng trong ti c nim phong bn ngoi (cch nh du nim phong do doanh nghip t
quy nh). Cch trnh by cc thng tin trn ti ng HSKTG nh sau:
- HSKTG: _____
- Tn, a ch, in thoi ca doanh nghip: _______.
- a ch np HSKTG : B Thng tin v Truyn thng, 18 Nguyn Du, H Ni.
- Tn d n: ________ [Ghi tn d n].
- Khng c m trc ____ gi, ngy ___ thng ___ nm ____
Trng hp sa i HSKTG, ngoi cc ni dung trn cn phi ghi thm dng ch "H
s ng k tham gia sa i.
2. Trong trng hp HSKTG gm nhiu ti liu, doanh nghip cn thc hin vic ng
gi ton b ti liu sao cho vic tip nhn v bo qun HSKTG ca B c thun tin,
m bo s ton vn ca HSKTG, trnh tht lc, mt mt.
3. Doanh nghip phi chu trch nhim v hu qu hoc s bt li nu khng tun theo
quy nh trong HSMKTG nh khng nim phong hoc lm mt nim phong HSKTG
trong qu trnh chuyn ti B, khng ghi ng cc thng tin trn ti ng HSKTG theo
hng dn ti Khon 1, 2 Mc ny. B s khng chu trch nhim v tnh bo mt thng
tin ca HSKTG nu doanh nghip khng thc hin ng ch dn ti Khon 1 v Khon

2 Mc ny.
Mc 12. Thi hn np HSKTG
1. Doanh nghip np trc tip hoc gi HSKTG n a ch ca B nhng phi m
bo B nhn c trc ___ gi, ngy ___ thng ___ nm ____. B tip nhn
HSKTG ca tt c doanh nghip np HSKTG trc thi im ht hn np HSKTG,
k c trng hp doanh nghip cha nhn HSMKTG trc tip t B.
2. B c th gia hn thi hn np HSKTG trong trng hp cn tng thm s lng
HSKTG hoc khi sa i HSMKTG theo Mc 4 Chng ny hoc theo yu cu ca
doanh nghip khi B xt thy cn thit.
3. Khi gia hn thi im ht hn np HSKTG B s thng bo bng vn bn cho cc
doanh nghip nhn HSMKTG hoc np HSKTG, ng thi ng ti thng bo
gia hn thi im ht hn np HSKTG trn cng thng tin in t ca B. Khi thng
bo, B s ghi r thi im ht hn np HSKTG mi doanh nghip c thi gian
sa i hoc b sung HSKTG (bao gm c hiu lc ca HSKTG) theo yu cu mi.
Doanh nghip np HSKTG c th nhn li sa i, b sung HSKTG ca mnh.
Trng hp doanh nghip cha nhn li hoc khng nhn li HSKTG th B qun l
HSKTG theo ch qun l h s mt.
Mc 13. HSKTG np mun
HSKTG c gi n B sau thi im ht hn np HSKTG s khng c m,
khng hp l, b loi v c tr li cho doanh nghip theo nguyn trng. Bt k ti liu
no c doanh nghip gi n sau thi im ht hn np HSKTG sa i, b sung
HSKTG np u khng hp l, tr ti liu doanh nghip gi n lm r
HSKTG theo yu cu ca B hoc ti liu lm r, b sung nhm chng minh t cch
hp l, nng lc v kinh nghim ca doanh nghip quy nh ti Mc 16 Chng ny.
Mc 14. Sa i, thay th hoc rt HSKTG
1. Sau khi np, doanh nghip c th rt, thay th hoc sa i HSKTG bng cch gi
vn bn thng bo c ch k ca ngi i din hp php ca doanh nghip, km theo
ni dung thay th hoc sa i HSKTG. Mi thng bo phi c doanh nghip chun
b v np cho B theo quy nh ti Mc 11 Chng ny, trn ti ng vn bn thng bo
phi ghi r RT H S NG K THAM GIA hoc THAY TH H S NG
K THAM GIA hoc SA I H S NG K THAM GIA. B phi nhn c
thng bo ny ca doanh nghip trc thi im ht hn np HSKTH theo quy nh ti

Mc 12 Chng ny.
2. HSKTG m doanh nghip yu cu rt li theo Khon 1 Mc ny s c tr li cho
doanh nghip theo nguyn trng. Doanh nghip khng c rt, thay th hoc sa i
HSKTG sau thi im ht hn np HSKTG cho n khi ht hn hiu lc ca
HSKTG nu trong th ng k thc hin hoc n khi ht hn hiu lc gia hn ca
HSKTG.
D. KT QU NG K THAM GIA
Mc 15. iu kin c la chn Ch u t
Doanh nghip c xem xt, la chn l Ch u t khi p ng y cc iu kin
sau:
1. C HSKTG hp l;
2. C HSKTG c gi thp nht hoc gi nh gi thp nht.
Mc 16. Thng bo kt qu ng k tham gia
Sau khi c quyt nh ph duyt kt qu ng k tham gia la chn ch u t, B ng
ti thng tin v kt qu ng k tham gia trn cng thng tin in t ca B, ng thi
gi vn bn thng bo kt qu ng k tham gia ti cc doanh nghip tham gia.
Chng II
CC THNG TIN C BN CA D N
Chng ny cung cp cc thng tin lin quan n d n, phc v cho vic lp xut
thc hin d n ca mi doanh nghip vin thng. Cc ni dung c bn bao gm:
1. Gii thiu chung v d n
[Nu thng tin tm tt v d n nh tn d n, ngun vn, ni dung h tr, mc h tr
ti a,]
2. M t s b v ni dung d n
[Nu thng tin tm tt v mc tiu, quy m, a im, cc ni dung chnh thc hin ca
d n, tm tt yu cu k thut, cng ngh ca d n....]
3. K hoch thc hin
[Nu d kin thi gian thc hin d n]
Mu 03/HT
H S NG K THAM GIA
Doanh nghip chun b cc ti liu quy nh ti Bng 01 di y:
Bng 01. H thng mu biu
STT
Ti liu
Biu mu p dng
Th ng k tham gia la chn Ch u t
Mu 03/HT/Ph biu 01
Kinh nghim ca doanh nghip
Mu 03/HT/Ph biu 02
K khai nng lc ti chnh ca doanh nghip
Mu 03/HT/Ph biu 03
xut thc hin d n
Mu 03/HT/Ph biu 04
Mu 03/HT/Ph biu01
TH NG K THAM GIA LA CHN CH U T
__________, ngy ___ thng ___ nm ___
Knh gi: B Thng tin v Truyn thng
Sau khi nghin cu h s mi ng k tham gia la chn Ch u t (bao gm vn bn
sa i h s mi quan tm, nu c), chng ti, Doanh nghip ____[Ghi tn doanh
nghip], ng k tham gia la chn Ch u t d n ______ [Ghi tn d n].
Chng ti gi xut d n km theo Th ng k tham gia la chn Ch u t trnh
by phng n d kin thc hin d n ______ [Ghi tn d n].
Nu c la chn lm Ch u t d n, chng ti cam kt thc hin d n
______ [Ghi tn d n] theo nhng ni dung ca xut thc hin d n trnh by.
Chng ti cam kt cc thng tin k khai trong h s ng k tham gia ny l chnh xc,
trung thc.
i din hp php ca doanh nghip

Mu 03/HT/Ph biu02
KINH NGHIM CA DOANH NGHIP
Cc d n tng t do doanh nghip thc hin trong vng 01 nm gn y.
Doanh nghip s dng bng sau k khai cho mi d n tng t nh c yu cu
trong d n ny m doanh nghip thc hin.
Tn d n
a im thc hin
Tn ch u t
Tng mc u t ca d n
Thi gian thc hin hp ng (ghi theo thi gian quy nh
trong hp ng; nu r t ngy.... n ngy...)
Thi gian thc t thc hin (nu r t ngy... n ngy)
Doanh nghip phi gi km theo bn chp cc vn bn, ti liu lin quan.
Mu 03/HT/Ph biu03
K KHAI NNG LC TI CHNH CA DOANH NGHIP
________, ngy ___ thng ___ nm ___
Tn doanh nghip: _______________________ [Ghi tn doanh nghip]
A. Tm tt cc s liu v ti chnh trong 03 nm ti chnh gn y.
n v tnh: t ng
Stt
Ni dung
Tng ti sn
Tng n phi tr
Nm____
Nm____
Nm____
Ti sn ngn hn
Tng n ngn hn
Doanh thu
Li nhun trc thu
Li nhun sau thu
B. Ti liu gi nh km nhm i chng vi cc s liu m doanh nghip k khai,

doanh nghip np Bo co ti chnh c kim ton v bn chp c chng thc ca
mt trong cc ti liu sau:
1. T khai quyt ton thu c xc nhn ca c quan qun l thu hoc t khai quyt ton
thu in t trong 03 nm ti chnh gn y;
2. Vn bn xc nhn ca c quan qun l thu (xc nhn s np c nm) v vic thc
hin ngha v np thu trong 03 nm ti chnh gn y;

Mu 03/HT/Ph biu04
XUT THC HIN D N
__________, ngy ___ thng ___ nm ___
D n: [Ghi tn ca d n]
Doanh nghip xut d n: [Ghi tn doanh nghip]
NI DUNG XUT
1. S ph hp ca d n vi quy hoch, k hoch pht trin ngnh, vng v k hoch
pht trin kinh t - x hi ca a phng;
2. D kin mc tiu, quy m, a im thc hin d n;
3. Phn tch la chn s b v cng ngh, k thut, tiu chun, cht lng cng trnh d
n, sn phm hoc dch v cung cp;
4. D kin thi gian thc hin d n;

5. Phng n t chc qun l, kinh doanh hoc cung cp dch v;
6. Phn tch s b phng n ti chnh ca d n gm nhng ni dung: s b Tng mc
u t, c cu ngun vn v phng n huy ng;
7. D kin s b hiu qu kinh t - x hi ca d n; nh hng ca d n i vi mi
trng, x hi v quc phng, an ninh;
8. Nhng ni dung cn thit khc (nu cn);
9. xut kinh ph h tr thc hin d n: [Ghi s tin bng s v ch],
Bao gm cc loi chi ph sau:
- Chi ph xy dng: [lit k chi tit tng loi chi ph thnh phn v kinh ph tng ng]
(nu c);
- Chi ph thit b: [lit k chi tit tng loi chi ph thnh phn v kinh ph tng ng]
(nu c);
- Chi ph qun l d n: [lit k chi tit tng loi chi ph thnh phn v kinh ph tng
ng] (nu c);
- Chi ph khc: [lit k chi tit tng loi chi ph thnh phn v kinh ph tng ng] (nu
c);
- Chi ph d phng: [mc d phng] (nu c);
10. Thit k s b ca d n (nu l d n h tr thit lp h tng vin thng bng rng).

Mu 01/DV n ng k thu bao

Ph biu 01(1)
N NG K THU BAO C HNG H TR
(Ban hnh km theo Thng t s
/2016/TT-BTTTT ngy
v Truyn thng)
/2016 ca B Thng tin

--------------
N NG K THU BAO HNG H TR

Knh gi: Doanh nghip [Tn doanh nghip cung cp dch v].
Tn ti l: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
S CMND . . . . . . . . . . . . . ni cp . . . . . . . . . . . . . ngy cp. . . . . . . .
Ch hin ti2): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
L ch h gia nh, m s h [m s h] (nu c) thuc din:
H ngho
H cn ngho theo quy nh ca Nh nc.
Hin nay, gia nh ti ang s dng dch v: 3). . . . . . . . . . . . . . . . . .
S thu bao: . . . . . . . . . , do Doanh nghip [Tn doanh nghip cung cp dch v] cung
cp, tn thu bao: [tn thu bao trong hp ng] l thnh vin trong h gia nh ti.
S hp ng: . . . . . . . . . . . . . . ., ngy k hp ng: . . . . . . . . . . . . . .
Ti lm n ny cam kt h gia nh ti cha c hng h tr (hoc ngng c
hng h tr i vi [Tn doanh nghip ng k ngng c hng h tr]) v ng
k S thu bao trn c hng h tr thuc Chng trnh vin thng cng ch n nm
2020.
Ti xin cam oan cc thng tin nu trn l ng s tht v xin chu trch nhim trc
php lut v cc thng tin trn.
Trn trng cm n./.
., ngythngnm
CH H4)
(K v ghi r h tn)
Ghi ch:
1)
n ny s dng trong trng hp ch h ng k thu bao hng h tr.
2)
Ch hin ti ghi r thn, x, huyn, tnh (Thnh ph).
3)
Ghi r tn dch v ang s dng: in thoi c nh mt t tr sau hoc dch v thng

tin di ng mt t tr sau.
4)
Ch h lu nhn li giy bin nhn t doanh nghip sau khi np n ng k.
Ph biu 02(1)
N NG K THU BAO C HNG H TR
/2016/TT-BTTTT ngy /
tin v Truyn thng)
/ 2016 ca B Thng

--------------
N NG K THU BAO HNG H TR

Tn n v: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
a ch: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ngi i din . . . . . . . . . . . . . Chc v: . . . . . . .
Hin nay, chng ti ang s dng dch v: 2). . . . . . . . . . . . . . . . . .
Thu bao: . . . . . . . . . , gi cc:[tn gi cc] do Doanh nghip [Tn doanh nghip cung
cp dch v] cung cp.
S hp ng: . . . . . . . . . . . . . . ., ngy k hp ng:3). . . . . . . . . . . . . .
Chng ti lm n ny cam kt n v chng ti cha c hng h tr (hoc ngng
c hng h tr i vi [Tn doanh nghip ng k ngng c hng h tr]) v
ng k Thu bao, gi cc trn c hng h tr thuc Chng trnh vin thng cng
ch n nm 2020.
Chng ti xin cam oan cc thng tin nu trn l ng s tht v xin chu trch nhim
trc php lut v cc thng tin trn.
Trn trng cm n./.
., ngythngnm
I DIN N V NG K3)
(K v ghi r h tn)
Ghi ch:
1)
n ny s dng trong trng hp n v ng k thu bao hng h tr.
2)
Ghi r tn dch v ang s dng l dch v truy nhp Internet bng rng c nh tr sau;
dch v knh thu ring c nh mt t hoc dch v truyn dn tn hiu truyn hnh s
(ghi r tn chng trnh truyn hnh) qua bng tn Ku ca v tinh VINASAT, dch v
thu knh truyn dn cp quang ca Tp on in lc Vit Nam.
n v lu nhn li giy bin nhn t doanh nghip sau khi np n ng k.
Ph biu 03 (1)
N NG K NGNG THU BAO C HNG H TR
/2016/TT-BTTTT ngy
B Thng tin v Truyn thng)
/ 2016 ca B trng

--------------
N NG K NGNG THU BAO HNG H TR

Tn ti l: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
S CMND . . . . . . . . . . . . . ni cp . . . . . . . . . . . . . ngy cp. . . . . . . .
Ch hin ti2): . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
L ch h gia nh, m s h [m s h] (nu c) thuc din:
H ngho
H cn ngho theo quy nh ca Nh nc.
Hin nay, gia nh ti ang s dng dch v: 3). . . . . . . . . . . . . . . . . .

S thu bao: . . . . . . . . . , do Doanh nghip [Tn doanh nghip cung cp dch v] cung
cp, tn thu bao:[tn thu bao trong hp ng] l thnh vin trong h gia nh ti.
S hp ng: . . . . . . . . . . . . . . ., ngy k hp ng: . . . . . . . . . . . . . .
Ti lm n ny ng k S thu bao trn ngng c hng h tr thuc Chng trnh
vin thng cng ch n nm 2020.
Ti xin cam oan cc thng tin nu trn l ng s tht v xin chu trch nhim trc
php lut v cc thng tin trn.
Trn trng cm n./.
., ngythngnm
CH H4)
(K v ghi r h tn)
Ghi ch:
1)
n ny s dng trong trng hp ch h ng k thu bao ngng hng h tr.
2)
Ch hin ti ghi r thn, x, huyn, tnh (Thnh ph).
3)
Ghi r tn dch v ang s dng: in thoi c nh mt t tr sau hoc dch v thng

tin di ng mt t tr sau.
4)
Ch h lu nhn li giy bin nhn t doanh nghip sau khi np n ng k.
Ph biu 04 (1)
N NG K THU BAO NGNG C HNG H TR
/2016/TT-BTTTT ngy
/2016 ca B trng
B Thng tin v Truyn thng)

--------------
N NG K THU BAO NGNG HNG H TR
Tn n v: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
a ch: . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . . .
Ngi i din . . . . . . . . . . . . . Chc v: . . . . . . .
Hin nay, chng ti ang s dng dch v: 2). . . . . . . . . . . . . . . . . .
Thu bao: . . . . . . . . . , gi cc: [tn gi cc] do Doanh nghip [Tn doanh nghip
cung cp dch v] cung cp.
S hp ng: . . . . . . . . . . . . . . ., ngy k hp ng:3). . . . . . . . . . . . . .
Chng ti lm n ny ng k Thu bao, gi cc trn ngng c hng h tr thuc
Chng trnh vin thng cng ch n nm 2020.
Chng ti xin cam oan cc thng tin nu trn l ng s tht v xin chu trch nhim
trc php lut v cc thng tin trn.
Trn trng cm n./.
., ngythngnm
I DIN N V NG K3)
(K v ghi r h tn)
Ghi ch:
1)
n ny s dng trong trng hp n v ng k thu bao ngng c hng h tr.
2)
Ghi r tn dch v ang s dng l dch v truy nhp Internet bng rng c nh tr sau;
dch v knh thu ring c nh mt t hoc dch v truyn dn tn hiu truyn hnh s
(ghi r tn chng trnh truyn hnh) qua bng tn Ku ca v tinh VINASAT, dch v
thu knh truyn dn cp quang ca Tp on in lc Vit Nam.
3)
n v lu nhn li giy bin nhn t doanh nghip sau khi np n ng k.
Mu 02/DV - Danh sch i tng th hng

Doanh nghip:
Tnh:
Mu 02/DV Ph biu 01
(Ban hnh km theo TT s./2016/TT-BTTTT)
DANH SCH H NGHO, H CN NGHO C HNG H TR I VI DCH V IN THOI C NH

MT T TR SAU V DCH V THNG TIN DI NG MT T TR SAU
Nm . . . .
S in thoi ng k
STT
A
1
2
3
4
.
M
huyn
M x
Tn ch M s
h
h
a ch
Tn thu
bao
C nh
Di ng
Ngy,
thng,
S hp ng
nm
Ghi ch
ng k
8
10
.., ngy.thng .. nm
XC NHN CA S THNG TIN V TRUYN
THNG
(K, ghi r h tn, ng du)
GIM C
Ghi ch:
- Ph biu ny do doanh nghip vin thng lp trn c s tng hp thng tin t n ng k thu bao c h tr ca h ngho, h
cn ngho v S Thng tin v Truyn thng xc nhn sau khi kim tra, m bo mi h ngho, h cn ngho ch c hng h
tr cho mt thu bao in thoi. S Thng tin v Truyn thng gi bn mm v Ban Qun l Chng trnh.
- Hng qu, doanh nghip lp danh sch thu bao pht sinh tng, danh sch thu bao gim theo ni dung Ph biu ny.
Cch lp biu:
Ct (A): Ghi s th t ca h.
Ct (B), ct (C): Ghi m huyn, m x (theo quy nh ti Quyt nh s 124/2004/Q-TTG v vic ban hnh Bng danh mc v m s
cc n v hnh chnh Vit Nam) ca a ch h ngho, h cn ngho.
Ct (1): Ghi h v tn ca ch h.
Ct (2): Ghi m s h ngho, h cn ngho.
Ct (3): Ghi a ch ca h: s nh, thn/bn/khi ph ca h ngho, cn ngho.
Ct (4): Ghi h tn ch thu bao trong h s hu s in thoi ng k c h tr.

Ct (6): Ghi s in thoi c nh mt t tr sau (C) ng k hng h tr.
Ct (7): Ghi s in thoi di ng mt t tr sau (D).
Ct (8): Ghi s hp ng ca thu bao ng k hng h tr.
Ct (9): Ghi ngy, thng, nm i tng ng k hng h tr hoc ng k ngng h tr (i vi danh sch gim).
Doanh nghip:
Tnh:
Mu 02/DV Ph biu 02
DANH SCH TRNG HC, BNH VIN, Y BAN NHN DN CP X C HNG H TR I VI DCH V
TRUY NHP INTERNET BNG RNG C NH TR SAU
Nm . . . . .
STT
M huyn
Ngy,
Tn trng hc,
a ch lp S hp
Gi cc thng, nm
M x bnh vin, y ban
M truy nhp
t
ng
truy nhp ng k h
nhn dn cp x
tr
C
Ghi ch
2
3
4
5
..
.., ngy.thng .. nm
XC NHN CA S THNG TIN V TRUYN THNG
GIM C
Ghi ch: - Ph biu ny do doanh nghip vin thng lp trn c s tng hp thng tin t n ng k thu bao c hng h tr ca
cc trng hc, bnh vin, UBND cp x v S Thng tin v Truyn thng xc nhn sau khi kim tra, m bo mi trng hc,
bnh vin, UBND cp x ch c hng h tr cho mt gi cc. S Thng tin v Truyn thng gi bn mm v Ban Qun l
Chng trnh.
- Hng qu, doanh nghip lp danh sch trng hc, bnh vin, UBND cp x pht sinh tng, danh sch trng hc, bnh vin,
UBND cp x gim theo ni dung Ph biu ny.
Cch lp biu:
Ct (A): Ghi s th t ca trng hc, bnh vin, UBND cp x.
Ct (B), ct (C): Ghi m huyn, m x (theo quy nh ti Quyt nh 124/2004/Q-TTG v vic ban hnh Bng danh mc v m s
cc n v hnh chnh Vit Nam) ca a ch trng hc, bnh vin, UBND cp x.
Ct (1): Ghi tn ca trng hc, bnh vin, UBND cp x iu kin c hng h tr.
Ct (2): Ghi a ch lp t thu bao.
Ct (3): Ghi s hp ng m trng hc, bnh vin, UBND cp x trn k kt vi doanh nghip cung cp dch v.
Ct (4): Ghi m truy nhp.
Ct (5): Ghi gi cc trong hp ng k.
Ct (6): Ghi ngy, thng, nm i tng ng k hng h tr hoc ng k ngng h tr (i vi danh sch gim)
Doanh nghip:
Tnh:
Mu 02/DV Ph biu 03
DANH SCH IM CUNG CP DCH V TRUY NHP INTERNET CNG CNG IU KIN
C H TR DUY TR
Nm . . . . .
STT M huyn M x
Tn im truy nhp
Thuc
Thit lp
a ch
S hp ng
M truy
nhp
Gi cc truy S my tnh
Ghi ch
nhp
truy nhp
CT74
mi
1
2
3
4
.
.., ngy.thng .. nm
GIM C
Ghi ch:
Ph biu ny do doanh nghip qun l vn hnh im truy nhp lp v c S Thng tin v Truyn thng xc nhn sau khi kim
tra, m bo mi im truy nhp thuc i tng h tr. S Thng tin v Truyn thng gi bn mm v Ban Qun l Chng trnh.
- Hng qu, doanh nghip lp danh sch im truy nhp Internet cng cng pht sinh tng, danh sch im truy nhp Internet cng
cng gim theo ni dung Ph biu ny.
Cch lp biu:
Ct (A): Ghi s th t ca im truy nhp Internet cng cng.
cc n v hnh chnh Vit Nam) ca im truy nhp cng cng.
Ct (1): Ghi tn ca im truy nhp Internet cng cng iu kin hng h tr thuc Chng trnh 74.
Ct (2): Ghi tn ca im truy nhp Internet cng cng iu kin hng h tr thit lp mi (500 im).
Ct (3): Ghi a ch im truy nhp Internet cng cng.
Ct (4): Ghi s hp ng cung cp dch v Internet cng cng.
Ct (5): Ghi m truy nhp
Ct (6): Ghi gi cc trong hp ng k
Ct (7): Ghi s lng my tnh truy nhp Internet trc tip cung cp dch v truy nhp Internet cho ngi s dung dch v
Doanh nghip:
Tnh:
Mu 02/DV Ph biu 04
DANH SCH BNH VIN IU KIN HNG H TR P DNG I VI DCH V KNH THU RING C
NH MT T
Nm . . . . . .
STT
M huyn
M x
Tn bnh vin
a ch lp
t
S hp ng
Thi hn
M knh
hp ng
4
Ghi ch
6
1
2
.
.., ngy.thng .. nm
GIM C
Ghi ch: - Ph biu ny do doanh nghip vin thng lp trn c s tng hp thng tin t n ng k knh thu ring c hng h
tr ca bnh vin v S Thng tin v Truyn thng xc nhn sau khi kim tra, m bo mi bnh vin ch c hng h tr cho
mt knh thu ring.
- Hng qu, doanh nghip lp danh sch knh thu ring pht sinh tng, danh sch knh thu ring gim theo ni dung Ph
biu ny.
Cch lp biu:
Ct (A): Ghi s th t ca bnh vin.
cc n v hnh chnh Vit Nam) ca bnh vin.
Ct (1): Ghi tn ca bnh vin iu kin c hng h tr v ang s dng knh thu ring c nh mt t.
Ct (2): Ghi a ch bnh vin.
Ct (3): Ghi s hp ng m bnh vin v tinh trn k kt vi doanh nghip cung cp dch v cho knh 2Mbps c d phng.
Ct (4): Ghi thi hn hp ng.
Ct (5): Ghi m knh.
Doanh nghip:
Tnh:
Mu 02/DV Ph biu 05
DANH SCH THU BAO C H TR CUNG CP DCH V VIN THNG DI NG HNG HI QUA H THNG
I THNG TIN DUYN HI
Nm
STT M huyn
M x
Tn ch thu
bao
Bin s a ch ch
M thu bao
tu
thu bao
2
S hp
ng
S giy chng
nhn ng k tu
c
Ghi ch
1
2
.., ngy.thng .. nm
GIM C
Ghi ch: - Ph biu ny do doanh nghip vin thng lp trn c s tng hp thng tin thu bao thng tin di ng hng hi ca cc ng
dn nh bt hi sn c hng h tr v S Thng tin v Truyn thng xc nhn sau khi kim tra, xc nhn. S Thng tin v
Truyn thng gi bn mm v Ban Qun l Chng trnh.
- Hng qu, doanh nghip lp danh sch thu bao pht sinh tng, danh sch thu bao gim theo ni dung Ph biu ny.
Cch lp biu:
Ct (A): Ghi s th t ca thu bao.
cc n v hnh chnh Vit Nam) ca a ch ch thu bao.
Ct (1): Ghi tn ca ch thu bao iu kin c hng h tr.
Ct (2): Ghi bin s tu nh bt hi sn
Ct (3): Ghi a ch ch thu bao

Ct (4): Ghi m thu bao
Ct (5): S hp ng k
Ct (6): S giy chng nhn ng k tu c
Doanh nghip:
Mu 02/DV Ph biu 06
DANH SCH I PHT THANH TRUYN HNH C H TR CUNG CP DCH V TRUYN DN TN HIU
TRUYN HNH S S DNG BNG TN KU CA V TINH VINASAT
Nm . . . . . .
STT
Tn tnh/thnh
ph
Tn i pht
thanh truyn
hnh
1
2
Tn knh chng
a ch i S hp ng Thi hn hp ng trnh truyn hnh
Ghi ch
.., ngy.thng .. nm
GIM C
Ghi ch: - Ph biu ny do doanh nghip vin thng lp trn c s tng hp thng tin thu ng truyn v tinh c hng h tr
ca i pht thanh truyn hnh cp tnh v S Thng tin v Truyn thng xc nhn sau khi kim tra.
- Hng qu, doanh nghip lp danh sch knh chng trnh truyn hnh pht sinh tng, danh sch knh chng trnh truyn
hnh gim theo ni dung Ph biu ny.
Cch lp biu:
Ct (A): Ghi s th t ca i.
Ct (1): Ghi tn ca i truyn hnh iu kin c hng h tr.
Ct (2): Ghi a ch i.
Ct (3): Ghi s hp ng m doanh nghip vin thng k kt vi i.
Ct (4): Thi hn hp ng.
Ct (5): Ghi tn knh chng trnh truyn hnh.
Doanh nghip:
Tnh:
Mu 03/DV Ph biu 01
K HOCH SN LNG V KINH PH H TR CUNG CP DCH V IN THOI C NH MT T TR SAU

V DCH V THNG TIN DI NG MT T TR SAU CHO H NGHO, H CN NGHO
Nm
DCH V MNG IN THOI C NH
DCH V MNG IN THOI DI NG
S
S liu c nm S liu nm k
lng
thc hin
hoch
S lng
thu
M
Tn
thu bao
STT
huyn huyn bao n Sn
Sn
n 30/6
lng
Kinh
30/6
Kinh ph lng
(lt
ph nm thc
nm
(ng) (lt thu
hin
thu
(ng)
thc
bao)
bao)
hin
A
1
2
S liu c nm
thc hin
Sn
lng
(lt
thu
bao)
7
S liu nm k
hoch
Ghi ch
Sn
lng
Kinh ph
Kinh ph
(lt
(ng)
(ng)
thu
bao)
8
10
11
Cng:
NGI LP BIU
(K ghi r h tn)
. ngy . thng . nm ..
TRNG N V
(K ghi r h tn)
Ghi ch:
- Ct (1), ct (6) s lng thu bao thuc h ngho, h cn ngho hin c n ngy 30/6.
- Ct (2), (7) sn lng lt thu bao l s lng thu bao nhn s thng h tr, v d mt thu bao c h tr 12 thng th sn lng
c tnh 12 lt.
- Ct (3), Ct (5), ct (8) ct (10), kinh ph bng Mc h tr nhn vi Sn lng (lt thu bao).
- S liu c nm thc hin l s liu thc hin Qu 1,2 v s liu c thc hin Qu 3,4 ca nm thc hin.
- Doanh nghip tng hp s liu Ton quc theo m tnh, tn tnh vi ni dung nh Mu 03/DV Ph biu 01.
Doanh nghip:
Tnh:
Mu 03/DV Ph biu 02
K HOCH SN LNG V KINH PH H TR CUNG CP DCH V TRUY NHP INTERNET BNG RNG C
NH TR SAU CHO TRNG HC, BNH VIN, Y BAN NHN DN CP X
Nm
STT
Tn huyn
Huyn A
Trng hc
Gi cc 1 (4 Mbps)
Gi cc 3 (32 Mbps)
Gi cc 4 (45 Mbps)
Bnh vin
Gi cc 2 (12 Mbps)
Gi cc 3 (32 Mbps)
S liu c nm thc
Sn lng
S liu nm k hoch
hin
thu bao
M
n 30/6
Sn lng
Sn lng
huyn
Kinh ph
Mc h tr Kinh ph
nm thc
(lt thu
(lt thu
(ng)
(ng)
(ng)
hin
bao)
bao)
C
6=4*5
Ghi ch
Gi cc 4 (45 Mbps)
3
UBND x
Gi cc 1 (4 Mbps)
II Huyn B
..
Cng (I + II..)
NGI LP BIU
(K ghi r h tn)
TRNG N V
(K ghi r h tn)
Ghi ch:
- Doanh nghip tng hp s liu ton quc theo m tnh, tn tnh vi ni dung nh Mu 03/DV Ph biu 02.
Doanh nghip:
Mu 03/DV Ph biu 03
K HOCH SN LNG V KINH PH H TR CUNG CP DCH V VIN THNG DI NG HNG HI QUA H

THNG I THNG TIN DUYN HI
Nm
STT
Tnh/Thnh ph
Tnh A
C nh ni tnh
C nh lin tnh
Di ng
Tnh B
Cng:
S lng
thu bao
n 30/6
nm thc
hin
S liu c nm thc hin

Sn lng
(lt thu
bao)
Sn lng
lin lc
(pht)
Kinh ph
(ng)
S liu nm k hoch
Sn lng Sn lng
(lt thu
lin lc
bao)
(pht)
4
Kinh ph
(ng)
Ghi ch
TRNG N V
(K ghi r h tn)
NGI LP BIU
(K ghi r h tn)
Ghi ch:
- S liu c nm thc hin l s liu thc hin Qu 1, 2 v s liu c thc hin Qu 3,4 ca nm thc hin.
- Kinh ph bng Mc h tr nhn vi Sn lng lin lc (pht).
Doanh nghip:
Tnh: ......
Mu 03/DV Ph biu 04
K HOCH SN LNG V KINH PH H TR CUNG CP DCH V KNH THU RING C NH MT T

Nm
STT
Tn huyn
S lng
S liu c nm thc hin
knh n 30/6
M huyn
Sn lng
Kinh ph
nm thc
(lt knh)
(ng)
hin
B
S liu nm k hoch
Sn lng
(lt knh)
Kinh ph
(ng)
Ghi ch
2
3
4
5
6
7
Cng:
NGI LP BIU
(K ghi r h tn)
TRNG N V
(K ghi r h tn)
Ghi ch:
- Ct (3), ct (5) kinh ph bng Mc h tr nhn vi Sn lng (lt knh).
- Doanh nghip tng hp s liu Ton quc theo m tnh, tn tnh vi ni dung nh Mu 03/DV Ph biu 04.
Doanh nghip:
Mu 03/DV Ph biu 05
K HOCH SN LNG V KINH PH H TR THIT LP NG TRUYN DN CP QUANG RA HUYN O

Nm
S liu c nm thc hin
STT
Tn huyn
M huyn
2
3
4
5
Cng:
S liu nm k hoch
Kinh ph h tr
Kinh ph h tr
Gi tr ha n
Gi tr ha n
(ng)
(ng)
1
Ghi ch
TRNG N V
(K ghi r h tn)
NGI LP BIU
(K ghi r h tn)
Ghi ch:
- Ct (2), ct (4) kinh ph bng t l h tr nhn vi gi tr trc thu VAT trn ha n thu si cp quang.
Doanh nghip:
Tnh: ....
Mu 03/DV Ph biu 06
K HOCH SN LNG V KINH PH H TR DUY TR IM TRUY NHP INTERNET CNG CNG

Nm
S im c
S liu c nm thc hin
n 30/6
STT M huyn M huyn
Kinh ph
nm thc
Sn lng (lt im)
(ng)
hin
A
S liu nm k hoch
Sn lng
(lt im)
Kinh ph
(ng)
Ghi ch
1
2
3
4
5
6
7
Cng:
NGI LP BIU
(K ghi r h tn)
TRNG N V
(K ghi r h tn)
Ghi ch:
- Ct (3), ct (5) kinh ph bng Mc h tr nhn vi Sn lng (lt im).
- Doanh nghip tng hp Ton quc theo m tnh, tn tnh vi ni dung nh Mu 03/DV Ph biu 06.
Doanh nghip:
Mu 03/DV Ph biu 07
K HOCH SN LNG V KINH PH H TR CUNG CP DCH V TRUYN DN TN HIU TRUYN HNH S

PHC V TRUYN HNH S DNG BNG TN KU CA V TINH VINASAT
Nm
STT
Tn tnh
1
2
3
4
5
S knh chng
M tnh trnh n 30/6
nm thc hin
C
S liu c nm thc hin
S liu nm k hoch
Sn lng
(lt knh)
Kinh ph
(ng)
Sn lng
(lt knh)
Kinh ph
(ng)
Ghi ch
6
7
Cng:
TRNG N V
(K ghi r h tn)
NGI LP BIU
(K ghi r h tn)
Ghi ch:
- Ct (3), ct (5) kinh ph bng Mc h tr nhn vi Sn lng (lt knh).
Doanh nghip:
Mu 03/DV Ph biu 08
K HOCH SN LNG V KINH PH H TR CUNG CP DCH V VIN THNG KHN CP V H TR TRA

CU S IN THOI C NH
Nm
S liu c nm thc hin

STT
Tnh/Thnh ph
S dch v
Tnh A
113
114
115
116
Tnh B
113
114
115
10
116
Sn lng
(pht)
Kinh ph
(ng)
S liu nm k hoch
Sn lng
Mc h tr (ng)
(pht)
3
Kinh ph
(ng)
5
Ghi ch
Cng:
TRNG N V
(K ghi r h tn)
NGI LP BIU
(K ghi r h tn)
Ghi ch: - S liu c nm thc hin l s liu thc hin Qu 1,2 v s liu c thc hin Qu 3,4 ca nm thc hin.
Doanh nghip:
Mu 03/DV Ph biu 09
K HOCH SN LNG V KINH PH H TR CUNG CP DCH V VIN THNG DI NG HNG HI PHC

V HOT NG TM KIM CU NN TRN BIN QUA H THNG I THNG TIN DUYN HI
Nm
S lng s kin n
STT
30/6 nm thc hin
A
S liu c nm thc hin
S liu nm k hoch
Ghi ch
Sn lng (pht)
Kinh ph (ng)
Sn lng (pht) Kinh ph (ng)

4
1
2
3
4
NGI LP BIU
(K ghi r h tn)
TRNG N V
(K ghi r h tn)
Ghi ch:
- Ct (1) s lng s kin n 30/6 l tng s s kin pht sinh t u nm n ht 30/6 nm thc hin.
- Thi gian bt u v thi im kt thc s kin c tnh t thi im C quan ch tr tm kim, cu nn yu pht v dng pht
thng tin tm kim, cu nn v ngi, phng tin ang gp nguy him trn bin.
- Ct (3), ct (5) kinh ph bng Mc h tr nhn vi Sn lng (pht).
Doanh nghip:
Mu 03/DV Ph biu 10
K HOCH SN LNG V KINH PH H TR CUNG CP DCH V VIN THNG PHC V HOT NG CH

O, IU HNH PHNG, CHNG THIN TAI
Nm
S liu c nm thc hin
STT
Dch v
Thu knh bng C VINASAT
Thu bao VSAT-IP
n v
Kinh ph Sn
(ng) lng
3
n v
5
knh
knh
thu bao
thu bao
Thoi/Fax
pht
pht
Truy nhp Internet ca trm
ngy
ngy
Thu bao VSAT-IP
Sn lng
S liu nm k hoch
Mc h tr Kinh ph
(ng)
(ng)
6
7=5*6
Ghi ch
VSAT-IP
4
Thu knh ring IP

2 Mbps
ngy/knh
ngy/knh
1 Mbps
ngy/knh
ngy/knh
512 Kbps
ngy/knh
ngy/knh
256 Kbps
ngy/knh
ngy/knh
128 Kbps
ngy/knh
ngy/knh
64 Kbps
ngy/knh
ngy/knh
2 Mbps
ngy/knh
ngy/knh
1 Mbps
ngy/knh
ngy/knh
512 Kbps
ngy/knh
ngy/knh
256 Kbps
ngy/knh
ngy/knh
Thit lp mng dng ring

VPN
128 Kbps
ngy/knh
ngy/knh
64 Kbps
ngy/knh
ngy/knh
pht
pht
Inmarsat tr sau loi

IsatPhonePro
thu bao
thu bao
Inmarsat tr sau loi BGAN
thu bao
thu bao
Inmarsat tr trc
thu bao
thu bao
Vin thng v tinh Inmarsat

Thoi/Fax/Truyn s liu ca
Inmarsat M n mng vin
thng c nh mt t
Cng
NGI LP BIU
(K ghi r h tn)
TRNG N V
(K ghi r h tn)
Doanh nghip:
Mu 03/DV Ph biu 11
K HOCH TNG HP KINH PH H TR CUNG CP DCH V VIN THNG CNG CH

Nm . . . . .
K hoch kinh ph theo dch v
Dch v Internet Di ng Thu
T c TH, BV, hng knh c
Tnh/Thnh
nh, di
UB x hi qua nh
STT
ph
ng
HF mt t
HN,HCN
An Giang
..
ng im TN Truyn Dch v
truyn Internet hnh s khn
dn cp cng
dng
cp,
quang
cng bng tn dch v
ra o
Ku ca tra cu
vinasat T
Tm
kim
cu
nn
trn
bin
qua HF
9
Hot
K
ng
hoch
c/o
Ghi ch
kinh ph
/hnh
theo tnh
phng
chng
thin tai
10
11
12
4
5
Cng:
NGI LP BIU
(K ghi r h tn)
Ghi ch:- S liu ct (9), ct (10) c tng hp trn ton quc.
TRNG N V
(K ghi r h tn)
Mu 04/DV
HP NG (MU)
T HNG CUNG NG DCH V VIN THNG CNG CH
(Km theo Thng t s
/2016/TT-BTTTT ngy .. thng . nm 2016 ca B Thng
tin v Truyn thng)
----------------
HP NG
T HNG CUNG CP DCH V VIN THNG CNG CH
S:
/H/VTCI
- Cn c B Lut Dn s ngy 14 thng 6 nm 2005;

- Cn c Lut Vin thng ngy 23 thng 11 nm 2009;
- Cn c Ngh nh s 25/2011/N-CPngy 06 thng 04 nm 2011ca Chnh ph quy
nh chi tit v hng dn thi hnh mt s iu ca Lut Vin thng;
- Cn c Quyt nh s 1168/Q-TTg ngy 24/7/2015 ca Th tng Chnh ph ph
duyt Chng trnh cung cp dch v vin thng cng ch n nm 2020;
- Cn c Quyt nh s
/Q-BTTTT ngy
thng nm
ca B Thng tin v
Truyn thng v vic ph duyt k hoch cung ng dch v vin thng cng ch nm;
Hm nay, ngy
thng
nm 20 , chng ti, i din cho cc Bn k Hp ng, gm
c:
Bn A - Bn t hng cung cp dch v dch v vin thng cng ch - (Tn Bn A):
Bn B - Bn nhn t hng cung cp dch v dch v vin thng cng ch - (Tn Bn
B):
Hai bn tha thun k Hp ng t hng cung cp dch v dch v vin thng cng ch
vi cc ni dung sau:
iu 1. Gii thch t ng:
Trong hp ng ny, cc t ng di y c hiu nh sau:
iu 2. i tng hp ng
Bn B nhn cung ng cc dch v vin thng cng ch nh cc Ph lc km theo hp
ng theo ng yu cu ca Bn A.
iu 3. Thnh phn Hp ng
Thnh phn Hp ng gm:
1. Vn bn Hp ng;
2. Cc Ph lc (s ph lc) km theo Hp ng. Cc ph lc l b phn khng tch ri
Hp ng ny.
3. Cc tha thun (nu c) gia hai bn tin hnh theo ng cc quy nh ca hp ng.
iu 4. Tiu chun cht lng v gi cc
Bn B m bo thc hin vic cung ng cc dch v vin thng cng ch nu ti iu 2
ca Hp ng p ng cc tiu chun cht lng v gi cc vin thng cng ch theo
quy nh hin hnh ca Nh nc.
iu 5. Khu vc, a im cung ng dch v vin thng cng ch
iu 6. Thi gian thc hin hp ng: Trong nm 20..
iu 7. Gi tr Hp ng
1. Tng gi tr ca Hp ng l (tm tnh):.......................... ng.
(S tin bng ch:......................... )
Hai bn thng nht s iu chnh gi tr Hp ng sau khi c Quyt nh ph duyt k
hoch kinh ph h tr cung ng dch v vin thng cng ch nm 20 . . . . ca B Thng
tin v Truyn thng.
2. Trng hp Bn B thc hin cung ng dch v vin thng cng ch vt ch tiu c
t hng ti Hp ng ny do pht sinh i tng th hng trong nm v lu lng lin
lc thc t th hai bn thng nht p dng cc nguyn tc thanh ton b sung.
iu 8. Tm ng, thanh ton kinh ph thc hin Hp ng
iu 9. Trch nhim ca Bn B
..
iu 10. Trch nhim ca Bn A
..
iu 11. Sa i, b sung Hp ng
1. Hai bn khng c t sa i, b sung cc ni dung hp ng k kt.
2. Khi mt bn c nhu cu sa i, b sung ni dung Hp ng th phi thng bo bn
kia tin hnh thng tho thay i ni dung hp ng k kt. Trong phm vi 10 ngy
lm vic, Bn nhn c ngh c trch nhim tr li bn kia cc kin cn sa i.
3. Mi tha thun v sa i, b sung Hp ng c hai bn th hin bng Bin bn sa
i b sung Hp ng v c lp thnh Ph lc sa i b sung Hp ng c hai bn
k kt v l b phn khng tch ri ca Hp ng.
iu 12. Vi phm Hp ng
1. Vi phm t Bn B:
a) Trng hp Bn B vi phm cc ni dung v gi cc, cht lng dch v th Bn B
chu hon ton trch nhim theo quy nh ca php lut. Trong trng hp vi phm
nghim trng, Bn A c quyn n phng chm dt Hp ng theo kt lun ca c
quan Nh nc c thm quyn.
b) Trng hp Bn B cung ng dch v vin thng cng ch khng ng a im, khng
ng i tng c h tr nh Hp ng, Bn A c quyn khng thanh ton kinh ph
h tr i vi sn lng dch v vin thng cung ng khng ng theo Hp ng.
c) Trng hp Bn B khng thc hin ngha v bo co tnh hnh thc hin cung ng cc
dch v vin thng cng ch theo quy nh ca nh nc; Bn A khng c ngha v phi
bi thng cc thit hi kinh t cho Bn B do vic khng nhn c tin tm ng, thanh
ton kinh ph theo ng tin tha thun trong Hp ng.
2. Vi phm t Bn A:
a) Trong trng hp Bn A tm ng, thanh ton kinh ph h tr chm cho Bn B qu thi
gian quy nh 01 thng, m khng c l do c Bn B chp thun th phi tr li s tin
chm thanh ton theo li sut tin vay trung hn ca Ngn hng u t Pht trin Vit
Nam cng thi im tng ng.
b) Trng hp Bn A t hy b, hoc thay i Hp ng m khng phi do nhng l
do bt kh khng nh khon 1 iu 14 di y th phi chu bi thng thit hi cho
Bn B. Mc bi thng do hai bn tha thun. Trng hp hai bn khng tha thun
c m mt hoc c hai bn a v vic ra Ta n, hai bn thng nht chp thun theo
phn quyt ca Ta n Thnh ph H Ni.
iu 13. Th tc chm dt Hp ng do vi phm

1. Nu mt trong hai bn c vi phm nghim trng nhng iu khon k kt trong
Hp ng th Bn kia c quyn n phng chm dt vic thc hin mt phn hay ton
b hp ng v trong vng 07 ngy v phi c vn bn thng bo cho Bn kia bit.
2. Trong trng hp hp ng b chm dt thc hin mt phn th Bn A c quyn k
hp ng vi n v cung ng dch v vin thng cng ch khc thc hin phn hp ng
b chm dt. Bn B vn c trch nhim thc hin tip phn hp ng khng b chm dt
hiu lc.
iu 14. Trng hp bt kh khng
1. Hai bn thng nht rng, trong trng hp c quan nh nc c thm quyn thay i
chnh sch, ch , trng hp c chin tranh, bo lon, nh cng, ha hon, l lt, dch
bnh, cch ly do kim dch, cm vn l cc trng hp bt kh khng cho tt c cc bn
v khng bn no c quyn i hi vic b p thit hi (nu c) t Bn cn li.
2. Khi xy ra trng hp bt kh khng, cc bn phi kp thi thng bo bng vn bn
cho nhau v cng phi hp gii quyt.
iu 15. Gii quyt tranh chp
1. Khi pht sinh tranh chp trc ht hai bn s tin hnh thng lng, ha gii.
2. Trong trng hp hai bn vn khng tha thun c vi nhau th c quyn gi yu
cu n Ta n Thnh ph H Ni gii quyt.
iu 16. Phi hp lm vic v t chc thanh l Hp ng
iu 17. Hiu lc hp ng
1. Hp ng c hiu lc k t ngy k kt gia hai bn.
2. Hp ng ht hiu lc sau khi:
a) Hai bn hon thnh thanh l Hp ng;
b) Hp ng b c quan nh nc c thm quyn tuyn b v hiu.
Hp ng c lp thnh 8 b, mi b c trang, nh s th t t trang 01 n trang
(bao gm c cc Ph lc Hp ng) mi bn gi 04 b, cc b Hp ng c gi tr php
l nh nhau.
I DIN BN A
I DIN BN B
MU 05/DV - Bo co sn lng thc hin

Ph biu 01 - Cng vn ngh nghim thu sn lng, kinh ph h tr qu
Tn doanh nghip
------S:.

--------------
V vic.......
......, ngy... thng.... nm ...
NGH
Qu ..............
NGHIM
THU
SN
LNG,
KINH
PH
TR
Knh gi: Ban Qun l Chng trnh vin thng cng ch

Thc hin Hp ng t hng . . . . . .. . .
Doanh nghip thc hin h tr cung cp dch v vin thng cng ch Qu . . .
nm ( c Ph lc bo co sn lng v kinh ph km theo)
..
.
ngh Ban Qun l Chng trnh cung cp dch v vin thng cng ch t chc nghim
thu theo quy nh
Lnh o doanh nghip

Ni nhn:
...
(K tn, ng du)
Doanh nghip:
Mu 05/DV Ph biu 02
BO CO SN LNG V KINH PH THC HIN H TR CUNG CP DCH V VIN THNG CNG CH

Qunm ...
Sn lng h tr
STT
Dch v
Dch v in thoi c nh mt t tr sau
Dch v thng tin di ng mt t tr sau
Dch v vin thng di ng hng hi phc v

hot ng tm kim cu nn trn bin
Dch v vin thng di ng hng hi qua h

thng i thng tin duyn hi
Dch v truy nhp Internet bng rng c nh

tr sau cho trng hc, bnh vin, y ban
Sn lng
n v
Kinh ph h tr
(ng)
Ghi ch
nhn dn x
Dch v truy nhp Internet bng rng c nh

tr sau ti cc im truy nhp Internet bng
rng
Dch v thu knh ring c nh mt t
Dch v truyn dn tn hiu truyn hnh s

qua bng Ku ca v tinh VINASAT
Dch v tr gip tra cu s thu bao in

thoi c nh v Dch v vin thng bt buc
Thit lp ng truyn dn cp quang kt nt

t t lin n trung tm hnh chnh ca cc
10
huyn o trn c s h tng cp quang ca
EVN
11
Dch v vin thng v tinh phc v hot ng

ch o, iu hnh phng, chng thin tai
NGI LP BIU
I DIN DOANH NGHIP
(K ghi r h tn)
Doanh nghip:
Mu 05/DV Ph biu 03
BNG K H NGHO, H CN NGHO C H TR CUNG CP DCH V IN THOI C NH MT T

TR SAU V DCH V THNG TIN DI NG MT T TR SAU
Thngnm
S
S in thoi
Kinh ph
M
Tn ch CMND M s
Tn ch
S hp S ha Cc
STT
M x
a ch
h tr Ghi ch
huyn
h
h
thu bao
ng n pht sinh
ca ch
C nh Di ng
(ng)
h
A
1
2
Ghi ch:
10
11
12
Doanh nghip vin thng ch bo co nhng thu bao c s dng dch v in thoi c nh mt t tr sau, dch v thng tin di ng
trong thng v gi bn mm v Ban Qun l Chng trnh.
Ct (9): Ghi s trn ha n c lp khi doanh nghip bn dch v cho khch hng.
Ct (10): Ghi gi tr cc pht sinh (cha bao gm thu VAT) do khch hng s dng dch v.
Ct (11): Ghi gi tr kinh ph doanh nghip ngh h tr.
Doanh nghip:
Tnh:....
Mu 05/DV Ph biu 04
BO CO SN LNG V KINH PH THC HIN H TR CUNG CP DCH V IN THOI C NH MT T

TR SAU CHO H NGHO, H CN NGHO
Qunm
Sn lng
Kinh ph
Thng th
Tng sn
ST M
Ghi
Thng th
Thng th Thng th Thng th Tng kinh ph
M x Thng th
hai
lng
T huyn
ch
nht
ba
nht
hai
ba
h tr
(thu
(lt thu
(thu bao)
(thu bao)
(ng)
(ng)
(ng)
(ng)
bao)
bao)
A
4=1+2+3
8=5+6+7
1
2
3
4
5
6
7
NGI LP BIU
(K ghi r h tn)
K TON TRNG
(K, ghi r h v tn)
GIM C
(K tn, ng du)
Ghi ch:
Doanh nghip vin thng ch tng hp nhng thu bao c s dng dch v in thoi c nh mt t tr sau hoc dch v thng tin di
ng trong thng.
Doanh nghip:
Tnh:....
Mu 05/DV Ph biu 05
BO CO SN LNG V KINH PH THC HIN H TR CUNG CP DCH V DCH V THNG TIN DI NG

MT T TR SAU CHO H NGHO, H CN NGHO
Qunm
Sn lng
ST
M
T huyn
A
1
2
3
4
Thng
M
Thng th
th hai
x
nht
(thu
(thu bao)
bao)
C
Kinh ph
Thng
th ba
(thu
bao)
Tng sn
lng
(lt thu
bao)
4=1+2+3
Thng th Thng th
nht
hai
(ng)
(ng)
5
Thng th Tng kinh ph Ghi ch

ba
h tr
(ng)
(ng)
7
8=5+6+7
5
6
7
NGI LP BIU
(K ghi r h tn)
K TON TRNG
(K, ghi r h v tn)
GIM C
(K tn, ng du)
Ghi ch:
Doanh nghip vin thng ch tng hp nhng thu bao c s dng dch v in thoi c nh mt t tr sau hoc dch v thng tin di
ng trong thng.
Doanh nghip:
Mu 05/DV Ph biu 06
BO CO SN LNG V KINH PH THC HIN H TR CUNG CP DCH V IN THOI C NH MT T

TR SAU V DCH V THNG TIN DI NG MT T TR SAU CHO H NGHO, H CN NGHO
Qunm
Dch v in thoi c nh mt t tr sau
STT
Tnh/Thnh
ph
1
2
3
4
5
6
7
Tng s lt thu
Kinh ph h tr trong Tng s lt thu bao Kinh ph h tr trong
bao c h tr
qu
c h tr trong qu
qu
trong qu (lt thu
(ng)
(lt thu bao)
(ng)
bao)
1
Ghi ch
NGI LP BIU
(K ghi r h tn)
GIM C
(K tn, ng du)
K TON TRNG
(K, ghi r h v tn)
Doanh nghip:
Mu 05/DV Ph biu 07
BNG K TRNG HC, BNH VIN, Y BAN NHN DN CP X C H TR CUNG CP DCH V TRUY
NHP INTERNET BNG RNG C NH TR SAU
Thngnm
STT
A
1
2
Tn trng
M
hc, bnh a ch lp M thu
M x
huyn
vin, y ban
t
bao
nhn dn x
B
S hp
ng
Gi cc S ha
truy nhp
n
Cc truy Kinh ph h
nhp
tr
Ghi ch
(ng)
(ng)
7
3
4
5
Ghi ch: Doanh nghip vin thng ch bo co nhng thu bao c s dng dch v trong thng v gi bn mm v Ban Qun l
Chng trnh.
Doanh nghip:
Tnh: ....
Mu 05/DV Ph biu 08
BO CO SN LNG V KINH PH THC HIN H TR CUNG CP DCH V TRUY NHP INTERNET BNG
RNG C NH TR SAU CHO TRNG HC, BNH VIN, Y BAN NHN DN CP X
Qunm
Sn lng
M
STT
huyn
M x
I M
huyn A
1
M x 1
Gi 4Mbps
Gi
12Mbps
Gi
32Mbps
Gi
45Mbps
Kinh ph
Thng
Thng Thng
Gi cc
th
Thng
th hai th ba
Tng s
truy nhp Thng th
nht
th hai
(thu (thu (lt thu bao)
nht (ng)
(ng)
(thu
bao)
bao)
bao)
1
4=1+2+3
Thng
th ba
(ng)
Tng kinh
ph h tr
(ng)
Ghi
ch
9=6+7+8
10
M x 2
Cng
NGI LP BIU
(K, ghi r h v tn)
K TON TRNG
(K, ghi r h v tn)
Doanh nghip:
GIM C
(K tn, ng du)
Mu 05/DV Ph biu 09
BO CO SN LNG V KINH PH THC HIN H TR CUNG CP DCH V TRUY NHP INTERNET BNG
RNG C NH TR SAU CHO TRNG HC, BNH VIN, Y BAN NHN DN CP X
Qunm
STT
Tnh/Thnh ph
Tng s lt thu bao

c h tr trong qu
(lt thu bao)
Gi cc truy nhp
Kinh ph h tr
(ng)
Ghi ch
A
1
Tnh A
Gi 4Mbps
Gi 12Mbps
Gi 32Mbps
Gi 45Mbps
Tnh B
NGI LP BIU
(K, ghi r h v tn)
K TON TRNG
(K, ghi r h v tn)
GIM C
(K tn, ng du)
Doanh nghip:
Mu 05/DV Ph biu 10
BNG K IM TRUY NHP INTERNET CNG CNG C H TR DUY TR

Thngnm
Tn im a ch lp
STT M huyn M x
truy nhp
t
A
M thu S hp
S ha
Gi cc
bao
ng
n
3
Cc truy Kinh ph h
nhp
tr
(ng)
(ng)
7
Ghi ch
1
2
3
Ghi ch: Doanh nghip vin thng ch bo co nhng im c cung cp dch v trong thng v gi bn mm v Ban Qun l Chng
trnh.
Doanh nghip:
Tnh:
Mu 05/DV Ph biu 11
BO CO SN LNG V KINH PH H TR DUY TR IM TRUY NHP INTERNET CNG CNG

Qunm
Sn lng
STT
M
huyn
1
2
3
4
M x Thng th Thng
nht
th hai
(im)
(im)
C
Kinh ph
Thng
Thng Thng
Tng s
th ba
th nht th hai
(lt (im)
(im)
(ng) (ng)
3
4=1+2+3
Thng
th ba
(ng)
Tng kinh
ph h tr
(ng)
Ghi ch
8=5+6+7
5
6
7
NGI LP BIU
(K, ghi r h v tn)
K TON TRNG
(K, ghi r h v tn)
Doanh nghip:
GIM C
(K tn, ng du)
Mu 05/DV Ph biu 12
BO CO SN LNG V KINH PH H TR DUY TR IM TRUY NHP INTERNET CNG CNG

Qunm
STT
Tnh/Thnh ph
Tng s lt im c h tr
(lt im)
Kinh ph h tr
(ng)
Ghi ch
1
2
3
4
5
6
7
NGI LP BIU
(K, ghi r h v tn)
Doanh nghip:
K TON TRNG
(K, ghi r h v tn)
GIM C
(K tn, ng du)
Mu 05/DV Ph biu 13
Tnh:....
BNG K KNH THU RING C NH MT T C H TR CA CC BNH VIN V TINH, BNH VIN

HT NHN
Thngnm
STT
M
huyn
1
2
3
4
5
6
7
M x
Tn bnh
vin
a ch
lp t
M
knh
S hp
ng
Tc
knh
S ha Cc
n thu knh
6
Kinh ph h
tr
(ng)
Ghi ch
Ghi ch: Doanh nghip vin thng ch bo co nhng knh trong thng v gi bn mm v Ban Qun l Chng trnh.
Ct (7): Ghi gi tr cc thu knh (cha bao gm thu VAT) do khch hng s dng dch v.
Doanh nghip:
Mu 05/DV Ph biu 14
BO CO SN LNG V KINH PH THC HIN H TR CUNG CP DCH V THU KNH RING C NH

MT T CA BNH VIN V TINH, BNH VIN HT NHN
Qunm
Sn lng
STT
Kinh ph
Tnh/Thnh ph
Thng
Thng
Thng
Tng s
Thng
Thng
Thng
Tng s
Ghi ch
th nht th hai
(knh)
(knh)
A
th ba (lt knh) th nht th hai

(knh)
(ng) (ng)
3
th ba
(ng)
(ng)
1
2
3
4
5
6
7
NGI LP BIU
(K, ghi r h v tn)
K TON TRNG
(K, ghi r h v tn)
GIM C
(K tn, ng du)
Doanh nghip:
Mu 05/DV Ph biu 15
BNG K KNH CHNG TRUYN DN TN HIU TRUYN HNH S S DNG BNG TN KU CA V TINH
VINASAT C H TR
Thng . . .nm.
STT
Tn i pht
thanh truyn hnh
a ch
S hp ng
S ha
n
1
2
3
4
5
6
Cc thu Kinh ph h
knh
tr
(ng)
(ng)
5
Ghi ch
Ghi ch: Doanh nghip vin thng ch bo co nhng knh chng trnh trong thng v gi bn mm v Ban Qun l Chng trnh.
Ct (5): Ghi gi tr cc thu knh (cha bao gm thu VAT) do khch hng s dng dch v.
Doanh nghip:
Mu 05/DV Ph biu 16
BO CO SN LNG V KINH PH THC HIN H TR CUNG CP DCH V TRUYN DN TN HIU

TRUYN HNH S PHC V TRUYN HNH S DNG BNG TN KU CA V TINH VINASAT
Qu . . .nm.
Sn lng
STT Tnh/Thnh ph
Thng Thng Thng th

th nht th hai
ba
(knh) (knh)
(knh)
Kinh ph
Tng s
(lt
knh)
Thng th Thng Thng

nht
th hai th ba
(ng)
(ng) (ng)
Tng s
(ng)
Ghi ch
1
2
3
4
5
6
7
NGI LP BIU
(K, ghi r h v tn)
Doanh nghip:
K TON TRNG
(K, ghi r h v tn)
GIM C
(K tn, ng du)
Mu 05/DV Ph biu 17
BNG K THU BAO VIN THNG DI NG HNG HI QUA H THNG I THNG TIN DUYN HI C
H TR
Thng . . .nm
STT
Lu lng lin lc
S giy
S ha
Kinh
Mc h
(pht)
Tn ch Bin s M thu S hp chng nhn n,
ph h
tr
thu bao
tu
bao
ng ng k tu chng
tr
C nh C nh
(ng)
Di ng
c
t
(ng)
ni tnh lin tnh
B
Ghi ch
1
2
3
Ghi ch: Doanh nghip vin thng ch bo co nhng thu bao c s dng dch v trong thng v gi bn mm v Ban Qun l
Chng trnh.
Ct (6): Ghi s lng pht lin lc do khch hng s dng dch v.

Doanh nghip:
Tnh: ....
Mu 05/DV Ph biu 18
BO CO SN LNG V KINH PH THC HIN H TR CUNG CP DCH V VIN THNG DI NG HNG

HI QUA H THNG I THNG TIN DUYN HI
Qunm
Sn lng
STT Tnh/Thnh ph
A
1
B
Tnh A
C nh ni tnh
Thng
Thng
th nht th hai
(pht)
(pht)
1
Kinh ph
Thng
th ba
(pht)
Tng s
(pht)
Thng Thng
th nht th hai
(ng) (ng)
5
Thng
th ba
(ng)
Tng s
(ng)
Ghi ch
C nh lin tnh
Di ng
2
Tnh B
NGI LP BIU
(K, ghi r h v tn)
Doanh nghip:
K TON TRNG
(K, ghi r h v tn)
GIM C
(K tn, ng du)
Mu 05/DV Ph biu 19
BNG K S KIN TM KIM, CU NN TRN BIN QUA H THNG I THNG TIN DUYN HI C H
TR
Thngnm
STT
M s kin
S kin/Phng Thi gian Thi gian

tin
bt u
kt thc
2
Thi lng Mc h Kinh ph

s kin
tr
h tr
(gi)
(ng)
(ng)
5
Ghi ch
1
2
3
4
5
Ghi ch: Doanh nghip vin thng ch bo co s kin trong thng v gi bn mm v Ban Qun l Chng trnh.
Ct (1): Ghi m h s s kin km theo.
Ct (2): Ghi bin s tu v tnh cht tai nn.
Ct (3), ct (4) Thi gian bt u v thi im kt thc s kin c tnh t thi im C quan ch tr tm kim, cu nn yu cu pht
v dng pht thng tin tm kim, cu nn v ngi, phng tin ang gp nguy him trn bin theo quy nh.
Ct (6): Mc h tr
Doanh nghip:
Mu 05/DV Ph biu 20
BO CO SN LNG V KINH PH THC HIN H TR CUNG CP DCH V VIN THNG DI NG HNG

HI QUA H THNG I THNG TIN DUYN HI PHC V HOT NG TM KIM, CU NN TRN BIN
Qunm
Sn lng
STT
A
1
Kinh ph
Thng th nht Thng th hai Thng th ba

(gi)
(gi)
(gi)
1
Tng s
(gi)
4
Thng th
Thng th hai Thng th ba
nht
(ng)
(ng)
(ng)
5
Tng s
(ng)
8
Ghi
ch
NGI LP BIU
(K, ghi r h v tn)
GIM C
(K tn, ng du)
K TON TRNG
(K, ghi r h v tn)
Doanh nghip:
Mu 05/DV Ph biu 21
BO CO SN LNG V KINH PH THC HIN H TR CUNG CP DCH V VIN THNG KHN CP V H

TR TRA CU S IN THOI C NH
Qunm
Thng th nht Thng th hai Thng th ba Tng s pht lin Mc h
STT Tnh/Thnh ph
(pht)
(pht)
(pht)
lc trong qu
tr
A
1
B
Tnh A
4=1+2+3
Kinh ph
h tr
(ng)
Ghi ch
113
114
115
116
Tnh B
113
114
115
10 116
NGI LP BIU
(K, ghi r h v tn)
K TON TRNG
(K, ghi r h v tn)
GIM C
(K tn, ng du)
Doanh nghip:
Mu 05/DV Ph biu 22
BO CO KINH PH THC HIN H TR CUNG CP DCH V VIN THNG V TINH PHC V HOT NG
CH O, IU HNH PHNG, CHNG THIN TAI
Qu . . .nm.
Lu lng pht sinh
STT
Tn dch v
1
2
3
4
Thng Thng
th nht th hai
(ng) (ng)
1
Thng
th ba
(ng)
Tng cc s
dng
4=1+2+3
Kinh ph h tr
Thng Thng Thng
Ghi ch
Tng kinh ph h
th nht th hai th ba
tr
(ng) (ng) (ng)
5
8=5+6+7
NGI LP BIU
(K, ghi r h v tn)
K TON TRNG
(K, ghi r h v tn)
GIM C
(K tn, ng du)
Ghi ch:
Ct (1), (2), (3) Ghi cc s dng cha bao gm thu VAT.
Ct (4): Ghi tng cc s dng cha bao gm thu VAT.
Ct (5), (6), (7) Ghi kinh ph h tr.
Ct (8): Ghi tng kinh ph h tr.
Doanh nghip:
Mu 05/DV Ph biu 23
BO CO SN LNG V KINH PH THC HIN H TR THIT LP NG TRUYN DN CP QUANG T

T LIN N TRUNG TM HNH CHNH CA CC HUYN O
Qu . . .nm.
STT
Tn huyn o
Gi tr ha n
Kinh ph h tr
Ghi ch
Thng
th nht
(ng)
Thng
th hai
(ng)
Thng
th ba
(ng)
Tng gi tr Thng
Thng
ha n
th nht th hai
(ng)
(ng)
(ng)
4=1+2+3
Thng
th ba
(ng)
Tng kinh
ph h tr
8=5+6+7
1
2
3
4
5
NGI LP BIU
(K, ghi r h v tn)
K TON TRNG
(K, ghi r h v tn)
Ghi ch:
Ct (1), (2), (3) Ghi gi tr ha n cha bao gm thu VAT.
GIM C
(K tn, ng du)
Ct (4): Ghi tng gi tr ha n cha bao gm thu VAT.

Ct (5), (6), (7) Ghi kinh ph h tr.
Ct (8): Ghi tng kinh ph h tr.
Mu 06/DV - Bin bn nghim thu

Ph biu 01 - Bin bn
-------------.., ngy .thng. nm 20..
BIN BN NGHIM THU
SN LNG, KINH PH H TR DCH V VIN THNG CNG CH
Qunm
Doanh nghip:.
I. Thnh phn tham gia
1. i din Ban Qun l Chng trnh cung cp dch v vin thng cng ch (bn A):
- ng (b):................................Chc v:..............................................................................
2. i din doanh nghip (bn B):
- ng (b):................................... Chc v: ..........................................................................
II. Ni dung nghim thu
Phm vi:
Nghim thu thc hin hp ng t hng cung ng dch v vin thng cng ch s .../
/H/VTCI qu... nm ......(hoc nm ......) ca.....................................................................
S liu nghim thu:
S liu nghim thu chi tit trong Ph lc km theo
Thuyt minh.
(Nu r nguyn nhn chnh lch gia s liu nghim thu ca Ban Qun l v s liu bo
co ca doanh nghip (nu c):.............................................................................................
...............................................................................................................................................
III. Nhn xt, kin ngh.
Nhn xt:
...........................................................................................................................................
Kin ngh vi c quan cp trn.

...............................................................................................................................................
3. Kt lun:
Bin bn ny c lp thnh bn, mi bn gi bn.
i din doanh nghip
i din Ban Qun l Chng trnh
(K, h tn, ng du)
(K, h tn, ng du)
Doanh nghip:
Mu 06/DV Ph biu 02
SN LNG V KINH PH THC HIN H TR CUNG CP DCH V VIN THNG CNG CH

Qu..nm ...
STT
Dch v
Dch v in thoi c nh mt t tr
sau
Dch v vin thng di ng hng hi

phc v hot ng tm kim cu nn
trn bin
Sn liu ngh
nghim thu
Sn liu nghim thu
Chnh lch
Ghi ch
Sn lng
Kinh ph
Sn lng
Kinh ph Sn lng Kinh ph

2
Dch v truy nhp Internet bng rng c

nh tr sau cho trng hc, bnh vin,
y ban nhn dn x
Dch v duy tr im truy nhp Internet

bng rng
Dch v thu knh ring c nh mt t
Dch v truyn dn tn hiu truyn hnh

s qua bng Ku ca v tinh VINASAT
Dch v tr gip tra cu s thu bao in

thoi c nh v Dch v vin thng bt
buc
Thit lp ng truyn dn cp quang

kt nt t t lin n trung tm hnh
10
chnh ca cc huyn o trn c s h
tng cp quang ca EVN
Dch v vin thng v tinh phc v hot
11 ng ch o, iu hnh phng, chng
thin tai
.., ngy. thng .. nm

I DIN BAN QUN L CHNG TRNH
(K, ghi r h tn)
I DIN DOANH NGHIP

(K, ghi r h tn)
Doanh nghip:
Mu 06/DV Ph biu 03

Dch v: . . . . . . . .
Qu . . . . . nm . . .
S liu ngh nghim thu
STT
A
1
2
Tnh/
Thnh ph
S liu nghim thu
S liu chnh lch
Sn lng
Kinh ph
(ng)
Sn lng
Kinh ph
(ng)
Sn lng
Kinh ph
(ng)
Ghi ch
3
4
5
6
7
Doanh nghip:
Mu 06/DV Ph biu 04

Nm ...
STT
Dch v
Sn liu hp Sn liu ngh Sn liu nghim

ng t hng
nghim thu
thu
Sn
Kinh
Sn
Kinh
Sn
Chnh lch
Kinh Sn lng Kinh ph
Ghi ch
Dch v in thoi c nh mt t tr
sau
Dch v thng tin di ng mt t tr

sau

phc v hot ng tm kim cu nn
trn bin
Dch v truy nhp Internet bng rng

c nh tr sau cho trng hc, bnh
vin, y ban nhn dn x
Dch v duy tr im truy nhp

Internet bng rng
Dch v thu knh ring c nh mt

t
lng
ph
lng
ph
lng
ph
(7)=(3)(8)=(4)-(6)
(5)
Dch v truyn dn tn hiu truyn

hnh s qua bng Ku ca v tinh
VINASAT
Dch v tr gip tra cu s thu bao

in thoi c nh v Dch v vin
thng bt buc
Thit lp ng truyn dn cp quang

kt nt t t lin n trung tm hnh
10
chnh ca cc huyn o trn c s h
tng cp quang ca EVN
Dch v vin thng v tinh phc v
11 hot ng ch o, iu hnh phng,
chng thin tai
I DIN DOANH NGHIP

(K, ghi r h tn)
.., ngy. thng .. nm

I DIN BAN QUN L CHNG TRNH
(K, ghi r h tn)
Doanh nghip:
Mu 06/DV Ph biu 05

Dch v: . . . . . . . .
Nm . . .
S liu ngh nghim thu
STT
Tnh/
Thnh ph
1
2
3
4
5
Sn lng
(lt thu bao)
Kinh ph
(ng)
S liu nghim thu

Sn lng
Kinh ph
(lt thu bao) (ng)
3
S liu chnh lch

Sn lng
(lt thu
bao)
Kinh ph
(ng)
Ghi ch
6
7
Mu 07/DV Bin bn thanh l hp ng t hng cung ng dch v vin thng cng ch

Ph biu 01 - Bin bn
c lp- T do- Hnh phc
-------------H Ni, ngy thng nm 20. . .
BIN BN THANH L HP NG T HNG
CUNG NG DCH V VIN THNG CNG CH
S: /H/VTCI 20. . .
S:
/H/DVVTCI
- Cn c B Lut Dn s ngy 14 thng 6 nm 2005;

- Cn c Lut Vin thng ngy 23 thng 11 nm 2009;
- Cn c Ngh nh s 25/2011/N-CP ngy 06 thng 04 nm 2011ca Chnh ph quy
nh chi tit v hng dn thi hnh mt s iu ca Lut Vin thng v vin thng;
- Cn c Quyt nh s 1168/Q-TTg ngy 24/7/2015 ca Th tng Chnh ph ph
duyt Chng trnh cung cp dch v vin thng cng ch n nm 2020;
- Cn c Quyt nh s
/Q-BTTTT ngy thng nm ca B trng B Thng
tin v Truyn thng v vic ph duyt k hoch cung ng dch v vin thng cng ch
nm;
Hm nay, ngy
thng
nm 20 , ti H Ni chng ti gm:
BN A: Bn t hng cung ng dch v vin thng cng ch Ban Qun l chng

trnh cung cp dch v vin thng cng ch
i din .............................................................................................................................
Chc v..............................................................................................................................
a ch................................................................................................................................
in thoi...........................................................................................................................
Fax......................................................................................................................................
Ti khon...........................................................................................................................
Ti......................................................................................................................................
M s thu..........................................................................................................................
BN B: Bn nhn t hng cung ng dch v vin thng cng ch i din ..........
Chc v..............................................................................................................................
a ch................................................................................................................................
in thoi...........................................................................................................................
Fax......................................................................................................................................
Ti khon...........................................................................................................................
Ti......................................................................................................................................
M s thu..........................................................................................................................
Hai bn thng nht k kt Bin bn thanh l Hp ng t hng cung ng dch v vin
thng cng ch s: /H/VTCI ngy / / vi cc ni dung nh sau:
I. H s ca Bin bn thanh l:
1. Bin bn thanh l v ph lc s liu chi tit.
2. Cc bin bn nghim thu sn lng, bin bn xc nh kinh ph cung ng dch v vin
thng cng ch:
- Bin bn nghim thu dch v vin thng cng ch nm
ngy
theo Hp ng t
hng s /H/VTCI
ngy gia Ban Qun l chng trnh cung cp dch v vin
thng cng ch vi . . . . . . . .. .. ;
II. Phm vi thanh l:
Thanh l phn sn lng v kinh ph thc hin cung ng dch v vin thng cng ch
thuc hp ng t hng s /H/VTCI
ngy cho .
III. Ni dung cc iu khon thanh l:
iu 1: Tnh hnh chung thc hin Hp ng t hng
iu 2: Kt qu thc hin Hp ng t hng
Tng kinh ph h tr doanh nghip c thanh ton trong nm
2.2. Bn B cung ng cc dch v vin thng cng ch cho cc i tng c hng

chnh sch h tr s dng dch v vin thng cng ch theo quy nh ca Nh nc.
iu 3: Thanh ton kinh ph thc hin Hp ng

3.1. Tng gi tr Hp ng t hng s
/H/VTCI
ngy
3.2. Kinh ph c B Thng tin v Truyn thng ph duyt l:

3.3. Tng kinh ph h tr doanh nghip c thanh ton theo cc bin bn nghim thu
kinh ph h tr cung ng dch v vin thng cng ch trong l:
3.4. Tng s kinh ph tm ng cho doanh nghip cung cp dch v vin thng cng ch
nm:
* Tm cp t 1:
ng ngy
* Tm cp t 2: ng ngy :
3.5. Kinh ph doanh nghip cn c thanh ton (hoc thu hi) = Kinh ph c thanh
ton (3.3) Kinh ph tm ng (3.4)
iu 4: Bn A c ngha v thanh ton cho bn B phn kinh ph nh ghi ti khon 3.5
iu 3 bin bn ny trong phm vi 01 thng, k t ngy hai bn hon thnh th tc thanh
l Hp ng t hng s /H/VTCI ngy (theo quy nh ti khon 6 iu 8 Hp
ng t hng s: /H/VTCI ngy
iu 5: Sau khi c B Thng tin v Truyn thng ph duyt quyt ton nm , bn A
s thng bo kt qu ph duyt quyt ton s kinh ph h tr cung ng dch v vin thng
cng ch nm
cho bn B.
iu 6: Ban Qun l chng trnh vin thng cng ch v thng nht c thanh l v
kt thc Hp ng t hng s /H/VTCI
ngy
Bin bn ny gm 06 iu, trang c nh s lin tc t trang 01 n trang v

ph lc i km. Bin bn ny c lp thnh 06 bn, c gi tr php l nh nhau. Mi
bn gi 03 bn./.
I DIN BN A
I DIN BN B
Mu 01/THS n ngh h tr u thu truyn hnh s

--------------
N NGH H TR U THU TRUYN HNH S

Knh gi: S Thng tin v Truyn thng Tnh (Thnh ph).........
Ti tn l: .............................................................................................................................
S CMND ca ch h ni cp cp ngy ......................................
in thoi:.............................................................................................................................
Ch hin ti:.......................................................................................................................
M s h ngho, cn ngho:
L ch h gia nh thuc din:
H ngho
H cn ngho
theo tiu chun ngho, cn ngho quy nh ti Quyt nh s 59/2015/Q-TTg ca Th
tng Chnh ph ngy 19/11/2015 v vic ban hnh chun ngho tip cn a chiu p
dng cho giai on 2016 - 2020.
Hin nay, gia nh ti ang s dng my thu hnh cng ngh tng t cha tch hp tnh
nng thu truyn hnh s theo chun DVB-T2, cha c u thu truyn hnh s DVB-T2,
cha s dng bt k mt trong cc phng thc truyn hnh tr tin nh truyn hnh cp,
truyn hnh v tinh, truyn hnh IPTV.
Ti lm n ny ngh c h tr u thu truyn hnh s s dng cho gia nh v
cam kt khng bn, cho, tng u thu c h tr. Ti xin cam oan cc thng tin nu
trn l ng s tht, nu sai ti xin chu hon ton trch nhim trc php lut.
Trn trng cm n./.
., ngythngnm
XC NHN CA TRNG THN/PH
NGI LM N
(K v ghi r h tn)
(K v ghi r h tn)
XC NHN CA UBND X, PHNG

Ghi ch: Ch hin ti ghi r thn, x, huyn, tnh (Thnh ph)
Mu 02/THS
Danh sch tng hp i tng c h tr u thu truyn hnh s
UBND TNH, THNH PH
BNG TNG HP I TNG IU KIN C HNG H TR U
THU TRUYN HNH S
(Ban hnh km theo Thng t s /2016/TT-BTTTT ngy thng nm 2016 ca B
trng B Thng tin v Truyn thng)
TT
A
i tng h tr
B
Tng
1
H ngho
H cn ngho
Ghi ch
2
Tng
NGI LP BIU
(K, ghi r h v tn)
.., ngy.thng .. nm
TM. Y BAN NHN DN
CH TCH
Mu 03/THS
Danh sch h ngho c hng h tr u thu truyn hnh s
UBND TNH, THNH PH
DANH SCH H NGHO IU KIN C HNG H TR U THU

TRUYN HNH S TRN A BN TNH, THNH PH
(Ban hnh km theo Thng t s /2016/TT-BTTTT ngy thng nm 2016 ca B
trng B Thng tin v Truyn thng)
STT
A
Qun/
Tn ch M s h S CMND
X/phng
in thoi
Huyn
h
ngho ca ch h
B
a ch
.., ngy.thng .. nm
NGI LP BIU
(K, ghi r h v tn)
CH TCH
Cch lp biu:
Ct (B), ct (C): Ghi tn huyn, x
Ct (2): Ghi m s h ngho.
Ct (3): Ghi s CMND ca ch h.
Ct (4): Ghi s in thoi ca h (nu c).
Ct (5): Ghi a ch ca h: s nh, thn/bn/khi ph.
Mu 04/THS Danh sch h cn ngho c h tr u thu truyn hnh s

UBND TNH, THNH PH
DANH SCH H CN NGHO IU KIN C HNG H TR
U THU TRUYN HNH S TRN A BN TNH, THNH PH
(Ban hnh km theo Thng t s /2016/TT-BTTTT ngy thng nm 2016 ca
B trng B Thng tin v Truyn thng)
STT
A
Qun/
Tn ch M s h S CMND
X/phng
in thoi
Huyn
h
cn ngho ca ch h
B
a ch
.., ngy.thng .. nm
NGI LP BIU
(K, ghi r h v tn)
Cch lp biu:
Ct (B), ct (C): Ghi tn huyn, x
Ct (2): Ghi m s h cn ngho.
CH TCH
Ct (3): Ghi s CMND ca ch h.

Ct (4): Ghi s in thoi ca h (nu c).
Ct (5): Ghi a ch ca h: s nh, thn/bn/khi ph
Mu 05/THS K hoch v d ton kinh ph h tr

UBND TNH, THNH PH
K HOCH V D TON KINH PH H TR U THU TRUYN HNH S
Tnh, Thnh ph: .
(Ban hnh km theo Thng t s /2016/TT-BTTTT ngy thng nm 2016 ca B trng B Thng tin v Truyn thng)
STT
Tnh, Thnh
ph/Huyn/x
A
1
B
Qun (Huyn).
1.1 X
1.2 X
2
Qun (Huyn).
2.1 X
2.2 X
S lng (u thu)
H ngho H cn ngho
1
Kinh ph h tr (triu ng)

Tng
3
H ngho H cn ngho
4
Tng
6
Thi gian
thc hin
Ghi ch
Cng
.., ngy.thng .. nm
TH TRNG N V
NGI LP BIU
(K, ghi r h v tn)
Mu 06/THS Bng k chi tit i tng nhn h tr u thu truyn hnh s

CH U T: .
BNG K CHI TIT I TNG NHN H TR U THU TRUYN HNH S
Tnh, Thnh ph: .
STT
Qun/HuynX/phng Tn ch M s h S CMND S in a ch i tng c h S thit b Ngy bn

h
ngho, ca ch h thoi
tr
giao/ lp
(Seri
cn
t
number)
H
H
cn
ngho
ngho
ngho
B
1
2
3
Tng s h c h tr: . h
XC NHN CA
UBND TNH, THNH PH
Tng kinh ph h tr: .. ng
NGI LP BIU
(K, ghi r h v tn)
.., ngy.thng .. nm
I DIN NH THU
Ghi ch:
+ Ct 5 - a ch: ghi r s nh, thn/bn/khi ph
Mu 07/THS - Bo co s lng v kinh ph h tr u thu truyn hnh s

CH U T: .
BO CO S LNG V KINH PH H TR U THU TRUYN HNH S
Tnh, Thnh ph: .
STT
Tnh, Thnh
ph/Huyn/x
Qun (Huyn).
S lng (u thu)
Kinh ph h tr (triu ng)

Ghi ch
H ngho
H cn ngho
Tng
H ngho
H cn ngho
Tng
1.1 X
1.2 X
2
Qun (Huyn).
2.1 X
2.2 X
Cng
NGI LP BIU
.., ngy.thng .. nm
TH TRNG N V
(K, ghi r h v tn)
Mu 01/BC
B THNG TIN V TRUYN CNG HA X HI CH NGHA VIT NAM
THNG
c lp T do Hnh phc
QU DCH V VIN THNG
CNG CH VIT NAM
------------S:
------------------------------------
/BCNV
, ngy
thng
nm .
BO CO NGUN VN HOT NG CA QU DCH V

VIN THNG CNG CH VIT NAM
(Qu/6thng/nm)
n v tnh: Triu ng
STT
Ni dung
Lu k s S tin ng gp ca doanh
tin Qu
nghip trong k
thu
K
Thc So snh
c t
hoch
hin
(%)
u
chng
trnh n
u k bo
co
1
Doanh nghip a
Doanh nghip b
Tng s
4=(3)/(2)
Lu k s Ghi
tin Qu ch
thu c t
u chng
trnh n
cui k bo
co
5=(1)+(3)
TH TRNG N V
(K tn, ng du)
Ghi ch
- Qu s dng mu bo co ny bo co ngun vn hot ng ca Qu.
- Qu gi Ban Qun l Chng trnh cc bo co qu I, qu III trc ngy 10 ca thng
u qu tip theo, bo co 6 thng trc ngy 10 thng 7 ca nm bo co, bo co nm
trc ngy 10 thng 02 nm sau.
Mu 02A/BC
BAN QUN L CHNG TRNH CUNG
CP DCH V VIN THNG CNG CH
-------------S:

c lp T do Hnh phc
--------------
/BCSDKP
, ngy
thng
nm .
BO CO TNH HNH S DNG KINH PH CA CHNG TRNH

(Qu/6thng/nm)
n v tnh: Triu ng
M s
A
1
Ni dung
B
(Theo cc nhim v ti
Tng s kinh ph h K hoch

tr doanh nghip t u c
chng trnh n u k duyt
bo co
trong
nm
1
S tin h tr
trong k
So snh
(%)
Thc Lu k
hin
t u
trong k nm
3
5=(4)/(2)
Lu k t u Ghi ch
chng trnh
n cui k bo
co
6=(1)+(3)
Quyt nh 1168/QTTg)
Tng s kinh ph
..
..
..
TH TRNG N V
(k tn, ng du)
Ghi ch
- Ban Qun l Chng trnh s dng mu ny bo co tnh hnh s dng kinh ph Chng trnh.
- Ban Qun l Chng trnh gi B Thng tin v Truyn thng cc bo co qu I, qu III trc ngy 10 ca thng u qu tip theo,
bo co 6 thng trc ngy 10 thng 7 ca nm bo co, bo co nm trc ngy 10 thng 02 nm sau.
Mu 02B/BC
BAN QUN L CHNG TRNH
CUNG CP DCH V VIN THNG
CNG CH
------S:
/BCSL

c lp T do Hnh phc
--------------
, ngy
thng
nm .
BO CO SN LNG C H TR CA CHNG TRNH

(Qu/6thng/nm)
M
s
Ni dung
(Theo cc nhim v ti
Quyt nh 1168/QTTg)
n v
Tng s sn K hoch Sn lng h tr trong

lng h tr c
k
doanh nghip
t u chng
trnh n u
k bo co
duyt
trong
nm
..
Thc
Lu k t u
hin
nm
trong k
3
..
So snh
(%)
Lu k t Ghi ch
u
chng
trnh n
cui k bo
co
5=(4)/(2) 6=(1)+(3)
..
TH TRNG N V
(k tn, ng du)
Ghi ch
- Ban Qun l Chng trnh s dng mu ny bo co sn lng dch v vin thng cng ch c h tr ca Chng trnh.
- Ban Qun l Chng trnh gi B Thng tin v Truyn thng cc bo co qu I, qu III trc ngy 10 ca thng u qu tip theo,
bo co 6 thng trc ngy 10 thng 7 ca nm bo co, bo co nm trc ngy 10 thng 02 nm sau.
Mu 03A/BC
DOANH NGHIP VIN THNG
--------
S:
/BCSDKP

c lp T do Hnh phc
-----------------------------------, ngy
thng
nm .
BO CO TNH HNH S DNG KINH PH CA CHNG TRNH

(Qu/6thng/nm)
n v tnh: Triu ng
M s
Ni dung
Tng s kinh ph K hoch

S tin h tr
h tr doanh
c
trong k
nghip t u
duyt
chng trnh n trong nm Thc hin Lu k
trong k t u
So snh
(%)
Lu k t Ghi
u chng ch
trnh n
cui k bo
u k bo co
A
1
nm
co
5=(4)/(2)
6=(1)+(3)
(Theo cc nhim v ti Quyt nh

1168/Q-TTg)
Tng s kinh ph
..
..
..
TH TRNG N V
(k tn, ng du)
Ghi ch
- Doanh nghip vin thng s dng mu ny bo co Ban Qun l Chng trnh tnh hnh s dng kinh ph Chng trnh.
- Doanh nghip vin thng gi Ban Qun l Chng trnh cc bo co qu I, qu III trc ngy 10 ca thng u qu tip theo, bo
co 6 thng trc ngy 10 thng 7 ca nm bo co, bo co nm trc ngy 10 thng 02 nm sau.
Mu 03B/BC
DOANH NGHIP VIN THNG
--------------------

c lp T do Hnh phc
------------------------------------
S:
/BCSL
, ngy
thng
nm .
BO CO SN LNG C H TR CA CHNG TRNH

(Qu/6thng/nm)
M s
A
1
2
Ni dung
B
(Theo cc nhim v ti Quyt
nh 1168/Q-TTg)
n v
Tng s sn K hoch c
lng h tr duyt trong
doanh nghip
nm
t u chng
trnh n u
k bo co
1
Sn lng h
tr trong k
Thc
Lu k
hin
t u
trong
nm
k
3
So snh Lu k t Ghi
(%)
u chng ch
trnh n
cui k bo
co
5=(4)/(2)
6=(1)+(3)
TH TRNG N V
(k tn, ng du)
Ghi ch
- Doanh nghip vin thng s dng mu ny bo co Ban Qun l Chng trnh sn lng dch v vin thng cng ch c h tr
ca Chng trnh.
- Doanh nghip vin thng gi Ban Qun l Chng trnh cc bo co qu I, qu III trc ngy 10 ca thng u qu tip theo, bo
co 6 thng trc ngy 10 thng 7 ca nm bo co, bo co nm trc ngy 10 thng 02 nm sau.

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B THNG TIN V

CNG HA X HI CH NGHA VIT NAM

H Ni, ngy 30 thng 3 nm 2016

4. Cn c cc tiu ch la chn Ch u t v H s ng k tham gia, Ban Qun l

c) Dch v vin thng cng ch v tinh phc v hot ng ch o, iu hnh phng,

mc, i tng th hng, phm vi, gi cc s dng v mc h tr cung cp dch v

iu 20. Kim tra, gim st v bo co

Mu 03/HT ng k tham gia la

Mu 02/DV Danh sch i tng th

Mu 03/DV K hoch sn lng v d

Mu 05/DV Bo co sn lng, kinh

9 Mu 06/DV Bin bn nghim thu sn

Mu 07/DV Bin bn thanh l hp

Mu 02/THS Danh sch tng hp i

Mu 03/THS Danh sch h ngho

Mu 04/THS Danh sch h cn ngho

Mu 05/THS K hoch v d ton

Mu 06/THS Bng k chi tit i

Mu 02A/BC Bo co tnh hnh s

20 Mu 02B/BC Bo co sn lng c Ban QLCTVTCI

Mu 03A/BC Bo co tnh hnh s

S dng trong trng hp lp Danh mc v s b Tng mc u t cc d n thc

S dng trong trng hp lp Danh mc v s b Tng mc u t cc d n thc

Kinh ph d kin l kinh ph xut h tr t ngun kinh ph Chng trnh.

Mi d n trong Ph biu 02 tng ng vi mt d n lit k ti Ph biu 01.

M tnh/thnh ph, huyn, x c quy nh ti Quyt nh s 124/2004/Q-TTg ngy

Mi d n ny tng ng vi mt d n lit k ti Ph biu 01.

Ni dung ny ch dng cho cc d n thc hin cc nhim v ti cc khon 1, 2, 3

Ni dung ny ch dng cho cc d n thc hin nhim v ti khon 4 iu 3 Thng t

Mu 01/HT/Ph biu 03/bng 1

Mi d n ny tng ng vi mt d n lit k ti Ph biu 01;

Bng ny ch dng cho cc d n thc hin cc nhim v ti cc khon 1, 2, 3 iu 3

Ct (4) ny ng vi mi x ti ct (3), nu x l x ng bng, in k t x, ngc

Ct (5) ny in k t x nu x c tn ti ct (3) c nhim v thit lp h thng

Ct (6) ny in k t x nu x c tn ti ct (3) c nhim v thit lp mng truy

Ct (7) ny in k t x nu x c tn ti ct (3) c nhim v thit lp mng truy

M tnh/thnh ph, huyn, x c quy nh ti Quyt nh s 124/2004/Q-TTg ngy

Mu 01/HT/Ph biu 03/bng 2

Danh sch cc im kt ni cn thit lp2) ti x thuc d n

Danh sch cc im kt ni sn c 3) c la chn cho d n

Mi d n ny tng ng vi mt d n lit k ti Ph biu 01.

Bng ny ch dng cho cc d n thc hin cc nhim v ti cc khon 1, 2, 3 iu 3

im kt ni cn thit lp l im m ti v tr c d tnh t tp trung cc thit

im kt ni sn c l im kt cui ca h thng truyn dn bng rng ang hot

M tnh/thnh ph, huyn, x c quy nh ti Quyt nh s 124/2004/Q-TTg ngy

Mu 01/HT/Ph biu 03/bng 3

[Tn [Tn im [chiu di

[Tn [Tn im [chiu di

[Tn [Tn im [chiu di

Mi d n ny tng ng vi mt d n lit k ti Ph biu 01.

Bng ny ch dng cho cc d n thc hin cc nhim v ti cc khon 1, 2, 3 iu 3

Mi tn im kt ni u hoc cui tng ng vi mt tn im kt ni cn thit lp

in ct (5) vi cc gi tr quang hoc viba hoc hn hp.

Mu 01/HT/Ph biu 03/bng 4

Mng truy nhp c nh x

[Tng chiu di mng

Mng truy nhp c nh x

[Tng chiu di mng

Mng truy nhp c nh x

[Tng chiu di mng

Tng chiu di cc tuyn cp [Tng chiu di cc tuyn

Mi d n ny tng ng vi mt d n lit k ti Ph biu 01.

Bng ny ch dng cho cc d n thc hin cc nhim v ti cc khon 1, 2, 3 iu 3

H ni, ngy _thng _ nm ____