![](data:image/png;base64,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)
| Mẫu ĐXTN-07 40/2014/TT-BKHCN |
CỘNG HÒA XÃ HỘI CHỦ NGHĨA VIỆT NAM
Độc lập - Tự do - Hạnh phúc
------------------
GIẤY XÁC NHẬN PHỐI HỢP THỰC HIỆN ĐỀ TÀI
Kính gửi: Quỹ Phát triển khoa học và công nghệ Quốc gia
1. Tên đề tài đăng ký xét chọn:.................................................................................
LĨNH VỰC: Khoa học xã hội và nhân văn ¨ Khoa học tự nhiên và kỹ thuật ¨
NGÀNH: ...............................................................................................................
LOẠI ĐỀ TÀI: Đột xuất ¨ Tiềm năng ¨
2. Tổ chức và cá nhân đăng ký chủ trì đề tài
Tên tổ chức chủ trì: .......................................................................................................
Địa chỉ: .......................................................................................................
Người đại diện: ..................................................... Chức vụ..............................
Chủ nhiệm đề tài: .......................................................................................................
3. Tổ chức đăng ký phối hợp thực hiện đề tài
Tên tổ chức chủ trì: .......................................................................................................
Địa chỉ: .......................................................................................................
Người đại diện: ..................................................... Chức vụ:.............................
4. Nội dung công việc tham gia trong đề tài của tổ chức phối hợp nghiên cứu:
(Nêu các nội dung công việc đăng ký tham gia thực hiện phù hợp với thuyết minh đề tài, hồ sơ đăng ký xét chọn gửi Quỹ Phát triển khoa học và công nghệ Quốc gia)
Trong trường hợp đề tài được tài trợ, chúng tôi cam đoan sẽ hoàn thành những thủ tục pháp lý về nghĩa vụ và quyền lợi của mỗi bên để thực hiện tốt nhất và đúng thời hạn mục tiêu, nội dung và sản phẩm của đề tài.
Thủ trưởng tổ chức đăng ký phối hợp thực hiện đề tài (Ký, ghi rõ họ tên và đóng dấu)
| ......, ngày... tháng... năm... Thủ trưởng tổ chức đăng ký chủ trì đề tài (Ký, ghi rõ họ tên và đóng dấu) |
| Cá nhân đăng ký chủ nhiệm đề tài (Ký, ghi rõ họ tên) |