PEOPLE’S COMMITTEELoc Hung village/ward Trang Bang district Tay Ninh province SOCIALIST REPUBLIC OF VIET NAM Independence - Freedom – Happiness Form BTP/HT-2006-KH.1 No.: 04 Book No: 01/
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Loc Hung village/ward
Trang Bang district
Tay Ninh province
SOCIALIST REPUBLIC OF VIET NAM Independence - Freedom – Happiness
Form BTP/HT-2006-KH.1 No.: 04
Book No: 01/2009
(Original) Full name of husband: LE HOANG QUY
Date, month, year of birth: September 10, 1984
Ethnic group: Kinh Nationality: Vietnam
Place of residence: Loc Thanh hamlet, Loc Hung village,
Trang Bang district, Tay Ninh province
Identity card No./ Passport: 290769750
Full name of wife: PHAN THI TUYET LAN
Date, month, year of birth: August 26, 1990 Ethnic group: Kinh Nationality: Vietnam Place of residence: Cau Xe hamlet, Hung Thuan village, Trang Bang district, Tay Ninh province
Identity card No./ Passport: 290930932
Husband's signature Wife’s signature
(Signed) (Signed )
Date of registration January 6, 2009
ON BEHALF OF PEOPLE’S COMMITTEE
Vice-Chairman
Justice, births, deaths and marriages officer (Signed and stamped)
Tran Van Buot (Signed) Hunh Van Thum
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SOCIALIST REPUBLIC OF VIET NAM Independence - Freedom – Happiness
MINISTRY OF JUSTICE
MARRIAGE