SOCIALIST REPUBLIC OF VIETNAM Independence – Freedom – Happiness ---APPLICATION FOR CERTIFICATION OF HOUSEHOLD REGISTRATION To: Public Security of Ky Phu commune, Ky Anh district, Ha T
Trang 1SOCIALIST REPUBLIC OF VIETNAM Independence – Freedom – Happiness
-APPLICATION FOR CERTIFICATION
OF HOUSEHOLD REGISTRATION
To: Public Security of Ky Phu commune, Ky Anh district, Ha Tinh province
My name is TO XUAN DUC Gender: Male
Date of birth: 07/12/1995 in Ky Phu – Ky Anh – Ha Tinh
ID/ passport number: 184149560
Date of issue: 21/04/2013 Place of issue: Ha Tinh Public security
Place of permanent residence: Ky Phu– Ky Anh – Ha Tinh
For this letter, I would like to kindly request Public security office to certify the registration of my permanent residence address from December 07th, 1995 to August 22nd,
2016 as mentioned above for necessary procedures when abroad
Deponent
(Signed)
To Xuan Duc
CERTIFICATION OF PUBLIC SECURITY
This is to certify Mr To Xuan Duc, date of birth on December 07th, 1995 registered his address of permanent residence in Ky Phu commune, Ky Anh district, Ha Tinh province from December 07th, 1995 to August 22nd, 2016
Head of Public security office
(signed and sealed)
Head of Public security
Le Xuan Tung
Photo 4x6 cm
(sealed by
Public security
office)
Trang 2Tôi: Nguyễn Thị Thanh Phúc, giấy chứng minh nhân dân số 183299928 cam đoan đã dịch chính xác nội dung của giấy tờ/văn bản này từ Tiếng Việt sang Tiếng Anh
I, Nguyen Thi Thanh Phuc, ID number: 183299928, hereby undertake that this is true and correct English translation I made from the version in Vietnamese attached hereto
Ngày: 24.08.2016 Date: 24 August, 2016
Người dịch/translator
Nguyễn Thị Thanh Phúc
Ngày/date: 24.08.2016
(Bằng chữ: ngày hai mươi tư tháng Tám, năm hai ngàn không trăm mười sáu)
Tại UBND thành phố Hà Tĩnh
(On the twenty forth date of August, twenty sixteen)
At the office of the People’s Committee of Ha Tinh city
Tôi ………., là Trưởng phòng Tư pháp thành phố Hà Tĩnh
I,………, the Head of the Judicial Division of Ha Tinh city,
Chứng thực/hereby certify
Bà: Nguyễn Thị Thanh Phúc là người đã ký vào bản dịch này trước mặt tôi
Ms Nguyen Thi Thanh Phuc affixed her genuine signature hereon this document in front of me
Số chứng thực: Quyển số: -SCT/CKND
Certification: Book: -SCT/CKND
Date: 24.08.2016
Trưởng phòng/ Head of the Division