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Trang 1CERTIFICATE OF BIRTH
(THE COPY)
Full name: Sex:
Date of birth:
(In words):
Place of birth:
Ethnic group: Nationality:
Native village:
Full name of father: Sex:
Ethnic group: Nationality:
Full name of mother: Sex:
Ethnic group: Nationality:
Full name of declarant:
Relationship with declarant:
Dated …… …… ……
Civil Status Judicial Officials (Signed) INSTATE PEOPLE’S COMMITTEE PP CHAIRMAN (Signed and sealed) Copy from Birth Registration Book Date … month …… year …
PP Chairman
PEOPLE’S COMMITTEE
Commune/ward:
District:
Province/City:
SOCIALIST REPUBLIC OF VIETNAM Independence - Freedom- Happiness
Form BTP/HT-2006-KS.1a No.: 345
Book no.: 01/2015