Khai sinh - Form HT 2P3

Khai sinh - Form HT 2P3

 

Form: HT 2 / P3.

PEOPLE’S COMMITTEE OF Commune/Town: Town District: Cho Moi Province/City: An Giang

       SOCIALIST REPUBLIC OF VIET NAM

 

      Independence – Freedom – Happiness

 

 

 

 

No. 352 Book No: 01

   CERTIFICATE OF BIRTH

 

 

 

 

Full name		Sex: Male  Female
Date of birth
Place of birth
Mother & Father	Father	Mother
Full name (or Date of birth)
	19	19
Ethnic Group Nationality	Kinh	Kinh
	Vietnamese	Vietnamese
Occupation, DKNK permanent address
Full name, age, place of registered the permanent address, ID Card or Certified Identification Document number of Declarant

 

Registered, on December 03^rd,  1984

On behalf of People’s Committee of Town             Chairperson             (Signed & Sealed)

 

 

 

CERTIFIED TRUE COPY FROM THE ORIGINAL DOCUMENT Certified No:  05237 Book No: 6 SCT/BS Date: 06/09/2017 Chairperson of People’s Committee of Binh Tri Dong B Ward (Signed and sealed) Nguyen Quang Minh