HANOI CITY PUBLIC SECURITY

0.1.1. FAMILY REGISTER

No.: 123456789

Name of the householder: Nguyen Van A

Permanent address: No.0, Alley 0/000, Nguyen Trai, Thanh Xuan Nam, Thanh Xuan

Jun 06^th, 2013

DEPUTY DIRECTOR OF THANH XUAN

PUBLIC SECURITY

(Signed and sealed)

                               Colonel. Nguyen Van B

Family record No.:

Reg. No.: 00                             Page: 00

1.

2.

3. HOUSEHOLDER

_____________

Full name:  LE THI B

Nickname:

Date of birth:  Mar 22^nd, 1960         Gender: Female

Native place: Ung Hoa, Ha Tay

Ethnic group:  Kinh                       Religion: None

ID No.:                                            Passport No.:

Occupation, working place:

………………………………………………………………………….

Date of Moving – on: October 17^th, 2009

Previous permanent place: Change

Reason for deregistration permanent :………………………..

4.

5.

6. RELATION WITH THE HOUSEHOLDER: DAUGHTER

_____________

Full name:  Nguyen Thi C

Nickname:

Date of birth:  Jul 28^th, 1988        Gender: Female

Native place: Vinh Phuc, Ha Noi

Ethnic group:  Kinh                       Religion: None

ID No.: 00000000                                       Passport No.:

Occupation, working place:  ………………………………………………………………………….

Moving – on date: Mar 29^th, 2013

Previous permanent place: Change

Reason for deregistration permanent:………………………..