SOCIALIST REPUBLIC OF VIETNAM

Independence - Freedom - Happiness

STATEMENT OF BIRTH RE-REGISTRATION

To: .......................................................................................................

Full name of informant: .................................................................................................................

Permanent/temporary residence: ......................................................................................................

ID card/Passport No.:..........................................................................................................................

Relation with birth re-registered person:........................................................................................

Propose to re-register birth for the following person:

Full name: ........................................................................................Sex:............................................

Date of birth:........................................................................................................................................

Place of birth:.......................................................................................................................................

Ethnic group:........................................................Nationality:................................................

Native country (1):..............................................................................................................................

Permanent/temporary residence: ........................................................................................................

........................................................................................................................................................

Full name of father:........................................................................................................................

Ethnic group:......................................................Nationality:...............................................................

Full name of mother:......................................................................................................................

Ethnic group:.......................................................Nationality:.............................................................

Re-registered birth at: .........................................................................................................................

....................................................................................day...........month...........year...............

            We assure that above statements are true and bear responsibility before the law on our assurance.

            Propose............................................................................. to register.

                                                  Done at:................................................

Confirmation of commune People’s Committee where re-registered birth before (2)

..........................................................................

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..........................................................................

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Day ............month............year............

 PRESIDENT OF PEOPLE’S COMMITTEE

 

 

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Day ............month............year............

    Informant