PEOPLES COMMITTEE

Ward: TX SOCIALIST REPUBLIC OF VIETNAM

District: TX Independence Freedom Happiness
City: Hanoi
No.: 2XX/UBND-XN Bao Loc, 08th Jun 20XX

CONFIRMATION OF MARITAL STATUS

THE PEOPLES COMMITTEE

Pursuant to the Law on Peoples Council and Peoples Committee Organization dated November
26th 2003;
Pursuant to Decree No. 158/2005/ND-CP dated December 27th 2005 by the Government on registration
and management of births, deaths and marriages;
Considering the proposal of Mr./Ms.: Nguyen Van C, registrar, according to the proposal of Ms. Nguyen
Van A,

CONFIRMS THAT:
Mr./Ms.: Nguyen A Sex: Female
th
Date of birth: 20 February 1XXX

Place of birth: Lam Dong

Ethnic group: Kinh Nationality: Vietnamese

ID card/Passport/Other document No.: 0000000000

Permanent/temporary residence: Lam Dong/Hochiminh City

Marital status: Single

This confirmation is issued to apply for applying Visa

and it is valid within 6 months from the date of issue.

In book issuing marital status confirmation No.: 000 Book No.: 00/0000

For the Peoples Committee

Registrar PP. THE Chairman
(Signed) (Signed and sealed)
XXX Vice Chairman
XXX
PEOPLES COMMITTEE
Commune/ward: Hoan Kiem
District: Dong Da BTP/HT-12345-KS.2
Province/City: Lam Dong SOCIALIST REPUBLIC OF VIETNAM No.: 345
Independence- Freedom- Happiness
-------------- Book : 01/2015
CERTIFICATE OF BIRTH
(THE COPY)

Full name: NGUYEN A Sex: Female

Date of birth: th
21 Mar 2009 In words:
The twenty-one of Mar in Two Thousand and Nine
Place of birth: Lam Dong II hospital
Ethnic group: Kinh Nationality:
Vietnamese
Native village:
Full name of father: Nguyen Van B

Ethnic group: Kinh Nationality:

Vietnamese
Full name of mother: Nguyen Thi C

Ethnic group: Kinh Nationality:

Vietnamese
Full name of declarant :
Relationship with declarant:

DECLARANT Civil StatusJudicial Officials

(Signed) (Signed)

Dated 21th Mar 2009

Instate Peoples Committee
PP. CHAIRMAN
(Signed and sealed)
Vice Chairman: Nguyen Van D

This certificate of birth must be store with care. It is strictly forbidden to erase, repair
content in the certificate of birth.
BN DCH CHNG MINH TH

Photo Socialist Republic of Vietnam

Independence- Freedom- Happiness
Certificate of identity card
Number: 0123456789
Full name: Nguyen Van A

Date of birth: September 28th 1983

Native place: Lam Dong, Viet Nam

Permanent residence: Lam Dong Vietnam

Group: Kinh Religion: None

Personal trace and heteromorphism
Point scar is 1cm far from the left ala nasi.
Left forefinger

Jun 11st 2011

Director of Hanoi Citys Public Security

Right forefinger
Nguyen Van B

(Signed and sealed)

 SOCIALIST REPUBLIC OF VIETNAM
Independence Freedom Happiness

FAMILY REGISTER
No.: 123456789

Name of the householder: Nguyen Van A

Permanent address: No.0, Alley 0/000, Nguyen Cong Tru, Bao Loc, Lam Dong

Jun 06th, 2013

DEPUTY DIRECTOR OF BAO LOC
PUBLIC SECURITY
(Signed and sealed)

Colonel. Nguyen Van B

Family record No.:

Reg. No.: 00 Page: 00

 HOUSEHOLDER
_____________

Full name: LE THI B

Nickname:
Date of birth: Mar 22nd, 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 17th, 2009
Previous permanent place: Change

October 09th, 2013

DEPUTY DIRECTOR OF BAO LOC PUBLIC
SECURITY
REGISTRAR (Signed and sealed)
(Signed) Colonel. Nguyen Van E

Reason for deregistration permanent :..

Date:
REGISTRAR DIRECTOR OF PUBLIC SECURITY
 RELATION WITH THE HOUSEHOLDER:
DAUGHTER
_____________

Full name: Nguyen Thi C

Nickname:
Date of birth: Jul 28th, 1988 Gender: Female
Native place: Bao Loc, Lam Dong
Ethnic group: Kinh Religion: None
ID No.: 00000000 Passport No.:
Occupation, working place:
.
Moving on date: Mar 29th, 2013
Previous permanent place: Change

July 09th, 2013

DEPUTY DIRECTOR OF LONG SAN PUBLIC
REGISTRAR SECURITY
(Signed) (Signed and sealed)
Colonel. Nguyen Van E

Reason for deregistration permanent:..

Date:
REGISTRAR DIRECTOR OF PUBLIC SECURITY