PEOPLE’S COMMITTEE Commune/Ward: District: City/ Province:

SOCIALIST REPUBLIC OF VIETNAM Independence – Freedom – Happiness

Form TP/HT-1999-A.2.a No.: Book No.:

BIRTH CERTIFICATE

(COPY)

Full name:                                               Sex:

Date of birth:

In words:

Place of birth:

Ethnic group:                                                 Nationality:

Native place:

01/ 2003 (Decision No. 1203 QD/TP-HT) QD.I	Declaration of parents	FATHER	MOTHER
	Full name
	Year of birth
	Nationality
	Native place
	Permanent/Temporary residence

Full name, year of birth, ID card No./Other valid documents of the declarant:

 

Relationship with the declared-person:

Declarant (Sign)	Registrar (Sign)	Registered on …….. ON BEHALF OF PEOPLE’S COMMITTEE OF……….  (Sign)
		Copied from Birth Registration Book (Date, month, year)  ON BEHALF OF PEOPLE’S COMMITTEE OF ……….. PP. CHAIRMAN CHIEF (Signed and sealed)

 

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