Ho Chi Minh City SOCIALIST REPUBLIC OF VIETNAM

District 1’s People’s Committee Independence - Freedom - Happiness

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No. 1000/TLKS-BS
District 3, June 21st 2017

EXCERPTS OF CERTIFICATE OF BIRTH

(COPY)

Name and surname : NGUYEN THI C

Date of birth : September 26th 1977 (The Twenty sixth day of September Nineteen seventy
seven)
Gender: Female Ethnic group: / Nationality: Vietnamese
Place of birth: 222 Cong Quynh
Native village: /
ID card no.: /
Full name of the mother: NGUYEN THI B
Year of birth: 1953 Ethnic group: / Nationality: Vietnamese
Permanent address: 222 Cong Quynh
Full name of the father: 222 Cong Quynh
Year of birth: 1945 Ethnic group: / Nationality: Vietnamese
Permanent address: 222 Cong Quynh
Registered in: District 1 - Saigon
No. 3247, on October 29th 1977
Remarks: excerpted from the registration of birth book.

EXCERPT CONFIRMATION
FOR DISTRICT 1’S PEOPLE’S COMMITTEE
HEAD OF JUDICE OFFICE
(Signed and sealed)
Nguyen Van D