Translated from Russian into English

THE LOOSE LEAF OF THE BIRTH CERTIFICATE

CONFIRMING THE PRESENCE OF THE RUSSIAN FEDERATION CITIZENSHIP
OF THE CHILD

1-ВГ No.***

***
surname
***
given name
***
patronymic

IS THE CITIZEN OF THE RUSSIAN FEDERATION

on the basis of the clause of the part 7, article 4 of the Federal law dtd. May 31, 2002
No. 62-FZ "About the Russian Federation Citizenship"

article 14 of the Russian Federation law "About the Russian Federation Citizenship" dtd.
November 28, 1991

The loose leaf is issued on ***

date of issue
to the birth certificate
(or to similar document of the foreign state)

series VII-TH No.***

***
authority, which issued the loose leaf
/signature/
official’s signature

Seal: /Passport and Visa Service of the Ministry of Internal Affairs of Russia 522-005/