SOCIALIST REPUBLIC OF VIETNAM

Independence - Freedom - Happiness

_________________________

HOUSEHOLD BOOK
 HOUSEHOLDER
PUBLIC SECURITY OF …
Full name:
Other full name (if any): ……………………………………….
Date of birth: Sex:
Native place:
HOUSEHOLD BOOK Ethnic group: Religion: ………………….
No.: Identity Card No. Passport No.: …………....
Occupation, work place: ……………………………………….
Full name of the householder:
Date of arrival:
Permanent residence:
Permanent residence before arriving:

…/…/…
REGISTRAR
CHIEF OF …
…/…/… (Signed)
PUBLIC SECURITY
CHIEF OF … (Signed and sealed)
PUBLIC SECURITY …
(Signed and sealed) …
… ____________________________________________________
Reason for deleting the permanent registration: ………………………….....
…………………………………………………………………….
REGISTRAR Date ………………………
Household file No.: ………………………………………….. (Full name and signature) CHIEF OF…
Permanent registration Book No.: ……… Sheet No.:……… PUBLIC SECURITY
…………………………
(Signature and seal)

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 RELATION WITH HOUSEHOLDER: RELATION WITH HOUSEHOLDER:

Full name: Full name:

Other full name (if any): ………………………………………. Other full name (if any): ……………………………………….
Date of birth: Sex: Date of birth: Sex:
Native place: Native place:
Ethnic group: Religion: ……………….. Ethnic group: Religion: ………………..
Identity Card No. …………… Passport No.: ………….... Identity Card No. …………… Passport No.: …………....
Occupation, work place: ……………………………………… Occupation, work place: ………………………………………

Date of arrival: Date of arrival:

Permanent residence before arriving: Permanent residence before arriving:

…/…/…… …/…/……
REGISTRAR REGISTRAR
CHIEF OF … CHIEF OF …
(Signed) (Signed)
PUBLIC SECURITY PUBLIC SECURITY
… …
(Signed and sealed) (Signed and sealed)
… …
____________________________________________________ ____________________________________________________
Reason for deleting the permanent registration: …………………………..... Reason for deleting the permanent registration: ………………………….....
……………………………………………………………………. …………………………………………………………………….
REGISTRAR Date ……………………… REGISTRAR Date ………………………
(Full name and signature) CHIEF OF… (Full name and signature) CHIEF OF…
PUBLIC SECURITY PUBLIC SECURITY
………………………… …………………………
(Signature and seal) (Signature and seal)

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