Province/City … SOCIALIST REPUBLIC OF VIETNAM Form TP-HT6

District … Independence - Freedom - Happiness Book No.:

Commune/Ward … No.:
7-96 QĐ 261/QĐ-HT(QĐI)

MARRIAGE CERTIFICATE

Name and surname of Wife: Name and surname of Husband:

Date of birth: Date of birth:

Native Village: Native Village:

Permanent Residence: Permanent Residence:

Occupation: Occupation:
7-96 QĐ 261/QĐ-HT(QĐI)

Ethnic group : Ethnic group :

Nationality : Nationality :

Identity Card/Passport: Identity Card/Passport:

Date … month … year …

Wife's signature Husband's signature ON BEHALF OF PEOPLE'S COMMITTEE

(Signed) (Signed) CHAIRMAN
(Signed and sealed)