SOCIALIST REPUBLIC OF VIETNAM

Independence – Freedom – Happiness

HOUSEHOLD RECORD BOOK

 HEAD OF HOUSEHOLD
PUBLIC SECURITY OF NAM DINH PROVINCE Full name: TRAN THANH TAM
Other name (if any): …………………………………………………………………..
HOUSEHOLD RECORD BOOK Date of birth: 23/11/1969 Gender :…Male…..

No.: 410305915 Native land: Yen Tien – Y Yen – Nam Dinh

Ethnics: Kinh Nationality: Vietnamese

Full name of the head of household: TRAN THANH TAM Identification card No. 161924859 Passport No………………

Permanent residence: 37/11 Bach Dang, Phan Dinh Phung Ward, Nam Dinh Province Occupation, place of work:………………………………………………………………
Place of residence before moving in:

January 05th, 2016 ………………………109 Le Hong Phong, Nam Dinh…………………… ……………

POLICE CHIEF OF NAM DINH CITY REGISTRATION OFFICER January 05th, 2016
(Sign, seal) (Sign, write full name) POLICE CHIEF OF NAM DINH CITY
(Signed and sealed) (Signed) (Sign, full name and seal)
DEPUTY POLICE CHIEF OF CITY Phan Thanh Ha (Signed and sealed)
Colonel: HOANG DUC GIANG

Number of household record: …….……………………………………………

Reason of permanent deregistration: .............................................................
Number of registered residence book: ……….……. Page No.: ………………….
…………………………………………………………………………………………..
REGISTRATION OFFICER Date ….. month … year……
(Sign, write full name) POLICE CHIEF OF: ………………
(Sign, full name and seal)
 RELATIONS WITH THE HEAD OF HOUSEHOLD: Wife RELATIONS WITH THE HEAD OF HOUSEHOLD: Son
Full name: PHAM THANH HUYEN Full name: TRAN DUY ANH
Other name (if any): ………………………………………………………………….. Other name (if any): …………………………………………………………………..
Date of birth: 07/08/1974 Gender :…Female….. Date of birth: 09/10/1999 Gender : Male
Native land: Vu Thu – Thai Binh Native land: Yen Tien – Y Yen – Nam Dinh
Ethnics: Kinh Nationality: Vietnamese Ethnics: Kinh Nationality: Vietnamese
Identification card No. 162853563 Passport No……………… Identification card No. ……… Passport No………………
Occupation, place of work: Freelancer Occupation, place of work: Student
…………………………………………………………………………………………… ……………………………………………………………………………………………
Place of residence before moving in: Place of residence before moving in:
…………… …… Follow husband…………………………………………………… ………………… …………………Follow parents……………………………………
REGISTRATION OFFICER January 05th, 2016 REGISTRATION OFFICER January 05th, 2016
(Sign, write full name) POLICE CHIEF OF NAM DINH CITY (Sign, write full name) POLICE CHIEF OF NAM DINH CITY
(Signed) (Sign, full name and seal) (Signed) (Sign, full name and seal)
Phan Thanh Ha (Signed and sealed) Phan Thanh Ha (Signed and sealed)

Reason of permanent deregistration: ............................................................. Reason of permanent deregistration: .............................................................

………………………………………………………………………………………….. …………………………………………………………………………………………..
REGISTRATION OFFICER Date ….. month … year…… REGISTRATION OFFICER Date ….. month … year……
(Sign, write full name) POLICE CHIEF OF: ……………… (Sign, write full name) POLICE CHIEF OF: ………………
(Sign, full name and seal) (Sign, full name and seal)
 RELATIONS WITH THE HEAD OF HOUSEHOLD: Daughter RELATIONS WITH THE HEAD OF HOUSEHOLD: Daughter
Full name: TRAN PHAM PHUNG ANH Full name: TRAN PHAM PHUNG DAN ANH
Other name (if any): ………………………………………………………………….. Other name (if any): …………………………………………………………………..
Date of birth: 06/07/1997 Gender : Female Date of birth: 14/01/2013 Gender : Female……..
Native land: Yen Tien – Y Yen – Nam Dinh Native land: Yen Tien – Y Yen – Nam Dinh
Ethnics: Kinh Nationality: Vietnamese Ethnics: Kinh Nationality: Vietnamese
Identification card No. 163411896 Passport No……………… Identification card No. Passport No………………
Occupation, place of work: Occupation, place of work:
…………………………………………………………………………………………… ……………………………………………………………………………………………
Place of residence before moving in: Place of residence before moving in:
…………… …… ………………Follow parents……………………………………… …………… …… ………………Birth Registration……………………………………
REGISTRATION OFFICER January 05th, 2016 REGISTRATION OFFICER January 05th, 2016
(Sign, write full name) POLICE CHIEF OF NAM DINH CITY (Sign, write full name) POLICE CHIEF OF NAM DINH CITY
(Signed) (Sign, full name and seal) (Signed) (Sign, full name and seal)
Phan Thanh Ha (Signed and sealed) Nguyen Van Tao (Signed and sealed)

Reason of permanent deregistration: ............................................................. Reason of permanent deregistration: .............................................................

………………………………………………………………………………………….. …………………………………………………………………………………………..
REGISTRATION OFFICER Date ….. month … year…… REGISTRATION OFFICER Date ….. month … year……
(Sign, write full name) POLICE CHIEF OF: ……………… (Sign, write full name) POLICE CHIEF OF: ………………
(Sign, full name and seal) ((Sign, full name and seal)
 RELATIONS WITH THE HEAD OF HOUSEHOLD: Phung Anh’s Son RELATIONS WITH THE HEAD OF HOUSEHOLD:
Full name: TRAN PHAN ANH Full name:
Other name (if any): ………………………………………………………………….. Other name (if any): …………………………………………………………………..
Date of birth: 18/02/2015 Gender : Male Date of birth: Gender : ……..
Native land: Nam My – Nam Truc – Nam Dinh Native land:
Ethnics: Kinh Nationality: Vietnamese Ethnics: Nationality:
Identification card No. Passport No……………… Identification card No. Passport No………………
Occupation, place of work: Occupation, place of work:
…………………………………………………………………………………………… ……………………………………………………………………………………………
Place of residence before moving in: Place of residence before moving in:
…………… …… …………Birth registration…………………………………………… …………… …… ………………Birth Registration……………………………………
REGISTRATION OFFICER July 04th, 2017 REGISTRATION OFFICER Date......Month........Year
(Sign, write full name) POLICE CHIEF OF NAM DINH CITY (Sign, write full name) POLICE CHIEF
(Signed) (Sign, full name and seal) (Sign, full name and seal)
Phan Thanh Ha (Signed and sealed)

Reason of permanent deregistration: ............................................................. Reason of permanent deregistration: .............................................................

………………………………………………………………………………………….. …………………………………………………………………………………………..
REGISTRATION OFFICER Date ….. month … year…… REGISTRATION OFFICER Date ….. month … year……
(Sign, write full name) POLICE CHIEF OF: ……………… (Sign, write full name) POLICE CHIEF OF: ………………
(Sign, full name and seal) (Sign, full name and seal)