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SOCIALIST REPUBLIC OF VIETNAM
INDEPENDENCE – FREEDOM – HAPPINESS



HO CHI MINH CITY




HOUSEHOLD REGISTRATION BOOK





Full Name of Householder: ……………………

House No.                   :     ……………………
Street                           :     ……………………
Ward, Village              :     ……………………
District, Town             :     ……………………








                        
No. ……………………

HOUSEHOLDER



Full Name           : ……………………
Codename           : ……………………
Date of Birth       : ……………………           Male/Female              
Place of Birth      : ……………………
Native Place        : ……………………
Ethnic Group       : ……………………          Religion:  ……………
Occupation          : ……………………
Working Place     : ……………………
ID Card Number   : ……………………
Date of Issue         :  ……………………        Place of Issue:………….
Date of Arrival      :  ……………………….
Place of Residence before Arrival: …………………….




                                                  …………………
                      On Behalf of ……………………………………..
                                                     ……………………
                               (Signed and Sealed)
                                     …………………………………..






. ……………………

RELATION WITH THE HOUSEHOLDER: …………




Full Name           : ……………………
Codename           : ……………………
Date of Birth       : ……………………           Male/Female             
Place of Birth      : ……………………
Native Place        : ……………………
Ethnic Group       : ……………………          Religion:  ……………
Occupation          : ……………………
Working Place     : ……………………
ID Card Number   : ……………………
Date of Issue         :  ……………………        Place of Issue:………….
Date of Arrival      :  ……………………….
Place of Residence before Arrival: …………………….


                                                  …………………
                      On Behalf of ……………………………………..
                                                     ……………………
                             (Signed and Sealed)
                                     …………………………………..


. ……………………

RELATION WITH THE HOUSEHOLDER: …………




Full Name           : ……………………
Codename           : ……………………
Date of Birth       : ……………………           Male/Female             
Place of Birth      : ……………………
Native Place        : ……………………
Ethnic Group       : ……………………          Religion:  ……………
Occupation          : ……………………
Working Place     : ……………………
ID Card Number   : ……………………
Date of Issue         :  ……………………        Place of Issue:………….
Date of Arrival      :  ……………………….
Place of Residence before Arrival: …………………….


                                                  …………………
                      On Behalf of ……………………………………..
                                                     ……………………
                                (Signed and Sealed)
                                     …………………………………..


. …………………
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