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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)                                      ………………………………….. . …………………