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SOCIALIST REPUBLIC OF VIETNAM

INDEPENDENCE – FREEDOM – HAPPINESS

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HOUSEHOLD REGISTRATION BOOK

Full Name of Householder: ……………………

House No: …………………………………………

Street: ……………………………………………..

Ward, ………………… Village: …………………

District, Town: ……………………………………

No. ……………………

HOUSEHOLDER

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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:…..…

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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)

…………………………………..

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)

…………………………………..