SOCIALIST REPUBLIC OF VIETNAM INDEPENDENCE – FREEDOM – HAPPINESS HO CHI MINH CITY HOUSEHOLD REGISTRATION BOOK 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: …………………… Full Name of Householder: …………………… House No Street Ward, Village District, Town : : : : No …………………… …………………… …………………… …………………… …………………… ………………… On Behalf of …………………………………… …………………… (Signed and Sealed) ………………………………… …………………… 1/2 RELATION WITH THE HOUSEHOLDER: ………… 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: …………………… 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) ………………………………… …………………… ………………… On Behalf of …………………………………… …………………… (Signed and Sealed) ………………………………… ………………… 2/2