SOCIALIST REPUBLIC OF VIETNAM Independence - Freedom - Happiness No: 00 Book: 00/0000 DEATH CERTIFICATE (Original) Full name: Gender: Date of birth: ETHNIC GROUP: NATIONALITY: Residence address/Last temporary address: ID No/alternative documents: Died at Place of death: Cause of death: Death notice/ alternative documents: Place of registration: Date of registration: Note: Notary (signed and named) Signer (signed and sealed)