PEOPLE’S COMMITTEE SOCIALIST REPUBLIC OF VIETNAM Independence- Freedom- Happiness Commune/ward: BTP/HT-12345KS.2 No: Book: District: Province/City: CERTIFICATE OF BIRTH Full name: Sex: Date of birth: In words: Place of birth: Ethnic group: Nationality: Native village: Full name of father: Ethnic group: Nationality: Full name of mother: Ethnic group: Nationality: Full name of declarant: RRelationship with declarant: DECLARANT (Signed) Civil StatusJudicial Officials (Signed) Dated Instate People’s Committee PP CHAIRMAN (Signed and sealed)