PEOPLE'S COMMITTEE SOCIALIST REPUBLIC OF VIETNAM Form HT3/P3

Ward : 01 Independence - Freedom - Happiness

District : 03
Province/City : Ho Chi Minh  No: 100
Book No.: 01

CERTIFICATE OF BIRTH

Name and surname NGUYEN THI C <Female>

Date of birth 30/09/1986 (at 3:50)
Place of birth Maternity Hospital
Declaration on parents FATHER MOTHER
Name and surname, NGUYEN VAN A NGUYEN THI B

Age (or date of birth) 1945 1953

Ethnic group Kinh Kinh
Nationality Vietnamese Vietnamese
Occupation Tailor Tailor
Permanent residence 222 Ly Thai To, Ward 1, District 3 222 Ly Thai To, Ward 1, District 3
Name, age, permanent Nguyen Thi B

residence, ID Card No of 222 Ly Thai To Ward 1, District 3

the declarant:

Register on December 6th 1986

FOR WARD 1’S PEOPLE'S COMMITTEE

CHAIRMAN

(Signed and sealed)