Cng ha x hi ch ngha vit nam

Socialist Republic of Vietnam

c lp T do Hnh phc
Independence Liberty Happiness

nh./Photo Nam/Male 2x2 Cha qu 6 thng taken within last 6 months

T khai ng k kt hn
Application for Marriage Registration

nh./Photo N/Female 2x2 Cha qu 6 thng taken within last 6 months

Knh gi: U ban Nhn dn Tnh/Thnh ph . . . . . . . . . . . . .

To: The Provincial Peoples Committee of

Ngi khai
Applicant

Nam
Male

N
Female

H v tn:
Full Name:

Ngy sinh:
Date of Birth (dd mm yyyy)

Ni sinh:
Place of Birth

Dn tc:
Ethnic Group

Quc tch
Nationality

Ngh nghip:
Occupation

Qu qun1:
Place of Origin

Ni c tr2:
Current Address

Loi giy t/Type of Doc.3 S/Number Ngy cp/Date of Issue

dd mm yyyy

CMND
ID Card

H chiu
Passport

Th xanh
Green Card

CMND
ID Card

H chiu
Passport

Th xanh
Green Card

Ni cp/Place of Issue Kt hn ln th:

Married for the ________time ________ time

Chng ti cam oan nhng li khai trn y l ng s tht, vic kt hn ca chng ti l t nguyn, khng vi phm lut hn nhan v gia nh Vit Nam , v xin chu trch nhim trc lut php v li khai ca mnh.
We solemnly declare that the above statements are true and complete, that our application for marriage is of our own free will and is not in violation of the Vietnam Family and Marriage Code, and that we take full responsibility before the law for our statements.

ngh U ban xem xt, ng k.

We respectfully submit to the Peoples Committee for consideration and registration.

Lm ti . . . . . . . . . , ngy . . . thng . . . nm . . . .
Place on dd mm yy

Ngi nam k tn
Signature (male)

Ngi n k tn
Signature (Female)

H v tn: .

. . . . . . . . . . .

H v tn: . . . . . .
Full Name in Print

. . . . .

Full Name in Print

Ghi theo ni sinh trng ca cha . Nu khng r cha l ai, th theo ni sinh trng ca m . Nu khng xc nh c cha, m , th theo ni sinh trng ca ngi nui dng t nh.
Indicate fathers birth place. If father is unkown, indicate mothers birth place. If both parents are unknown, indicate childhood guardians birth place.
2

Ghi ng theo ni thng tr. Trong trng hp khng c ni thng tr, th ghi theo ni tm tr v ghi r Tm tr. Indicate the exact permanent address. If there is no permanent address, indicate temporary

address and state clearly temporary address. Ghi r loi giy t. Indicate clearly the type of the document.