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Type of the Household:

Head of Household’s Name:

Household No.:

Address:

Seal of Provincial Pubic Security Authority:

Seal of Household Registration Authority:

Handled by:

Issue Date:

Name:

Head of Household/ Relationship with the Head of Household:

Sex: Nationality:

Place of Birth:

Place of Origin:

Date of Birth:Blood Type:

ID No.:Height:

Level of Educational:Marital Status:

Service Location:

Occupation:

When and from where moved to this city (county):

When and from where moved to this address:

Name:

Head of Household/ Relationship with the Head of Household: Sex:

Nationality:

Place of Birth:

Place of Origin:

Date of Birth:Blood Type: ID No.:Height:

Level of Educational:Marital Status: Service Location:Occupation: When and from where moved to this city (county):

When and from where moved to this address:

Name:

Head of Household/ Relationship with the Head of Household: Sex:

Nationality:

Place of Birth:

Place of Origin:

Date of Birth:Blood Type:

ID No.:Height

Level of Educational:Marital Status: When and from where moved to this address:

Registration Date:

Name:

Head of Household/ Relationship with the Head of Household:

Sex:

Nationality:

Place of Birth:

Place of Origin:

Date of Birth:Blood Type:

ID No.:Height:

Level of Educational:Marital Status:

When and from where moved to this address:

Registration Dat e:

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