PEOPLE’S COMMITTEE SOCIALIST REPUBLIC OF VIETNAM Form TP/HT – 1999-A.2.

a
Commune/Ward: Independence – Freedom - Happiness No. : 55
District: TP/VT Book No.: 01
Province/City: BR-VT

BIRTH CERTIFICATE
(THE COPY)
Name in Full : Nguyen Thi A Gender: Female
Date of Birth : September 24th, 1979 (In word): The twenty-four of September in one thousand nine
hundred and seventy nine
Place of Birth : Le Loi Hospital, Vung Tau - Con Dao Special Economic Zone
Ethnic Group : Kinh Nationality: Vietnamese
Native village :
Information of parents FATHER MOTHER
Full name NGUYEN VAN B NGUYEN THỊ C
Date of birth 1960 1961
Ethnic Group Kinh Kinh
Nationality VIETNAMESE VIETNAMESE
Native village
555 Truong Cong Dinh Street, Bau
Place of Residence Regiment 5, Battalion 3
Sen, Thang Tam, Vung Tau
01/2003 (QĐ/TP-HT) QĐ.1

Full name, date of birth, ID Card No./Legally superseded documents of the declarant: Nguyen Thi C –
Year of birth: 1961
Relation with the declared person: Mother
Registered on October 19th,1981
Declarant signature Civil Registrar ON BEHALF OF PEOPLE’S COMMITTEE OF
THANG TAM WARD
(Registrar signed) (Registrar signed) CHAIRMAN

Nguyen Thi C
(Registrar signed)

CERTIFIED TRUE COPY OF THE ORIGINAL

Vung Tau, October 06th 2003
ON BEHALF PEOPLE’S COMMITTEE OF
VUNG TAU CITY
VICE CHAIRMAN
(Signed, wrote full name and sealed)
Le Minh Trung