PEOPLE’S COMMITTEE SOCIALIST REPUBLIC OF VIETNAM Form: BTP/HT-2006-KS.

1
Commune/ward: Binh Trung Dong Independence – Freedom – Happiness No.: ........278……..….......
District: 2 Book No.: 01/2008………
Province/city: Ho Chi Minh

BIRTH CERTIFICATE
(ORIGINAL)

Full name: …PHAM TUAN KIET………Gender: ……Male ...........................

Date of birth: 02 December 2008 (In words): the second of December twenty and eight....................

Place of birth: Tu Du Hospital, Ho Chi Minh City................................................................................

Ethnic group: ........ Kinh .................................... Nationality: …Vietnamese……… ............................

2008 (Decision No.: 01/2006/QD-BTP) XBTP

Native lace: Thai Binh ………………...................................................................................

Father’s full name: .…Pham Quang Tuyen …...........................................................................

Ethnic group: ………Kinh ………..Nationality: ………Vietnamese .................................................

Mother’s full name: …Nguyen Thi Thu No ……………................................................................

Ethnic group: ........ Kinh……….Nationality: …………Vietnamese… ................................................

Full name of birth declarant: Pham Quang Tuyen ......................................................................

Relationship with the declared person: Father..................................................................

Registered on 05th day of May 2008

PP. THE PEOPLE’S COMMITTEE
The declarant’s signature REGISTRAR
(Signed) CHAIRMAN
(Signed) (Signed and sealed)
Pham Quang Tuyen Duong That Dinh Lam Son Dong

This Birth certificate must be stored carefully. Erasing or modifying information in this Birth certificate is prohibited.
 NOTES ON MODIFICATION, DEADS AND MARRIAGES CORRECTION, RE-DETERMINATION
OF ETHNIC GROUP AND GENDER, ADDITIONAL CONTENTS ON THE BIRTH CERTIFICATE

Full name and signature of civil

CONTENT OF NOTE judicial officers/
No. Date of note Foundation of note
judicial staff of
judicial departments