Type of

Household:

Non-agricultural family

(Non-agricultural corporate)

Name of Householder:

xxx

xxx

Household Number:

xxxxxxxx

Current residential address:

No. xxx xxx xxx Road East, xxx District,

Guangzhou.

Authorized

supervisor:

Public Security

Authorized

Administrator:

Public Security Sub-Bureau of

Department of

Guang

GuangDong (sealed)

Xxx Road Police Station (sealed)

Registrar:

xxx

Date of Issue:

20^st June 2006

中文名(sealed)

New Address

Date of registration update

Registrar

Name

Xxx

xxx

Householder him/herself or Relation to the householder

Householder himself

Former name

(if available)

Sex

Male / Female

Place of birth

xxxx

Ethnicity

Han / Manchu / Uigur / Tibetan, etc.

Ancestral

native place

xx

Date of birth

xx^th April xxxx

Other

residential address in this city (county)

Religious belief

Nil

Citizen ID

card number

xxxxxxxxxxxxxxxxxx

Stature

xxx cm

Blood group

B

Educational degree

Undergraduate

Marital

status

Never

married

Military service status

Nil

Employer

xxx

Occupation

Commercial personnel

When and from where

immigrated to this city (county)

Xx Oct xxxx     xxxxx District,xx City, xx Province

When and from where moved

in current residential address

xx Jun xxxx     xxxxxxxx

Registrar:

Xxx

Date of register:

20^th Jun 2006

xxx

Autborized

Public Security Sub-Bureau of Guangzhou

Administrator:

Xxx Road Police Station(sealed)