C NG HOÀ XÃ H I CH NGHĨA VI T NAM Ộ Ộ Ủ Ệ
Đ c l p - T do - H nh phúcộ ậ ự ạ
T KHAI ĐĂNG KÝ L I VI C SINHỜ Ạ Ệ
Kính g i: ử.......................................................................................................
H và tên ng i khai:ọ ườ .................................................................................................................................................
N i th ng trú/t m trú: ơ ườ ạ .................................................................................................................................................
S h chi u/gi y t h p l thay th :ố ộ ế ấ ờ ợ ệ ế .........................................................................................................................
Quan h v i ng i đ c đăng ký l i khaiệ ớ ườ ượ ạ
sinh:........................................................................................................
Đ ngh đăng ký l i vi c sinh cho ng i có tên d i đây:ề ị ạ ệ ườ ướ
H và tên: ọ............................................................................................................Gi i tính:ớ............................................
Ngày, tháng, năm sinh:...................................................................................................................................................
N i sinh:ơ............................................................................................................................................................................
Dân t c:ộ....................................................................................Qu c t ch:ố ị ......................................................................
Quê quán:..........................................................................................................................................................................
N i th ng trú/t m trú: ơ ườ ạ .................................................................................................................................................
H và tên cha:ọ.................................................................................................................................................................
Dân t c:ộ....................................................................................Qu c t ch:ố ị ......................................................................
H và tên m :ọ ẹ .................................................................................................................................................................
Dân t c:ộ....................................................................................Qu c t ch:ố ị ......................................................................
Đã đăng ký khai sinh t i:ạ...............................................................................................................................................
.................................................................................................................................ngày...........tháng...........năm...........
Tôi cam đoan l i khai trên đây là đúng s th t và ch u trách nhi m tr c pháp lu t v ờ ự ậ ị ệ ướ ậ ề
cam đoan c a mình.ủ
Đ nghề ị............................................................................. đăng ký.
Làm t i:ạ................................................,ngày ............tháng............năm............
Ng i khaiườ
.......................................
Chú thích:
(1) Ch c n thi t trong tr ng h p n i đăng ký l i vi c sinh khác v i n i đăng ký khai sinh tr c đây.ỉ ầ ế ườ ợ ơ ạ ệ ớ ơ ướ
2007 (QĐ s : 04/2007/QĐ-BTP) Mã s : TPE-07-13ố ố
M u BTP-NG/HT-2007-KS.3ẫ
Xác nh n c a c quan có th m quy nậ ủ ơ ẩ ề ,
n iơ đã đăng ký khai sinh tr c đây (1)ướ
..........................................................................
..........................................................................
..........................................................................
..........................................................................
Ngày...........tháng...........năm...........
.........................................
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