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Residence Type Non Agricultural Residence Name of House Owner XXX Residence Number Address XXX Certified Seal of Certified Seal of Beijing Household Registration Office Public Security Bureau For Hukou certificate only XXX Local Police Station Beijing Public Security Bureau Undertaker’s Stamped signature : XXX Issue Date: XXX Household Register Under Supervision of The Ministry of Public Security of P.R.C No.0XXX Page 1 of 2 Permanent resident populations register Name? ? XXX Householder r or Relation with The Householder XXX Former Name Sex XXX Place of Birth Beijing Nationality Han native place XXX Date of Birth XXX Other Dwelling Placein the City/Town Religious Belief Citizen ID Number XXXX Height XXX Blood Group X Highest Academic XXX Marital Status XXX Military Service Place of Work XXX Occupation XXX Previous Dwelling PlaceBefore Moving into the City/Town and Date of Moving Previous Dwelling Placein the City/Town and Date of Moving into Present Dwelling Place XXX Seal of Registrar: xxxx Issued Dart: XXXX Page 2 of 2