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Household Register

Under Supervision of the Ministry of Public Security of P. R. C.

Basic Information of Household

No. 000000000

Non-agricultural family Room 888,No. 98, Lane8,888Road, PuTuo District, shanghai Type of Household: Name of Householder: Household 00000 Number: Current residential address: Authorized Authorized Public Security Bureau of aaaRoad Police Station supervisor: Shanghai Administrator: Registrar: Register of Residence Change Date of registration update Date of Issue: New Address Registrar Information of Member

Householder Householder herself him/herself or Relation to the 户主 householder G Name Former name (if available) Place of birth shanghai Sex Female Ethnicity Han Ancestral native ZhenHai ZheJiang place Province Other residential address in this city (county) Citizen ID card 310****** number Date of birth Religious belief Stature 1** cm Blood group O Educational degree College or vocational Marital college（大学专科或专 status 科学校） Shanghai *******Co;LTDl Military service status Employer （工作单位） When and from where immigrated to this city (county) When and from where moved in current Registrar: Occupation （职务，可以不填） 迁移来的时间 Room***,No. ***, Lane**** WanHangDu Road, （迁移来的地址） Date of register: Updates of Member's Information

Updated item Updated content Move out (移出) No.**, Lane****, ***** Road 移出日期 （移出后的地址） Date of Update Registrar