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HouseholdRegisterUnderSupervisionoftheMinistryofPublicSecurityofP.R.C.ResidenceTypeNonAgriculturalResidenceNameofHouseholderResidenceNumberAddressCertifiedSealofCertifiedSealof____ProvinceHouseholdRegistrationOfficePublicSecurityBureauForHouseholdRegistrationonly______PoliceStationPeopleRoadUndertake’sStampedsignature:IssueDate:1PermanentResidentPopulation’sRegisterNameHouseholderorRelationwithHouseholderHouseholderFormerNameSexMalePlaceofBirthNationalityPlaceofOriginDateofBirthOtherAddressinThisCity(County)ReligiousBeliefNoneCitizenIDNumberHeightBloodTypeEducationalLevelMaritalStatusMilitaryServiceStatusPlaceofWorkOccupationDateofMovingtotheCity(County)andPreviousPlaceDateofMovingtoPresentDwellingPlaceandPreviousDwellingPlaceUndertake’sStampedsignature:IssueDate:2
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