
Under Supervision of the Ministry of Public Security of P.R.C.
| Residence Type | Non Agricultural Residence | Name of Householder | |||
| Residence Number | Address | ||||
| Certified Seal of Certified Seal of ____ Province Household Registration Office Public Security Bureau For Household Registration only ______ Police Station People Road Undertake’s Stamped signature: Issue Date: | |||||
Permanent Resident Population’s Register
| Name | Householder or Relation with Householder | Householder | ||||
| Former Name | Sex | Male | ||||
| Place of Birth | Nationality | |||||
| Place of Origin | Date of Birth | |||||
| Other Address in This City (County) | Religious Belief | None | ||||
| Citizen ID Number | Height | Blood Type | ||||
| Educational Level | Marital Status | Military Service Status | ||||
| Place of Work | Occupation | |||||
| Date of Moving to the City (County) and Previous Place | ||||||
| Date of Moving to Present Dwelling Place and Previous Dwelling Place | ||||||
