SOCIALIST REPUBLIC OF VIETNAM

Independence- Freedom- Happiness

NOTICE OF HOUSEHOLD CHANGE

1.     Full name: …………………………………………………….
2.     Sex: ……………………………………………………………
3.     Dossier No.:…………………………………………………….
4.     Other names:………………………………………………….
5.     Date of birth: …………………………………………………
6.     ID No.: ………………………………………………………..
7.     Native place:……………………………………………………
8.     Ethnic: ………………………………….  ……………………..
9.     Religion: ………………………………………………………
10.   Occupation, place of work: …………………………………….
11.   Place of permanent residence: ………………………………..
12.   Place of move-in: ……………………………………………….
13.   Householder’s full name: ………………………………………..
14.   Content of the change: ………………………………………….
15.   Companions in the household: …………………………………..