BIRTH CERTIFICATE

Full name of baby: XXXXXX        Sex:              Date of birth:

Place of birth: XXX Province XX City County(District) Township    Gestation(week):40+

Health status: Well√               Weight: 2500g                    Height:    cm

Full name of mother: XXXXXX     Age: XX     Nationality: China     Ethnicity: Han

ID card No.: XXXXXXXXXXX

Full name of father: XXXXXX      Age: XX     Nationality: China      Ethnicity: Han

ID card No.: XXXXXXXXXXX

Type of place: General Hospital√

Name of facility: XXXXXXXXXX

Birth certificate No.: XXXXXXXX               Date of Issue: XXXX      

Issuing organization(seal)

                                                                               Special Seal of XXX Province Birth Certificate