Type of Household:

Non-agricultural family

(Non-agricultural corporate)

Name of Householder:

Zhang San

（張三）

Household Number:

Current residential address:

No. 888, X Road,

Dongcheng District, Beijing

Authorized supervisor:

Public Security Bureau of Beijing (sealed)

Authorized

Administrator:

X Road Police Station (sealed)

Registrar:

Wang Wu (sealed)

Date of Issue:

1^st January 2000

New Address

Date of registration update

Registrar

Name

Zhang San

（張三）

Householder him/herself or Relation to the householder

Householder himself / herself;

Son / Son’s wife, etc.

Former name (if available)

Sex

Male / Female

Place of birth

Beijing

Ethnicity

Han / Manchu / Uigur / Tibetan, etc.

Ancestral native place

Bazhou, Hebei Province

Date of birth

1^st October 1949

Other residential address in this city (county)

Religious belief

Nil

Citizen ID card number

110000491001888

Stature

175 cm

Blood group

O

Educational degree

Master of Laws

Marital status

Married

Military service status

Nil

Employer

X Corporation Limited

Occupation

General Manager

When and from where immigrated to this city (county)

When and from where moved in current residential address

18 Aug 2005

No. 7, Z Road, Xicheng District, Beijing

Registrar:

(sealed)

Date of register:

15^th Sept 2000

Updated item

Updated content

Date of Update

Registrar

ID card No.

110000194910018889

1999-04-20

(sealed)