Certificate of Birth Registration
After checking the household registration dated July 23, 2003, the inquired information is as follows:
| Name | Former Name | Gender | Date of Birth | Birthplace | Name of Father | Name of Mother |
| XXX | XXX | X |
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| XXX | XXX |
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(In case of foster parent, please specify)
Seal of Unit Issuing the Certificate
October 8, 2015
XXX Police Station of Jinniu District Branch of Chengdu Public Security Bureau (Seal)
XXXCommunity Neighborhood Committee of XXX Town Subdistrict, Jinniu District, Chengdu City (Seal)