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Type of Residence Family Household Name of Householder

Residence Number Address

Undertaker’s Stamped signature : Issue Date:

Permanent resident registration card

Name Relation with The

Householder

Former Name Sex

Place of Birth Ethnic

Native place Date of Birth Certified Seal of Liaoning Province

Public Security Bureau For Hukou Certified Seal of Fushun Public Security

Bureau Other Dwelling

Place

in the City/Town Religion

Citizen ID Number Height Blood Type

Degree of

Education Marital

Status Married Military

Service

Work Unit Occupation

Previous Dwelling Place Before Moving

into the City/Town and Date of Moving

Previous Dwelling Place in the City/

Previous Dwelling Place in the City/Town

and Date of Moving into Present Dwelling

Place

Undertaker’s Stamped signature: Registration Date:

Permanent resident registration card

Name Relation with The

Householder Former Name Sex

Place of Birth Ethnic

Native place Date of Birth

Other Dwelling

Place

in the City/Town Religion

Citizen ID Number Height Blood Type

Degree of

Education Marital

Status Married Military

Service

Work Unit Occupation

Previous Dwelling Place Before Moving

into the City/Town and Date of Moving

Previous Dwelling Place in the City/

Previous Dwelling Place in the City/Town

and Date of Moving into Present Dwelling

Place Undertaker’s Stamped signature: Registration Date:

Permanent resident registration card

Name Relation with The

Householder

Former Name Sex

Place of Birth Ethnic

Native place Date of Birth

Other Dwelling

Place

in the City/Town Religion

Citizen ID Number Height Blood Type

Degree of

Education Marital

Status Married Military

Service

Work Unit Occupation

Previous Dwelling Place Before Moving into the City/Town and Date of Moving

Previous Dwelling Place in the City/

Previous Dwelling Place in the City/Town

and Date of Moving into Present Dwelling

Place

Undertaker’s Stamped signature: Registration Date: