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

1st 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:

15th Sept 2000