One-childcertificateFamilyPlanningBureauofShiquanCountySupervisoryUnit:FamilyPlanningBureauofXXXCertificationUnit:FamilyPlanningBureauofXXX(seal)SignedDate:ValidPeriod:No.:2007050ChildName:Sex:DateofBirth:27thAugust,1984Father:Name:Age:WorkPlace:Mother:Name:Age:WorkPlace:ContraceptiveMeasureAdopted:Type:contraceptiveringDate:Update:Re-certificationduetooriginallostFamilyPlanningBureauofXXX(seal)TuitionandMiscellaneousFeesExemptionRecordDateAmountSchoolSystem&ClassHouseholderSignatureUndertakerSignatureHealthsubside,WelfareandBonusReceiptsRecordDateItemAmountPayeeSignatureUndertakerSignature