Applicantsignature:PublicSecurityDepartment(sealed)Theundertakersignature:Registerdate:(sealed)(sealed)NanjingPublicSecurityBureauHouseholdSpecialStampPoliceStationofXXHouseholdNo.:TypeofhouseholdHouseholdregisterNameofhouseholdRelationCorporateXUSHENGYUNon-relativeNameGenderFemaleFormernameEthnicityHanDateofbirthGuardianPlaceofbirthRelationCitizenbirthcertificateIssueddateAddressThiscityOtheraddressPlaceoforiginReligionNon-religionIDcardNo.Issueddate——EducationGraduatestudentMaritalstatusSingleMilitaryserviceNon-militaryHeight162cmBloodtypeOccupationEmployerWhen&wheremovetothiscityWhen&whyFromwheretohereWhen&whyTothisaddressWhen&whyCancelhouseholdMaleoneMaletwoMalethreeUpdatesofMember'sInformationitemAfterthechangeDateofchangeApplicantsignaturerecordstelephoneResidentIDAPPLICANTREASONResidentIDValidperiodResidentIDPayment&cancelSocialrelationNameRelationtoAddressorworkplaceFemaleoneFemaletwoFemalethree