Applicantsignature:PublicSecurityDepartment(sealed)Theundertakersignature:Registerdate:xxxxxx,20xx(sealed)(sealed)NanjingServiceCenterforHumanResourcesNanjingPublicSecurityBureauHouseholdSpecialStampHouseholdSpecialStampPoliceStationofxxxxxHouseholdNo.:xxxxxxTypeofhouseholdHouseholdregisterNameofhouseholdRelationCorporatexxxxxxNon-relativeNamexxxxxxGenderMaleFormernamexxxxxxEthnicityHanDateofbirthxxxx,19xxGuardianPlaceofbirthxxxxCounty,xxxxProvinceRelationCitizenbirthcertificateIssueddateAddressNo.xxx,xxxxxRoad,XuanwuDistrict,NanjingThiscityOtheraddressPlaceoforiginxxxxCounty,xxxxProvinceReligionNon-religionIDcardNo.xxxxxxxxxxxxxxxxxxIssueddateDec30th,20xxEducationGraduatestudentMaritalstatusSingleMilitaryserviceNon-militaryHeight185cmBloodtypexOccupationStaffEmployerNanjingxxxxxxxxxxCo.,LtdWhen&wheremovetothiscityMovedfromNo.x,xxxxRoadxxxDistrict,xxx,xxxProvinceonxxx10th,20xxWhen&whyFromwheretohereWhen&whyTothisaddressWhen&whyCancelhouseholdMaleoneMaletwoMalethreeUpdatesofMember'sInformationitemAfterthechangeDateofchangeApplicantsignaturerecordstelephoneResidentIDAPPLICANTREASONResidentIDValidperiodResidentIDPayment&cancelSocialrelationNameRelationtoAddressorworkplaceFemaleoneFemaletwoFemalethree