THE SOCIALIST REPUBLIC OF VIETNAM

Form TP/QT-2010-KTLL

Photography

(4x6)THE SOCIALIST REPUBLIC OF VIETNAM

Independence - Freedom Happiness

BIOGRAPHY FORM

Full Name (1)

Sex: Male. ..Female..Date of birthPlace of birth (2).Place of birth registration (3)..Nationality at present4)...Passaport/ substitute legal documents (5)...

Dated issue..,Agency issue...Current residenceOcuppation.Place of employment.SUMMARY ABOUT YOURSELF

Previous to now, living, working and where.SUMMARY OF FAMILY

Full name of father:Date of birth:.

Nationality:..

Place of residence

.

Full name of mother

Date of birth:.

Nationality:..

Place of residence

.

Full name of husband/wife..Dae of birth:..Place of birth.Nationality:..

Place of residence

.

Full name of first child..

Dae of birth:.Place of birth.Nationality:Place of residence...Full name of second child..Dae of birth:.Place of birth.Nationality:Place of residence

.

I hereby declare that the above statements are true and would be responsible under the law of Vietnam on my testimony.

Date.....

Declarant

(Signed and full name)Remarks:

(1) Print letter as passport/legal substitute documents;(2) Write an administrative place or hostpital;(3) Write the office of birth registration;(4) Specify in each nationality in case of two or more;(5) Specify what types of documentation. PAGE 1