Residence Type Residence Number Non Agricultural Residence Name of House Owner XXX Address XXX Certified Seal of Certified Seal of Beijing Household Registration Office Public Security Bureau For Hukou certificate only XXX Local Police Station Beijing Public Security Bureau Undertaker’s Stamped signature: Issue Date: XXX XXX Local Police Station Household Register

Under Supervision of The Ministry of Public Security of P.R.C

No. XXX

Page 1 of 5

Permanent resident population's register Householder or Name XXX Relation with The Householder Former Name Place of Birth native place XXX XXX Sex Nationality Date of Birth Religious House Owner XXX XXX XXX Other Dwelling Placein the City/Town Citizen ID Number Highest Academic Place of Work Previous Dwelling PlaceBefore Moving into the City/Town and Date of Moving Previous Dwelling Placein the City/Town and Date of XXX Moving into Present Dwelling Place Seal of Registrar: XXX Page 2 of 5

Issued Dart: XXX XXX Belief Height XXX Military Service Occupation XXX Blood X Group XXX MaritalStatus XXX XXX

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