PUBLIC SECURITY BUREAU RESIDENCE REGISTRATION CERTIFICATE SHANGHAI CERTIFICATE No. NAME HOUSEHOLD No. ID CARD No. SEX DATE OF BIRTH ETHICITY ADDRESS EDUCATION WORKING PLACE OCCUPATION MARITAL STATUS OTHER NAMES ANCESTRAL NATIVE PLACE PLACE OF BIRTH THE ITEMS TO BE CETIFIED HOUSEHOLD OF A CORPORATE RESIDENCE REGISTRATION CERTIFICATE FOR DOMESTIC USE ONLY(EXCLUDING HONGKONG, MACAU AND TAIWAN REGIONS) VALID FOR 30 DAYS LOCAL POLICE STATION ISSUED DATE: xx-xx-xxxx I hereby certify that, to the best of my knowledge, this is an accurate translation of the original document. Translator’s full name: Signature: Date of the translation: Tel:
