Basic Personal Information
| Marital Status | Education | Ancestral Native Place | ||||
| Military Service Status | Religion | Residential District | ||||
| Industry Engaged in | Category of Occupation | Detailed Address | ||||
| Telephone | Occupation | Employer | ||||
| Ancestral Native Country | Country of Birth | City/County of Birth | ||||
| Detailed Place of Birth | ID No. of Father | Name of Father | ||||
| ID No. of Mother | Name of Mother | ID No. of Spouse | ||||
| Name of Spouse | ID No. of Guardian Ⅰ | Relation to Guardian Ⅰ | ||||
| Guardian Ⅰ | ID No. of Guardian Ⅱ | Relation to Guardian Ⅱ | ||||
| Guardian Ⅱ | Category of Migration | Date of Migration | ||||
| Country Migrated to | City/County Migrated to | Detailed Address Migrated to | ||||
| Reason of Immigration | Date of Immigration | Country Immigraed from | ||||
| City/County Immigrated from | Detailed Address Immigrated from |
 Category of Death
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| Date of Death | ||||||
| Father: , born on ID No. | ||||||
| Mother: , born on , ID No. | ||||||
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(SEALED: Sealed by XX Branch Of XX Public Security Bureau, used Exclusively for Household Register)
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