SOCIALIST REPUBLIC OF VIETNAM

Independence – Freedom – Happiness

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DEATH CERTIFICATE

 (Original)

Full name:                   PHAM ANH A                              Gender: Male

Date of birth:              Jun 06^th, 1985

ETHNIC GROUP:             KINH                            NATIONALITY: VIETNAMESE

Residence address/Last temporary address: No.10, Alley 000/000, Nguyen Trai Street, Thanh Xuan Nam Ward

ID No/alternative documents: 000000

Died at ……………on Mar 18^th, 2013

Place of death:             Hoan Kiem Ward, Long Bien, Ha Noi

Cause of death:           Traffic accident

Death notice/ alternative documents: Burial Permit issued by Ha Noi public security on Mar 21^st, 2013

Place of registration: Thanh Xuan Nam Ward People’s Committee, Thanh Xuan, Ha Noi

Date of registration: July 09^th, 2013

Note: Overdue death report