(选填)NameinChinese(ifAny)性别Sex男(M)○女(F)○(居)-modation宿舍Dormitory○居民家HomeStay○出租房屋RentedHouse○自购房屋Self-purchasedHouse○其它Others○,sTelephoneNumber紧急情况下的联系人ContactinEmergency联系电话TelephoneNumber备注Remarks申报人签名:填表日期:日月年SignatureDate:ddmmyy公安派出所盖章:SealofPohceStation
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