(选填)NameinChinese(IfAny)性别Sex男(M)○女(F)○upation出生日期DateofBirth日月年ddmmyy身份证件Passport/(居)留证件Visa/-modation宿舍Dormitory○居民家中HomeStay○出租房屋RentedHouse○自购房屋Self-purchasedHouse○其他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:日月年登记人签名:Signature:Date:ddmmyy公安派出所盖章:SealofPoliceStation:
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