Certificate Of Acceptance Of Birth Report Form
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1*This translation template is to be used for US passport/report of birth applications.*
CERTIFICATE OFACCEPTANCE OF BIRTH REPORT
DATE OF REPORT :
CHILD
NAME :
DATE OF BIRTH :
PERMANENT DOMICILE (HONSEKI) :
NAME OF FATHER :
NAME OF MOTHER :
RELATION TO PARENTS :
PLACE OF BIRTH :
This is to certify the forgoing report was accepted on
Issue Date :
Title :
Name :
I certify that the foregoing is a correct translation.
Translator's signature :
Translator's Name :
Date :
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