1964_BIRTHS_AND_DEATHS_REGISTRATION_ORDINANCE — Page 17

CAP. 174]

Births and Deaths Registration

[1986 Ed.

in Hong Kong

Declared at

此項聲明係於一九

this

day of.

年

月

日在香港

19..

在本人面前提出。1

Before me,

(Signed)

(簽署)

I, (Name)

本人(姓名),

(Address)

(地址)

Registrar.

註冊官

(Replaced, L.N.214|74)

FORM 5

[s. 13(1).]

表格五

〔條例第一三條第(一)款〕

Declaration of name of child 兒童命名聲明書

(Description)

(身份)

Parent (or guardian) of the child of

乃下述兒童之父親/母親/監護人,該童係由

and

與

was registered on the

其出生經於

day of 年

月

whose birth 所生

7

日

without a name, solemnly and sincerely declare that the said child has received the 註冊在案 但未有名字 本人慈謹以至誠聲明: name(s) of

該童現已取名

and that I desire that the said name(s) shall be added to the register.

同時本人欲將該名字加在登記冊內

要誠提出此

And I make this solemn declaration conscientiously believing the same to be 本人謹根據宣誓及聲明條例 true and by virtue of the Oaths and Declarations Ordinance.

並確信其為真實無訛

(Cap. 11.)

項聲明

(Signed) A.B.

(簽署) 某甲

Declared at

此項聲明係於

九

年

月

this

day of 在本人面前提出

19 ......

Before me,

Parent (or Guardian). 父親/母親/監護人

in Hong Kong 日在香港

(Signed)

(簽署 )

Registrar.

註冊官

(Replaced, L.N. 214(74))