1. Name .......... ...... Name ................. Last Name Date of birth ................ ............................................ Month BE ...................... Age ................. Pig blood ................. Nationality ......................... Ethnicity .............................. ............................... Religious identity card number .................................................. .................................................. .............. ................................ Hometown No. Mu .............. ................................ Village , district, provincial .............. .............. Code ............................. homepage ......................... Mobile .................. current address at .................................. Mu .............. ........... Village parish road ................. ......... District ...................... Province .............. Code ................................... Home Phone ......................... Mobile ..................... E-Mail .................. ..................... Facebook ......................................................................................................
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