[Form No.34]

Alteration report of surname ․ place of family origin ( Day Month Year)												※Please write after reading the guidelines below and, when required to select one option, please circle the number as follows "○".
① Person of affair (Subject)	Name		Korean or English								Resident registration No.				-
			Chinese characters
	Permanent domicile address
	Address
② Surname ․ Place of family origin	Previous surname(姓)		Korean or English			Chinese characters					Previous place of family origin(本)		Korean or English						Chinese characters
	Changed surname(姓)		Korean or English			Chinese characters					Changed place of family origin(本)		Korean or English						Chinese characters
③Permission date			Day Month Year								Name of court
④Other
⑤Declarer		Name	Seal or signature							Resident Registration No.								-
		Qualification	ꊱSelf ꊲLegal representative ꊳOther(Please state : )
		Address						Tel. No.						E-mail address
⑥Submitter		Name						Resident Registration No.								-

Written Method
※ This report has to be reported within one month after receiving the decision copy of permission for alteration of surname․place of family origin. No. ② : Please write to divide as before and after surname․place of family origin of the affair's person. No. ③ : Permission date for alteration of surname․place of family origin has to be written by the date on decision copy of permission for alteration of surname․place of family origin. No. ④ : Please write specially necessary matters for clearing the data on family relation register. No. ⑥ : Please write the name and the resident register No. of submitter(Regardless of declarer is true or not). [접수담당공무원은 신분증과 대조]
Attached documents
1. One set of the decision copy of permission for alteration of surname․place of family origin. 2. Identification [According to Article 23 the established rule of family relation register] - In case of declarer's attendance : Certificate of identification - In case of submitter's attendance : Identification of submitter - In case of postal submission : Copy of declarer's identification

Alteration report of surname ․ place of family origin

[성.본 변경신고서]

* Writing method (작성방법) :

- This report has to be reported within one month after receiving the decision copy of permission for alteration of surname․place of family origin.

- 본 신고는 성․본변경허가결정등본을 받은 날로부터 1개월 이내에 신고하여야 합니다.

1. Person of affair(Subject) (사건본인)

￭ Please write person of affair's name in Korean or English and in Chinese characters. (사건본인의 성명을 한글과 한자로 쓰세요)

￭ Please write person of affair's resident registration No.

(사건본인의 주민등록번호를 쓰세요)

￭ Please write person of affair's permanent domicile address and address.

(사건본인의 등록기준지와 주소를 쓰세요)

2. Surname & place of family origin (성.본)

* Writing method (작성방법) :

- Please write to divide as before and after surname․place of family origin of the

affair's person.

- 사건본인의 성․본은 변경 전의 성․본과 변경한 성․본을 나누어 기재합니다.

￭ Please write previous surname in Korean or English and in Chinese characters.

(변경전의 성을 한글과 한자로 쓰세요)

￭ Please write previous place of family origin in Korean or English and Chinese

characters. (변경전의 본을 한글과 한자로 쓰세요)

￭ Please write the changed surname in Korean or English and in Chinese characters.

(변경된 성을 한글과 한자로 쓰세요)

￭ Please write the changed place of family origin in Korean or English and Chinese

characters. (변경된 본을 한글과 한자로 쓰세요)

3. Permission date (허가일자)

* Writing method (작성방법) :

- Permission date for alteration of surname․place of family origin has to be written by the date on decision copy of permission for alteration of surname․place of family origin.

- 성․본 변경허가일자는 성․본 변경허가결정등본에 기재된 연월일을 기재합니다.

￭ Please write permission date and name of court.

(허가일자와 법원명을 쓰세요)

4. Other (기타사항)

* Writing method (작성방법)

- Please write especially necessary informations for clarifying the family relation register.

- 가족관계등록부에 기록을 분명하게 하는데 특히 필요한 사항을 기재합니다.

5. Declarer (신고인)

￭ Please write name with seal and signature and resident registration No.

(신고인의 성명과 함께 서명날인하고 주민등록번호를 쓰세요)

￭ Please check on relationship. (신고인의 자격에 체크하세요)

ꊱSelf  ꊲLegal representative  ꊳOther (Please state:          )

(ꊱ본인  ꊲ법정대리인  ꊳ기타 (자격:        ))

￭ Please write address, telephone No. and e-mail address.

(신고인의 주소, 전화번호, 이메일 주소를 쓰세요)

6. Submitter (제출인)

* Writing method (작성방법)

- Submitter(Regardless of declarer)'s name and resident registration No.

제출자(신고인 여부 불문)의 성명 및 주민등록번호 기재

[접수담당공무원은 신분증과 대조]

￭ Please write name and resident registration number.

(성명과 주민등록번호를 쓰세요)

Attached documents 첨부서류

1. One set of the decision copy of permission for alteration of surname․place of family origin 성․본 변경허가결정등본 1부.

2.  Identification 신분확인

[According to Article 23 the established rule of family relation register]

[가족관계등록예규 제23호에 의함]

- In case of declarer's attendance : Certificate of identification

신고인이 출석한 경우 : 신분증명서

- In case of submitter's attendance : Identification of submitter

제출인이 출석한 경우 : 제출인의 신분증명서

- In case of postal submission : Copy of declarer's identification

우편제출의 경우 : 신고인의 신분증명서 사본