[Form No.5]

Adoption report for paternal adopted child ( ..... Day ..... Month .......... Year)	※ Please write after reading the guidelines on the back and, when required to select one option, please circle the number as follows "○".
Section	Adoptive father	Adoptive mother
① Adoptive parents	Name	Korean or English		Place of family origin		Korean or English		Place of family origin
Chinese characters		Date of birth		Chinese characters		Date of birth
Resident Registration No.	-	Resident Registration No.	-
Permanent domicile address
Address
② Paternal adopted child	Name	Korean or English		Place of family origin		Resident Registration No.	-
Chinese characters		Sex	ꊱ Male ꊲ Female	Date of birth
Permanent domicile address
Address
Previous surname	Korean		Chinese characters		Previous place of family origin	Korean		Chinese characters
Changed surname	Korean		Chinese characters		Changed place of family origin	Korean		Chinese characters
③Real biological parents of paternal adopted child	Father	Name		Permanent domicile address
Place of family origin	-
Mother	Name		Permanent domicile address
Place of family origin	-
④Other
⑤Judgement confirmed date	..... Day ..... Month ........ Year	Court name
⑥Declarer	Name	(Seal) or signature	Resident Registration No.	-
Relationship	ꊱPropounder of trial ꊲOpponent of trial ꊳOther(Please state : )
Address
Telephone No.		E-mail address
⑦Submitter	Name		Resident Registration No.	-

Written method
① and ② : If you wrote the resident registration number, you can omit the date of birth according to the Article 25 section 2 of the law. ④ : Please write especially necessary informations for clarifying the family relation register and check the submission true or not the agreement which child's surname and place of family origin follow as child's mother's ones. ⑥ : If the adoption of paternal adopted child was confirmed, the propounder of trial or the opponent of trial can report unilaterally. In this case, please mark as “○” on the relevant number and then seal and signature(or sign). ⑦ : Submitter(Regardless of declarer)'s name and resident registration No. [접수담당공무원은 신분증과 대조]
Attached documents
※ If the details of below No. 1 is checked by data processing at office of family relation register, omit the attached. 1. Each one set basic certificate and family relation certificate of family relation register for adopting person the paternal adopted child. 2. Copy of adoption trial for paternal adopted child and decision certificate. 3. Identification [according to Article. 23 of the family relation register established rule] - In case of declarer's attendance : Identification card - In case of submitter's attendance : Submitter's identification card - In case of postal submission : Copy of declarer's identification card

Adoption report of paternal adopted child

(친양자입양신고서)

1. Adoptive parents (adoptive father / adoptive mother) 양친 (양부/양모)

※ Writing method (No. 1and 2) ( 작성방법 1번 ~ 2번) :

￭ If you wrote the resident registration number, you can omit the date of birth

according to the Article 25 Section 2 of the Law.

(법 제25조제2항에 따라 주민등록번호란에 주민등록번호를 기재한 때에는 출생 연월일의

기재를 생략할 수 있습니다.)

￭ Please write the adoptive parents(adoptive father/adoptive mother)'s name in

Korean or English and in Chinese characters.

(양친(양부/양모)의 성명을 한글과 한자로 쓰세요.)

￭ Please write the adoptive parents(adoptive father/adoptive mother)'s place of

family origin in Chinese characters. (양친(양부/양모)의 본을 한자로 쓰세요.)

￭ Please write the adoptive parents(adoptive father/adoptive mother)'s date of

birth(day/month/year). 양친(양부/양모)의 출생연월일을 쓰세요.

￭ Please write the adoptive parents(adoptive father/adoptive mother)'s resident

registration No. 양친(양부/양모)의 주민등록번호를 쓰세요.

￭ Please write the adoptive parents(adoptive father/adoptive mother)'s permanent

domicile address and address. (양친(양부/양모)의 등록기준지와 주소를 쓰세요.)

2. Paternal adopted child (친양자)

￭ Please write the paternal foster child's name in Korean or English and in Chinese

characters. (친양자의 성명을 한글과 한자로 쓰세요)

￭ Please write the paternal adopted child's place of family origin in Chinese characters.

(친양자의 본을 한자로 쓰세요)

￭ Please check the paternal adopted child's sex. 1)Male  2)Female

(친양자의 성별을 체크하세요 1)남 2)여 )

￭ Please check the paternal adopted child's resident registration No.

(친양자의 주민등록번호를 쓰세요)

￭ Please write the paternal adopted child's date of birth(Day/Month/Year).

(친양자의 출생연월일을 쓰세요)

￭ Please write the paternal adopted child's permanent domicile address and address.

(친양자의 등록기준지와 주소를 쓰세요)

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

(친양자의 종전의 성을 한글과 한자로 쓰세요)

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

(친양자의 부활된 성을 한글과 한자로 쓰세요)

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

characters. (친양자의 종전의 본을 한글과 한자로 쓰세요)

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

characters. (친양자의 부활된 본을 한글과 한자로 쓰세요)

3. Real biological parents of parental adopted child(father/mother)

친양자의 친생부모(부/모)

￭ Please write real biological parents(father/mother)'s name.

(친생부모(부/모)의 성명을 쓰세요)

￭ Please write real biological parents(father/mother)'s permanent domicile address.

(친생부모(부/모)의 등록기준지를 쓰세요)

￭ Please write real biological parents(father/mother)'s resident registration No.

(친생부모(부/모)의 주민등록번호를 쓰세요)

4. Other (기타)

※ Writing method (작성방법)

￭ Please write especially necessary informations for clarifying the family relation

register and check the submission true or not the agreement that child's surname

and place of family origin follow as child's mother's ones.

(가족관계등록부에 기록을 분명하게 하는데 특히 필요한 사항을 기재하며 혼인 신고시

자녀가 모의 성,본을 따르기로 협의하였는지 여부도 기재합니다.)

5. The confirmed date of judgement (재판확정일자)

￭ Please write the judgement confirmed date(day/month/year) and the court name.

(재판확정일자(년,월,일)와 법원명을 쓰세요)

6. Declarer (신고인)

※ Writing method (작성방법)

￭ If the judgment for adoption of paternal adopted child was confirmed, the

propounder of trial or the opponent of trial can report unilaterally. In this             case, please circle the relevant number and then seal and signature(or sign).

(친양자입양의 재판이 확정된 경우에는 소 제기자 또는 소의 상대방 단독으로 신고할

수 있습니다. 이 경우에는 해당 항목번호에 “o"으로 표시한 후 기명날인 (또는 서명)합니

다.)

￭ Please write name and resident registration No.

(신고인의 성명과 주민등록번호를 쓰세요)

￭ Please check qualification. (신고인의 자격에 체크하세요)

1) Propounder of trial (소 제기자)

2) Opponent of trial (소의 상대방)

3) Other (기타) : Please state(자격) :

￭ Please write address, telephone number and e-mail address.

(신고인의 주소, 전화번호, 이메일을 쓰세요)

7. Submitter (제출인)

※ Writing method (작성방법)

￭ Please write submitter's(regardless of declarer) name and resident registration No.

(제출자(신고인 여부 불문)의 성명 및 주민등록번호 기재)

([접수담당공무원은 신분증과 대조])

￭ Please write name and resident registration number.

(제출인의 성명과 주민등록번호를 쓰세요)

□ Attached documents 첨부서류

※ If the details of below No. 1 is checked by data processing at office of family

relation register, omit the attached.

(아래 1항은 가족관계등록관서에서 전산으로 그 내용을 확인할 수 있는 경우

첨부를 생략합니다.)

1.  Each one set basic certificate and family relation certificate of family relation register

for adopting person the paternal adopted child

( 친양자입양당사자의 가족관계등록부의 기본증명서, 가족관계증명서 각 1통)

2. Copy of adoption trial for paternal adopted child and decision certificate

(친양자 입양재판의 등본 및 확정증명서)

3.  Identification  신분확인

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

[가족관계등록예규 제23호에 의함]

￭ In case of declarer's attendance : Identification card

(신고인이 출석한 경우 : 신분증명서)

￭ In case of submitter's attendance : Submitter's identification card

(제출인이 출석한 경우 : 제출인의 신분증명서)

￭ In case of postal submission : Copy of declarer's identification card

(우편제출의 경우 : 신고인의 신분증명서 사본)