中华人民共和国驻外使领馆领事认证申请表

中华人民共和国驻外使领馆领事认证申请表Application Formof ConsularLegalization of the Embassy/Consulateof thePeoples Republicof China★申请人须如实、完整、清楚地填写本表格，请逐项在空白处用中文或英文大写字母打印体填写,或在□内打选择J Theapplicant shouldfill inthis formtruthfully,completely andclearly.Please typetheanswer incapital Englishletters inthe spaceprovided ortick dthe relevantbox toselect.、个人申请1Applicant ForIndividual Use Only姓名性别出生地点Name GenderPlace ofbirth出生日期国籍职业Date ofbirthNationality Occupationyyyy-mm-dd身份证件种类身份证件号码Type of ID Numberof ID工作机构或学校名称工作机构或学校地址Name ofemployer/schoolAddress ofemployer/school家庭住址电子邮箱Home addressE-mail address住宅电话手机Home phone number Mobilephonenumber、企业及其他组织申请2Applicant ForCompany/Organization UseOnly企业或其他组织名称Name of company/organization电话联系地址AddressPhone Number姓名出生日期法定代表人信息Name Dateof birthyyyy-mm-ddLegal Representative■ofcompany/organization证件种类证件号码Type of ID NumberofID、公证书或其他证明文书证明的事项3Matters certifiedby thenotarial deedsor othercertificates□出生证□结婚证□无犯罪记录证明Birth certificate;Marriage certificate;Certificate ofnon-criminal record;□健康证明口学历证明□委托书□声明书Health certificate;Diploma;Authorization letter;Statement;□商业文件□其他请注明Business documents;Other pleasespecify:、认证办理目的和文书使用地点4Purpose andDestination of Legalization办理目的□婚姻□寄养□房产Purpose oflegalization:Marriage;Fosterage;Real estate;□诉讼□签证□领养□商务贸易Litigation;Visa;Adoption;Business andtrade;□其他请注明Othersplease specify:文书使用地Destination oflegalization:、提交材料及申办认证书的份数5Supporting documentsand CopiesofLegalization提交材料Supporting documents份数Copies、办理时间□普通X个工作日6Processing timeRegularservice for X business days注加急和特急服务须经领事官员批准，并将加收费用□加急X个工作日口特急Note:Express andrush serviceneeds approvalof consular officials,and extrafees Expressservice forX businessdaysX个工作日may apply.Rush serviceforXbusinessdays、代办人7Agent代办人姓名性别国籍Name ofagent GenderNationality身份证件种类身份证件号码职业Type ofID NumberofIDOccupation与申请人的关系联系地址Relationship withtheAddressapplicant联系电话电子邮箱Phone numberE-mail address、申请人/代办人声明8Declaration ofthe Applicant/Agent我保证以上所填内容真实如有不实之处，本人愿承担一切法律责任I herebydeclare thatall theinformation aboveis tmeand correctorwhich Ishall bearall thelegal responsibilities.★申请人签名日期Signature ofapplicant:___________________________________Dateyyyy-mm-dd:________________________★代办人签名日期Signature ofagent:______________________________________Dateyyyy-mm-dd:________________________我声明，我已阅读并理解以下内容领事认证是指领事认证机构根据自然人、法人或者其他组织的申请，对国外有关文书上的最后一个印鉴、签名的真实性予以确认的活动领事认证不对公证书或者其他证明文书证明的事项行使证明职能，不对文书内容本身的真实性、合法性负责，文书内容由文书出具机构负责领事官员有权对可能损害国家利益和社会公共利益的和存在不予办理领事认证有关情形的文书不予认证I herebydeclare thatI haveread andunderstood thecontent below:The consular legalization refersto thepractice ofconfirming the authenticity ofthe lastseal orsignature onrelevant documentsissuedby othercountries,performed byconsularlegalizationagencies uponthe applicationof naturalpersons,legal personsor otherorganizations.Consular legalizationdoes notundertake theresponsibility ofcertifying thematters certifiedby thenotarial deedsor othercertificates,and itis notresponsible fortheauthenticityand validityofthedocuments^content,which shallbe theresponsibility ofthe issuinginstitution.The applicationwill berefused byconsularofficialif thedocuments mayharm thenational interestsor socialpublic interestsorhave othercircumstances underwhich consularlegalization shallnot beperformed.★申请人签名日期Signature ofapplicant:_______________________________Dateyyyy-mm-dd:____________________________以卜项目仅供领事官员填写For OfficialUseOnly:接案人、接案日期签署人、签署日期复核人如有、复核日期。