中华人民共和国驻外使领馆领事认证申请表
Application Form of Consular Legalization of the
Embassy/Consulate
of the Peoples Republic of 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。
The applicant should fill in this form truthfully,completely and clearly. Please type the
answer in capital English letters in the space provided or tick (√) the relevant box to select.
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个人申请
Applicant (For Individual Use Only)
姓名
Name
性别
Gender
出生地点
Place of birth
出生日期
Date of birth
(yyyy-mm-dd)
国籍
Nationality
职业
Occupation
身份证件种类
Type of ID
身份证件号码
Number of ID
工作机构或学校名称
Name of employer/school
工作机构或学校地址
Address of employer/school
家庭住址
Home address
E-mail address
住宅电话
Home phone number
手机
Mobile phone number
2
企业及其他组织申请
Applicant (For Company/Organization Use Only )
企业或其他组织名称
Name of company/organization
联系地址
Address
电话
Phone Number
法定代表人信息 Legal
Representative of
company/organization
姓名
Name
出生日期
Date of birth
(yyyy-mm-dd)
证件种类
Type of ID
证件号码 Number of ID
3公证书或其他证明文书证明的事项 Matters certified by the notarial deeds or other certificates
出生证 Birth certificate;
结婚证 Marriage certificate;
无犯罪记录证明 Certificate no-criminal record;
健康证明 Health certificate;
学历证明 Diploma;
委托书 Authorization letter;
商业文件Business documents;
其他
(请注明)Other (please specify) :
___________________________________________________
4
认证办理目的和文书使用地点
Purpose and Destination of Legalization
办理目的 Purpose of legalization:
□婚姻 Marriage;
寄养 Fosterage;
房产 Real estate;
□诉讼 Litigation
; □签证 Visa; □领养 Adoption; □商务贸易 Business and trade;
□其他(请注明Others(please specify):
__________________________________________________
文书使用地
Destination of legalization:
声明书 Statement;
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RESET FORM
PASSPORT
CHINA
5
提交材料及申办认证书的份数
Supporting documents and Copies of Legalization
提交材料 Supporting documents
份数
Copies
6
办理时间
Processing time
注:加急服务须经领事官员批准,并将加收费用。
Note: Express service needs approval of consular officials,and extra fees may apply.
普通
Regular service
加急
Express service
7
代办人
Agent
代办人姓名
Name of agent
性别
Gender
国籍
Nationality
身份证件种类
Type of ID
身份证件号码
Number of ID
职业
Occupation
与申请人的关系
Relationship with
the applicant
联系地址
Address
联系电话
Phone number
电子邮箱
E-mail address
8
申请人/代办人声明
Declaration of the 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 hereby declare that all the information above is true and correct,for which I shall bear all the legal responsibilities.
申请人签名:
日期:
Signature of applicant: ___________________ Date(yyyy-mm-dd): ___________________
代办
人签名: 日期:
Signature of agent: ______________________ Date(yyyy-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
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 hereby declare that I have read and understood the content below:
The consular legalization refers to the practice of confirming the authenticity of the last seal or signature on
relevant documents issued by other countries,performed by consular legalization agencies upon the application of
natural persons,leg
al persons or other organizations.Consular legalization does not undertake the responsibility of
certifying the matters certified by the notarial deeds or other certificates,and it is not responsible for the authenticity
and validity of the documents’s content,which shall be the responsibility of the issuing institution.The application
will be refused by consular official if the documents may harm the national interests or social public interests or
have other circumstances under which consular legalization shall not be performed.
申请人签名: 日期:
Signature of applicant: Date(yyyy-mm-dd):
以下项目仅供领事官员填写(
For Official Use Only
:
接案人、接案日期: 签署人、签署日期: 复核人(如有)、复核日期:
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PASSPORT COPY & APOSTILLE COPY
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