Residing at House No. : ………………… Road, Lane or Alley : ………………………. Village No. : ……….
Sub-district : ……………………………… District :Bang Khae District Province : ………………………..
Father’s Name : Luciano Mother’s Name : ..................
has been granted permission to change the personal name to " macos “
the District Registrar hereby issued this certificate as evidence.
District Office of : Bang Khae District Ba
Given on : ๑๐ January BE ๒๕๕๔
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This is to certify that
…………………………………………………………………………
Residing at House No. : ………………… Road, Lane or Alley : ………………………. Village No. : ……….
Sub-district : ……………………………… District :Bang Khae District Province : ………………………..
Father’s Name : Luciano Mother’s Name : ..................
has been granted permission to change the personal name to " macos “
the District Registrar hereby issued this certificate as evidence.
District Office of : Bang Khae District Ba
Given on : ๑๐ January BE ๒๕๕๔
(Signed)
Local Registrar
(Officialseal affixed)
Certifiedcorrect translation