中华人民共和国驻外使领馆领事认证申请表.doc

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1、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 s

2、pace provided or tick () the relevant box to select.1、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电子邮箱

3、E-mail address住宅电话Home phone number手机Mobile phone number2、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 Representativeof 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 ID3、公证书或其他证明

4、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 of non-criminal record;健康证明Health certificate; 学历证明Diploma; 委托书Authorization letter; 声明书Statement;商业文件Business documents; 其他（请注明）Other (please specify) : 4、认证办理目的和文书

5、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:5、提交材料及申办认证书的份数Supporting documents and Copies of Legalization提交材

6、料Supporting documents份数Copies6、办理时间Processing time 注：加急和特急服务须经领事官员批准，并将加收费用。 Note: Express and rush service needs approval of consular officials,and extra fees may apply. 普通（5个工作日）Regular service for 5 business days 加急（2或3个工作日）Express service for 2 or 3 business days 特急（1个工作日）Rush service for 1 busi

7、ness day7、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 address8、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 infor

8、mation 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，不对文书内

9、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

10、,performed by consular legalization agencies upon the application of natural persons,legal 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 auth

11、enticity and validity of the documentss 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：- 2 -