預收養(yǎng)父母基本情況表???????
INFORMATION ABOUT PROSPECTIVE ADOPTIVE
PARENTS??????????????
?????????????????????????????????????????????????????????????????
DATA：
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項 目
Item
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收 養(yǎng) 父 親
Adoptive Father
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收 養(yǎng) 母 親
Adoptive Mother
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姓 名
Name
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出生日期
D.O.B
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國 籍
Citizenship
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受教育狀況
Education
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身體狀況
Health Status
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婚姻狀況
Marital Status
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職 業(yè)
Occupation
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年收入
Annual Incomes
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是否受過刑事處罰
If there is any criminal record
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是/否
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是/否
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凈資產
Net Worth
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子女情況
Children at Home
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撫育特需兒童的有利條件
Advantages of Nurturing
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收養(yǎng)愿望
Adoptive Expectation
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遞交文件時間
Submission Date of Application
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*填表須知見背面
(The reverse side)
Points for Attention
1. This form should be filled in truthfully by the authorized
adoption organization according to the actual situation of the
family;
2. In the Health Status column, it should be truthfully
stated whether the person has ever suffered any serious
disease/contagious disease, major operation, and ever had history
of alcoholism/drug abuse; if there is any such incidents mentioned
above, please state in detail;
3. In the Marital Status column, please state accurately
the date of present marriage, whether any previous marriages, the
number of previous marriages, the cause of ending each previous
marriage, the dates of beginning and ending of each of them
etc.
4. In the Children at Home column, children include
children born out of the present marriage and previous marriages,
children born out of wedlock, and adopted children; if there is
any, please state their age, health status; the over-ten-year old
children's attitude toward their parents' application of adoption;
the grown-up children may not be included.
5. In the Criminal Punishment column, if there is any
criminal punishment, please put down in detail the incident, date
and punishment.
6. This form is merely used by the China Center of Adoption
Affairs for preliminary verification; should there be any big
discrepancy between the contents of the family's actual situation
and the contents in this form, the former shall prevail.
(China-ccaa.org October 16, 2006)