Male

30

Dalian Institute of Chemical Physics

Female

30

Dalian Plastics Research Institute

Child’s name

Sex

Male

Date of birth

Jan. 26,1995

Issuing unit and time of health   subsidies to children

3.5 Yuan respectively from the units of the   couple,

Jan. 1995

Introductions

1.     This certificate is issued to a couple willing to   give birth to only one child and may not be lent or transferred.

2.     This certificate is invalid without seal or with   alteration.

3.     If the couple gives birth to another child, this   certificate shall be recovered by the issuing authority.

4.     If lost, this certificate will not be reissued.

            No.:   63103

Issuing authority: Dalian   Xigang District Family Planning Committee (sealed):

Feb.   15, 1995