[Form No.33]

Report of creating a new surname ( ..... Day ..... Month .......... Year)															※ Please write after reading the guidelines below and, when required to select one option, please circle the number as follows "○".
①Originator (Subject)		Name		Korean or English										Resident registration No.				-
				Chinese characters
		Permanent domicile address
		Address
②Surname & place of family origin		Previous surname				Korean or English				Chinese characters						Previous place of family origin			Korean or English				Chinese characters
		Created surname				Korean or English				Chinese characters						Created place of family origin			Korean or English				Chinese characters
③Permission date			...... Day ..... Month .......... Year													Court name
④Other
⑤Declarer	Name		(Seal) or signature									Resident Registration No.								-
	Relationship						ꊱSelf ꊲLegal representative ꊳOther (Please state: )
	Address												Telephone No.									E-mail address
⑥Submitter	Name												Resident registration No.					-

Writing method
※ When the person who is using foreign surname and acquired Korean nationality want to use new surname & place of family origin instead of the foreign surname, this report has to be reported within one month from getting the notification of the permission judgement for creating surname with the copy of permission judgment after obtaining the permission judgement for creating surname from the jurisdiction domestic court. ④ : Please write especially necessary informations for clarifying the family relation register. : If previous surname and place of family origin aren't in Chinese characters or in Korean, write as original characters(letters). ⑥ : Submitter(Regardless of declarer)'s name and resident registration number. [접수담당공무원은 신분증과 대조]
Attached documents
1. One set a copy of permission judgement for creating surname 2. Identification [according to Article. 23 of the family relation register established rule] - In case of declarer's attendance : Identification card - In case of submitter's attendance : Submitter's identification card - In case of postal submission : Copy of declarer's identification card

Report of creating a new surname

(창성신고서)

※ Writing method (작성방법)

￭ When the person who is using foreign surname and who acquired Korean

nationality want to use new surname & place of family origin instead of the

foreign surname, this report has to be declared within one month from getting the

notification of the permission judgement for creating surname with the copy of

permission judgment after obtaining the permission judgement for creating a new

surname from the jurisdiction domestic court.

￭ 본 신고는 외국의 성을 쓰는 국적취득자가 그 성을 쓰지 않고 새로이 성과 본을            정하고자 하는 경우, 관할 가정법원에서 창성허가심판을 받아 그 허가심판서 등본을

첨부하여 창성하가심판의 고지를 받은 날로부터 1개월 이내에 하는 신고입니다.

① Originator(Subject) (창성자)

￭ Please write originator's name in Korean or English and in Chinese characters.

(창성자의 성명을 한글과 한자로 쓰세요)

￭ Please write originator's resident registration No.

(창성자의 주민등록번호를 쓰세요)

￭ Please write originator's permanent domicile address and address.

(창성자의 등록기준지와 주소를 쓰세요)

② Surname & place of family origin (성.본)

￭ Please write previous surname in Korean or English and in Chinese characters.

(종전의 성을 한글과 한자로 쓰세요)

￭ Please write previous place of family origin in Korean or English and Chinese

characters. (종전의 본을 한글과 한자로 쓰세요)

￭ Please write the created surname in Korean or English and in Chinese characters.

(변경된 성을 한글과 한자로 쓰세요)

￭ Please write the created place of family origin in Korean or English and Chinese

characters. (변경된 본을 한글과 한자로 쓰세요)

③ Permitted date (허가일자)

￭ Please write the permitted date and name of court.

(허가일자와 법원명을 쓰세요)

④ Other (기타사항)

※ Writing method (작성방법)

￭ Please write especially necessary informations for clarifying the family relation

register. (가족관계등록부에 기록을 분명하게 하는데 특히 필요한 사항을 기재합니다.)

￭ If previous surname and place of family origin aren't Chinese characters or

Korean, write as original characters(letters).

(창성전의 성과 본이 한자나 한글이 아닌 경우에 원래의 문자표기)

⑤ Declarer (신고인)

￭ Please write name with signature and sign and resident registration No.

(신고인의 성명과 함께 서명날인하고 주민등록번호를 쓰세요)

￭ Please check on relationship. (신고인의 자격에 체크하세요)

ꊱ Self   ꊲ Legal representative   ꊳ Other (Please state :          )

(ꊱ 본인   ꊲ 법정대리인   ꊳ 기타 (자격:        ))

￭ Please write address, telephone No. and e-mail address.

(신고인의 주소, 전화번호, 이메일 주소를 쓰세요)

⑥ Submitter (제출인)

※ Writing method (작성방법)

￭ Submitter(Regardless of declarer)'s name and resident registration No.

(제출자(신고인 여부 불문)의 성명 및 주민등록번호 기재 [접수담당공무원은 신분증과 대조])

￭ Please write name and resident registration number.

(성명과 주민등록번호를 쓰세요)

※ Attached documents 첨부서류

1. One set a copy of permission judgement for creating surname

(창성허가 심판 등본 1부)

2.  Identification 신분확인

[according to Article 23 of the family relation register established rule]

[가족관계등록예규 제23호에 의함]

￭ In case of declarer's attendance : Identification card

(신고인이 출석한 경우 : 신분증명서)

￭ In case of submitter's attendance : Submitter's identification card

(제출인이 출석한 경우 : 제출인의 신분증명서)

￭ In case of postal submission : Copy of declarer's identification card

(우편제출의 경우 : 신고인의 신분증명서 사본)