Adoptive Relation Certificate 입양관계증명서
Permanent domicile address 등록기준지
Section 구분	Full Name 성명		Date of Birth 출생년월일	Resident Registration No. 주민등록번호	Sex 성별	Origin of Family Name 본
Self 본인
Information on adoption 입양사항
Section 구분		Full Name 성명	Date of Birth 출생년월일	Resident Registration No. 주민등록번호	Sex 성별	Origin of Family Name 본
Real biological father 친생부
Real biological mother 친생모
Adoptive father 양부
Adoptive mother 양모
Adopted child 양자
Section 구분		Details 상세내용
Adoption 입양		[Date of report] [신고일] [Adopted child] [양자]
Adoption 입양		[Date of report] [신고일] [Adoptive father] [양부] [Adoptive mother] [양모]
Adoption 입양		[Date of report] [신고일] [Adopted child] [양자] [Resident Registration No. of adopted child] [양자의 주민등록번호] [Processing Government office] [처리관서]
This certifies that above adoptive relation certificate fully reflects the information in the original family relation register. But, the adoptive relation of paternal adopted child is only written on adoptive relation certificate of paternal adopted child. 위 입양관계증명서는 가족관계등록부의 기록사항과 틀림없음을 증명합니다. 단, 친양자입양관계는 친양자입양관계증명서에만 표시합니다. Day Month Year 년 월 일 Head of Heaundae District, in Busan Metropolitan City, Korea 대한민국 부산광역시 해운대 구청장

[Annex Form No.3]<Revised 2010.6.3>