外籍配偶或子女採用中文姓名聲明書

Declaration Of Adoption of Chinese Names

茲聲明本人 (I, the undersigned)

1. 姓名 (Full Name):
2. 性別 (Sex):
3. 國籍 (Nationality):
4. 出生日期 (Date of Birth):
5. 護照號碼 (Passport No.):
6. 地址 (Address):
7. 電話號碼 (Phone No.):
8. 關係人 (Person related)
稱謂 (relationship) :
姓名 (Full Name):
出生日期 (Date of Birth):
地址（Address）:
電話號碼(Phone No.):

申請中華民國戶籍登記時決定採用 (姓) （名）為中文姓名，且充分瞭解，此中文姓名非依法令不得任意更改。特此聲明。(I do solemnly declare and affirm that I shall use the Chinese surname and first name for household registration in Taiwan(the Republic of China), and fully understand that the said Chinese name can only be altered under relevant laws and regulations.

簽名(SIGNATURE)：

法定代理人(GUARDIAN, if applicable)：

請注意：依我國「姓名條例」第1 條第3 項規定，中華民國國民與外國人、無國籍人結婚，其配偶及所生子女之中文姓名，應符合我國國民使用姓名之習慣。(Please note: In accordance with Paragraph 3 of Article 1 of the Name Act, the Chinese name of an ROC citizen’s foreign/stateless spouse and children should comply with the conventions practiced in the ROC. Otherwise, the Household Registration Office may reject the declaration for this adoption of Chinese names.)