Consulado Geral de Portugal em Newark

[Pages:1]Consulado Geral de Portugal em Newark

FICHA PARA PEDIDO DE CERTID?O DE REGISTO CIVIL POR CORREIO ELECTR?NICO FORM TO REQUEST A CIVIL REGISTRY CERTIFICATE

Tipo de Certid?o requerida: Type of Requested certificate:

Nascimento Birth

Casamento Marriage

?bito Dea th

Nome completo do requerente: _____________________________________________________________ Applicant's full name

Data de Nascimento: ______ / ________ / _________

Date of Birth

Dia (day) M?s (month)

Ano (year)

N? de Inscri??o Consular: ____________________ Consular Registration N?

Naturalidade: ____________________________ / ______________________________ / _________________

Place of Birth

Freguesia (Parish)

Concelho (Municipality)

Distrito (District)

Filia??o: _______________________________________________________________________________

Parents Names

Pai (Father)

E (And)

________________________________________________________________________________

M?e (Mother)

N? do Registo: __________ Ano de : ____________ Conservat?ria: _______________________________

Registry n?

Year:

Civil Registry Office:

Observa??es: Com o averbamento de ________________________________________________________ Observations: With the endorsement of

Ocorrido em _______ / __________ / _____________

Occurred in Dia (Day)

M?s (Month)

Ano (Year)

N? de telefone do Requerente (para contacto pelo Consulado Geral): ________________________________ Applicant's phone number (to be contacted by the Consulate General): Email: ___________________________________________________

FIM A QUE DE DESTINA A CERTID?O AGORA SOLICITADA: ________________________________________ PURPOSE INTENDED FOR THE CERTIFICATE NOW REQUESTED: ___________________________________________________________________________________________

Data/Date: ___________________________________

Assinatura/ Signature: __________________________________________________________

A PREENCHER PELO CONSULADO:

Data do Pedido: ________ / __________ / ____________ Rubrica do Funcion?rio Consular: Date of Request: Dia (Day) M?s (Month) Ano (Year) Initials of the Consular Officer:

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