ACCOUNT_FIRST_NAME  ACCOUNT_LAST_NAME

ACCOUNT_ADDRESS_SINGLE_LINE

ACCOUNT_PHONE_NO ACCOUNT_EMAIL

To AUTHORITY, 

ADDRESS

04 May 2024

Dear Sir or Madam, 

Re: Request for Amendment of Birth Certificate - Ref. no:  

I am writing with the intention to make a formal request for the amendment of my official birth certificate.

Below are a list of amendments that I would like to make:

口 Name

Old Name: [insert old name]

New Name: [insert new name]

口 Gender

Old Gender: [Male]/[Female]

New Gender: [Male]/[Female]

口 Birthday

........................................