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["                 生育登记服务承诺书（信息表）"]
[]
[]
[" 受理单位：                               （申请□      代办□      补办□）                    编号："]
["姓名",null,"身份证号码","婚姻状况","登记时间","户籍地","现居住地","工作单位"]
["夫"]
["妻"]
["生育   情况","孩次","出生年月","性别","政策属性","出生医学证明编号",null,"生育备注"]
[]
[]
[]
["本人 承诺","  我们夫妻郑重承诺：                                                                                                                                                                                                                                                                                            "]
[null,"上述婚育信息均属实，如有不实，我们愿承担相应法律责任。（加黑文字由当事人手写） "]
[null,"  承诺人签字：女方_________________                     联系电话（                  ）"]
[null,"              男方_________________                     联系电话（                  ）"]
[" 登记时间：                               委托代办人：                               经办人："]

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