[ตัวอย่าง] คำแปลหนังสือสำคัญแสดงการจดทะเบียนเปลี่ยนชื่อ-สกุล (แบบ ช.5) ภาษาอังกฤษ

Official Emblem 

    No……………..                                                                                      Form : Chor 5

Certificate of Surname Change Registration

…………………………

Identification No. ……………………………………………………………………………

 Residing at House No…………………………………………………… ………………….

                                    …………………………………………………………………………………….

 Father’s Name: …………………….. Mother’s Name: …………………………………….
 Has  requested to change the surname to: “…………………………….”
 Owing to:………………………………………………………

 The Registrar has granted permission as per application No……………dated………

 therefore, issued this certificate as evidence.

District Office: ……………………………………

      Issued on ……………………………………....

-signature-
(……………………….)

Local Registrar
(Official Seal Affixed)

Position Seal Affixed