申請離婚登記聲明書
DECLARATION FOR DIVORCE REGISTRATION APPLICATION

出處：http://www.nnmz.gov.cn/88/2009_9_7/88_641_1252306916453_(1).html

我們雙方申請離婚登記，謹此聲明：
Solemnly declare, that
  

男方姓名：                                   國籍：                      
Name(Male):                                  Nationality:　　　　

出生日期：        年    月    日    民族：           職業(yè)：                   
Date of Birth:        Y    M   D                        Occupation:

文化程度：                   身份證件號：                                 
Educational Level:           Passport Number:

常住戶口所在地：                                                          
Registered Permanent Residence:
 

女方姓名：                                      國籍：                      
Name(Female):                               Nationality:

出生日期：        年    月    日  民族：            職業(yè)：                   
Date of Birth:     Y    M   D                      Occupation:

文化程度：                   身份證件號：                                 
Educational Level:           Passport Number:

常住戶口所在地：                                                          
Registered Permanent Residence:
  

　　我們于       年     月   日登記結婚，結婚字號               ，離婚原因是                      。我們雙方自愿離婚，對于子女撫養(yǎng)、財產(chǎn)、債務等事項已達成一致處理意見并共同簽署了離婚協(xié)議書。
We married on       , the certificate of marriage registration number is    .
Now we apply for divorce due to        . We apply for divorce at our free will and signed divorced agreement under unanimous disposal of take care of our children, assets and liabilities.
   

　　上述聲明完全真實，如有虛假，愿承擔法律責任。
　　I swear that the above is true and reliable, and I promise to undertake all corresponding legal responsibilities if there’s any falsehood.

聲明人：                                                 年      月      日
                                                                 年      月      日

監(jiān)誓人：                                                 年      月      日

(注：聲明人簽名須在監(jiān)誓人面前完成) （Notice: the signature should be executed before supervisor.）