Sample custody certificate

___word___

I certify that ______, ______ year ___ month ___ was born, is the birth mother of _________. According to the provisions of Article 16 of the General Principles of the Civil Law of the People's Republic of China, _________ is the legal guardian of a minor _________.

People's Republic of China ___省___Notary Office

Notary:__________________

__________year month day