[Form No.6]

Report for dissolution of adoption ( Day Month Year)	※ Please write after reading the guidelines on the back and, when required to select one option, please circle the number as follows "○".
Section	Adoptive father	Adoptive mother
① Adoptive Parents	Name	Korean or English		Place of family origin (Chinese characters)		Korean or English		Place of family origin (Chinese characters)
Chinese characters		Date of birth		Chinese characters		Date of birth
Resident Registration No.	-	Resident registration No.	-
Permanent domicile address
Address
② Adopted child	Name	Korean or English		Place of family origin (Chinese characters)		Resident registration No.
Chinese characters		Date of birth		-
Permanent domicile address
Address
③Real biological parents of adopted child	Father	Name		Permanent domicile address
Resident registration No.	-
Mother	Name		Permanent domicile address
Resident registration No.	-
④Other
⑤Confirmed date of judgment	Day Month Year	Name of court
⑥Witness	Name	Seal or signature	Resident registration No.	-
Address
Name	Seal or signature	Resident registration No.	-
Address
⑦Assentient	Father	Name	Seal or signature
Mother	Name	Seal or signature
Lineal ascendant	Seal or signature	Resident registration No.	-	Relationship
Guardian	Seal or signature	Resident registration No.	-	Court of Permission		Permission date
⑧Declarer	Adoptive father	Seal or signature	Tel. No.
E-mail address
Adoptive mother	Seal or signature	Tel. No.
E-mail address
Adopted child	Seal or signature	Tel. No.
E-mail address
ꊱ Legal representative if aged under 15	□Father	Seal or signature	Tel. No.
E-mail address
□Mother	Seal or signature	Tel. No.
E-mail address
□Guardian	Seal or signature	Tel. No.
E-mail address
ꊲ Lineal ascendant	Dissolution agreement for less than 15 years old	Permission court		Permission date
ꊳPropounder of trial ꊴOpponent of trial	Seal or signature	Tel. No.
E-mail address
⑨Submitter	Name		Resident registration No.	-

Written method
※ If adoptive parents or adopted child are foreigner, please write nationality on section of the permanent domicile address. No. ① and No. ② :If you wrote the resident registration No. on section of resident registration No., you can omit to write the date of birth in accordance with article 25 section 2 of the Law. No. ④ : Please write specially necessary matters for clearing to register of family relation with below matters. : If the adopted child of agreement dissolution is under 15 years old, person to permit the adoption at that time must agree the dissolution, but if he can't agree by death or by the other reason, must receive to agree from the other lineal ascendance of birthplace or guardian and in this case attach the reason. No. ⑦ : If the adopted child of agreement dissolution is minor(over full 15 years old and under full 20 years old), must receive the agreement from parents but if parents can't agree as death or the other reason, must receive to agree from the nearest and the eldest of the other lineal ascendance. : In case above item, if the minor hasn't parents or lineal ascendance for agreement, must receive to agree by guardian who is permitted from family court. : If adoptive parents or adoptive child are incompetent, must receive to agree from guardian. No. ⑧ : Dissolved child seal and signature(or sign) on section of adoptive child, but if dissolved child by agreement is under 15 years old, must seal and signature by the person who permitted on adopting the adoptive child but if he can't report by death or the other reason, the other lineal ascendance of birthplace or guardian who is permitted by family court must seal and signature(or sign) after marking as “○” on each relevant number, if judgment of dissolution is confirmed, can report propounder or opponent of trial as alone. also in this case, please seal and signature(or sign) after marking as “○” on relevant number. No. ⑨ : Please write name and resident register No. of submitter(Regardless of declarer) [접수담당공무원은 신분증과 대조]
Attached documents
※ Please can omit to attach below No.1 if the data is checked by computer processing at office of family relation register. 1. Each one set the relation of adoption certificate of family relation register for dissolution of adoption person. 2. Each one set the judgment copy and confirmation certificate in case of judicial dissolution of adoption. 3. If the conciliation(settlement) was established for dissolution of adoption, attach each one set of the copy for report of conciliation(settlement) and the certificate of delivery. 4. One set of written certificate for relevant person on Article 4. each section of exemption law(the adopted child in accordance with「Exemption law of promotion and procedure for adoption」was dissolved by dissolution report so if the adoptive child want to revive as original surname and place of family origin, attach on report of dissolution). 5. Each one set certificate for agreement fact which is written by person who agreed the dissolution and if guardian agreed the dissolution of adoption or if guardian or the other lineal ascendance of the birthplace agreed the dissolution of adoption, please attach each one set of the written permission. 6. Identification[According to Article 23. established rule of family relation register] ① In case of judicial dissolution of adoption - In case of declarer's attendance : Identification paper - In case of submitter's attendance : Identification paper of submitter - In case of postal submission : Copy of identification paper of declarer ② In case of agreement dissolution - In case of declarer's attendance : Identification paper of all declarer - In case of declarer's nonappearance and submitter's attendance : Identification paper of submitter and of all declarer or written notarization or certificate of seal impression(If declarer signed on report without identification paper, attach the sign notarization and if sealed on report, attach the certificate of seal impression) - In case of postal submission : Sign notarization or certificate of seal impression of all declarer(If signed on report, attach the sign notarization and if sealed on report, attach the certificate of seal impression) ※ On agreement dissolution of adoption, attendance of agreed person of Article 64. section 1 of the law or submission of identification paper or attachment of certificate of seal impression is same the submission of identification paper of declarer or the attachment of certificate of seal impression.

Report for dissolution of adoption

(파양신고서)

※ Writing method(작성방법)

￭ If adoptive parents or adopted child are foreigner, please write nationality

on section of the permanent domicile address.

(양친 또는 양자가 외국인인 경우에는 그 등록기준지란에 국적을 기재합니다.)

① Adoptive Parents(adoptive father / adoptive mother) 양친 (양부/양모)

※ Writing method (No. 1and 2) ( 작성방법 1번 ~ 2번)

￭ If you wrote the resident register No. on section of resident register No.,

you can omit to write the date of birth in accordance with Article 25 Section 2 of the Law.

(법 제25조제2항에 따라 주민등록번호란에 주민등록번호를 기재한 때에는 출생연월일의

기재를 생략할 수 있습니다.)

￭ Please write the adoptive parents(adoptive father/adoptive mother)'s name in Korean

or English and in Chinese characters.

(양친(양부/양모)의 성명을 한글과 한자로 쓰세요.)

￭ Please write the adoptive parents(adoptive father/adoptive mother)'s place of

family origin in Chinese characters. (양친(양부/양모)의 본을 한자로 쓰세요.)

￭ Please write the adoptive parents(adoptive father/adoptive mother)'s date of

birth(day/month/year). (양친(양부/양모)의 출생연월일을 쓰세요.)

￭ Please write the adoptive parents(adoptive father/adoptive mother)'s resident             registration No. (양친(양부/양모)의 주민등록번호를 쓰세요.)

￭ Please write the adoptive parents(adoptive father/adoptive mother)'s permanent

domicile address and address.

(양친(양부/양모)의 등록기준지와 주소를 쓰세요.)

② Adopted child (양자)

￭Please write name in Korean or English and in Chinese characters of adopted child.     (양자의 성명을 한글과 한자로 쓰세요)

￭ Please write place of family origin in Chinese characters of adopted child.

(양자의 본을 한자로 쓰세요)

￭ Please write resident registration No. of adopted child.

(양자의 주민등록번호를 쓰세요)

￭ Please write date of birth(Day/Month/Year) of adopted child.

(양자의 출생연월일을 쓰세요)

￭ Please write permanent domicile address and address of adopted child.

(양자의 등록기준지와 주소를 쓰세요)

③ Real biological parents of adopted child(Father/Mother)

양자의 친생부모(부/모)

￭ Please write name of real biological parents.

(친생부모의 성명을 쓰세요.)

￭ Please write resident registration No. of real biological parents.

(양자의 주민등록번호를 쓰세요)

￭ Please write permanent domicile address real biological parents.

(양자의 등록기준지와 주소를 쓰세요)

④ Other (기타)

※ Writing method(작성방법)

￭ Please write specially necessary matters for clearing to register of family relation

with below matters.

(아래의 사항 및 가족관계등록부에 기록을 분명하게 하는데 특히 필요한 사항을

기재합니다.)

￭ If the adopted child of agreement dissolution is under 15 years old, person to

permit the adoption at that time must agree the dissolution, but if he can't

agree by death or by the other reason, must receive to agree from the other

lineal ascendance of birthplace or guardian and in this case attach the reason.

(협의파양을 하는 양자가 만15세 미만인 경우에는 양자의 입양 당시 입양을 승낙한

자가 파양의 협의를 하여야 하고, 그 자가 사망 그 밖의 사유로 협의를 할 수 없는

때에는 생가의 다른 직계존속 또는 후견인이 가정법원의 허가를 받아 협의를 하여야

하는데 그러할 경우에는 그 사유)

⑤ Confirmed date of judgment (재판확정일자)

￭ Please write the confirmed date(day/month/year) of judgement and the name

of court . (재판확정일자(년,월,일)와 법원명을 쓰세요)

⑥ Witness (증인)

￭ Please write name with seal and signature.

(증인의 성명과 서명날인하세요.)

￭ Please write the resident registration No. of witness.

(증인의 주민등록번호를 쓰세요.)

￭ Please write address of witness.

(증인의 주소를 쓰세요.)

⑦ Assentient (동의자)

※ Writing method(작성방법)

￭ If the adopted child of agreement dissolution is minor(over full 15 years old

and under full 20 years old), must receive the agreement from parents but if

parents can't agree as death or the other reason, must receive to agree from

the nearest and the eldest of the other lineal ascendance.

(협의파양을 하는 양자가 미성년자(만15세 이상 만20세 미만)인 경우에는 부․모의 동의를

받아야 하며 부 ․모가 사망 그 밖의 사유로 인하여 동의를 할 수 없는 경우에는

다른 직계존속이 있으면 직계존중 제일 가까운 존속 중 ․연장자 순으로 동의를

받아야 합니다.)

￭ Please write father's name with seal and signature.

(부의 성명과 서명날인하세요.)

￭ Please write mother's name with seal and signature.

(모의 성명과 서명날인하세요.)

￭ Please write lineal ascendance's name with seal and signature.

(직계존속의 성명과 서명날인하세요.)

￭ Please write the resident registration No. of lineal ascendance.

(직계존속의 주민등록번호를 쓰세요.)

￭ Please write the relation with adopted child.

(양자와의 관계를 쓰세요.)

※ Writing method(작성방법)

￭ In case above item, if the minor hasn't parents or lineal ascendance for agreement,

must receive to agree by guardian who is permitted from family court.

(전항의 경우 미성년자에게 동의할 부․모나 직계존속이 없으면 가정법원의 허가를

받은 후견인의 동의가 있어야 합니다.)

￭ If adoptive parents or adopted child are incompetent, must receive to agree

from guardian.

(양친이나 양자가 금치산자인 때에는 후견인의 동의를 받아야 합니다.)

￭ Please write guardian's name with seal and signature.

(후견인의 성명과 서명날인하세요.)

￭ Please write the resident registration No. of guardian.

(후견인의 주민등록번호를 쓰세요.)

￭ Please write name of permission court.

(허가법원의 이름을 쓰세요.)

￭ Please write date of permission.

(허가날짜를 쓰세요.)

⑧ Declarer (신고인)

※ Writing method(작성방법)

￭ Dissolved child seal and signature(or sign) on section of adopted child, but if

dissolved child by agreement is under 15 years old, must seal and signature by

the person who permitted on adopting the adopted child but if he can't report

by death or other reason, other lineal ascendance of birthplace or guardian who

is permitted by family court must seal and signature(or sign) after marking as

“○” on each relevant number, if judgment of dissolution is confirmed, can

report propounder or opponent of trial as alone. also in this case, please seal and

signature (or sign) after marking as “○” on relevant number.

(양자란은 파양을 하는 양자가 기명날인(또는 서명)하며, 다만 협의 파양을 하는 양자가

15세미만인 때에는 그 양자 입양시 입양을 승낙한 자가, 그 자가 사망 그 밖의 사유로

신고할 수 없는 때에는 가정법원의 허가를 받은 생가의 다른 직계존속 또는 후견인이

각각 그 해당되는 항목번호에 “○”으로 표시한 후 기명날인(또는 서명)하여야 하며,

파양의 재판이 확정된 경우에는 소 제기자 또는 소의 상대방 단독으로 신고할 수

있습니다. 이 경우에도 해당 항목번호에 “○” 으로 표시한 후 기명날인(또는 서명)합니다.)

￭ Please write adoptive father's name with seal and signature.

(양부의 성명과 서명날인하세요.)

￭ Please write adoptive father's telephone number and e-mail address.

(양부의 전화번호와 이메일을 쓰세요.)

￭ Please write adoptive mother's name with seal and signature.

(양모의 성명과 서명 날인하세요.)

￭ Please write adoptive mother's telephone number and e-mail address.

(양부의 전화번호와 이메일을 쓰세요.)

￭ Please write adopted child's name with seal and signature.

(양자의 성명과 서명날인하세요.)

￭ Please write adopted child's telephone number and e-mail address.

(양자의 전화번호와 이메일을 쓰세요.)

□ Legal representative for under 15 years old (15세미만자의 법정대리인)

￭ Please write father's name with seal and signature.

(부의 성명과 서명날인하세요.)

￭ Please write father's telephone number and e-mail address.

(부의 전화번호와 이메일을 쓰세요.)

￭ Please write mother's name with seal and signature.

(모의 성명과 서명날인하세요.)

￭ Please write mother's telephone number and e-mail address.

(모의 전화번호와 이메일을 쓰세요.)

￭ Please write guardian's name with seal and signature.

(후견인의 성명과 서명날인하세요.)

￭ Please write guardian's telephone number and e-mail address.

(후견인의 전화번호와 이메일을 쓰세요.)

□ Lineal ascendant (직계존속)

※ Dissolution agreement for less than 15 years old (15세미만자의 파양협의)

￭ Please write name of permission court.

(허가법원의 이름을 쓰세요.)

￭ Please write date of permission.

(허가날짜를 쓰세요.)

￭ Please check on whether propounder of trial or opponent of trial.

(소의 제기자인지 소의 상대방인지 확인 하세요.)

￭ Please write telephone number and e-mail address.

(전화번호와 이메일을 쓰세요.)

⑨ Submitter (제출자)

※ Writing method(작성방법)

￭ Please write name and resident register No. of submitter

(Regardless of declarer)

(제출자(신고인 여부 불문)의 성명 및 주민등록번호 기재)

￭ Please write name and resident registration No. of submitter.

(제출자의 성명과 주민등록번호를 쓰세요.)

□ Attached documents 첨부서류

※ Please can omit to attach below No.1 if the data is checked by computer             processing at office of family relation register.

(아래 1항은 가족관계등록관서에서 전산으로 그 내용을 확인할 수 있는 경우

첨부를 생략합니다.)

1. Each one set the relation of adoption certificate of family relation register for       dissolution of adoption person.

(파양당사자의 가족관계등록부의 입양관계증명서 각 1통.)

2. Each one set the judgment copy and confirmation certificate in case of judicial      dissolution of adoption.

(재판상 파양의 경우 판결등본 및 확정증명서 각 1부.)

3. If the conciliation(settlement) was established for dissolution of adoption, attach

each one set of the copy for report of conciliation(settlement) and the certificate

of delivery.

(파양의 조정(화해)성립의 경우 조정(화해)조서등본 및 그 송달증명서 각 1부.)

4. One set of written certificate for relevant person on Article 4. each section of

Exemption Law(the adopted child in accordance with「Exemption law of promotion     and procedure for adoption」was dissolved by dissolution report so if the adopted     child want to revive as original surname and place of family origin, attach on         report of dissolution).

(특례법 제4조 각 호에 해당되었던 사람임을 증명하는 서면 1부(「입양촉진 및 절차에

관한 특례법」에 따라 입양된 양자가 파양으로 인한 파양신고를 하면서 양자의 본래의

성과 본을 회복하고자 하는 경우 파양신고서에 첨부합니다).

5. Each one set certificate for agreement fact which is written by person who agreed

the dissolution and if guardian agreed the dissolution of adoption or if guardian

or the other lineal ascendance of the birthplace agreed the dissolution of

adoption, please attach each one set of the written permission.

(파양을 동의한 사람이 작성한 동의사실을 증명하는 서면과 후견인이 파양 동의한 경우

이거나 후견인 또는 생가의 다른 직계존속이 파양협의를 한 경우에는 법원의 허가서 각 1부.)

6. Identification[According to Article 23 established rule of family relation register]

(신분확인[가족관계등록예규 제23호에 의함])

① In case of judicial dissolution of adoption 재판상 파양

￭ In case of declarer's attendance : Identification paper

(신고인이 출석한 경우 : 신분증명서)

￭ In case of submitter's attendance : Identification paper of submitter

(제출인이 출석한 경우 : 제출인의 신분증명서)

￭ In case of postal submission : Copy of identification paper of declarer

(우편제출의 경우 : 신고인의 신분증명서 사본)

② In case of agreement dissolution 협의파양의 경우

￭ In case of declarer's attendance : Identification paper of all declarer

(신고인이 출석한 경우 : 신고인 모두의 신분증명서)

￭ In case of declarer's nonappearance and submitter's attendance : Identification

paper of submitter and of all declarer or written notarization or certificate of

seal impression(If declarer signed on report without identification paper, attach

the sign notarization and if sealed on report, attach the certificate of seal impression)

(신고인 불출석, 제출인 출석의 경우 : 제출인의 신분증명서 및 신고인 모두의

신분증명서 또는 서면공증 또는 인감증명서(신고인의 신분증명서 없이 신고서에

신고인이 서명한 경우 서명공증, 신고서에 인감 날인한 경우 인감증명)

￭ In case of postal submission : Sign notarization or certificate of seal impression

of all declarer(If signed on report, attach the sign notarization and if sealed

on report, attach the certificate of seal impression)

(우편제출의 경우 : 신고인 모두의 서명공증 또는 인감증명서(신고서에 서명한

경우 서명공증, 인감을 날인한 경우는 인감증명서)

※ On agreement dissolution of adoption, attendance of agreed person of Article 64 section

1 of the law or submission of identification paper or attachment of certificate of

seal impression is same the submission of identification paper of declarer or the

attachment of certificate of seal impression.

(협의파양에 있어서 법 제64조제1항의 협의를 한 사람의 출석 또는 신분증명서의 제시가

있거나 인감증명서의 첨부가 있으면 신고인의 신분증명서 제시 또는 인감증명서의

첨부한 것으로 볼 수 있습니다.)