■ Enforcement Rule of the Special Adoption Act [Attached Form No.16] Petition for Adoption Information Disclosure ※ Please mark (√) the check box [ ] as appropriate Receipt No. Date Received Processing Duration (Korean) (Telephone) Contact (Fax) Name (English) Number Petitioner (E-mail) Resident Registration Number (Passport Number/Foreign Registration Number) Address (Domicile) Personal Information on Birth Parents (at the time of [ ] Name [ ] Date of Birth [ ] Address [ ] Contact Number adoption) Age of birth parents at the time of adoption, adoption date and [ ] Adoption Background adoption reasons, name of the domicile area of birth parents (name of a si/gun/gu) Petition Details [ ] Name, resident registration number, date of birth, and place of birth of the petitioner before the adoption [ ] Name, address, and contact number of the protective facility or adoption agency where the petitioner was taken into care before adoption [ ] Others: Disclosure [ ] Perusal [ ] Copy/Printout [ ] Storage Device (electronic file) [ ] E-mail (electronic Method file) Receipt [ ] Visit [ ] Mail [ ] Fax [ ] Information Communication Network Method I hereby request that my adoption information be disclosed as indicated above pursuant to Article 36.1 of the Special Adoption Act, Article 14.1 of the Enforcement Decree of the same Act, and Article 29 of the Enforcement Rule of the same Act. __________Month _____Day, ___________Year Petitioner (signature or seal) Attention: President of Korea Adoption Services Head of Adoption Agency 1 11. A copy of a document certifying that the petitioner is an adoptee. This document need not Fee bbe submitted if the petitioner has been confirmed as an adoptee by presenting his/her ididentification card (ie, resident registration card, passport, foreign registration card, or other Attached ccertificate(s) confirming the petitioner's identity) to an employee of the Korea Adoption Document SServices or an adoption agency. None 22. A copy of a document certifying that there is a compelling reason for disclosure, such as a mmedical need, as per Article 36.3 of the Special Adoption Act Note A foreign national may use this form as the original copy and the form written in Korean as a translated version. 2 Application for Post-adoption Services Korea Social Service, Inc. Name First Middle Last Sex (Korean) (Present) Date of Birth Day / Month / Year Case K- ID No. Address Phone E-mail Education Occupation Marital Status Hobbies/ Skills Short description about your childhood, your current life, etc. Please check the service(s) desired. ___ A. Review of adoption file for a request or inquiry ___ B. Search for birth mother (family) & reunion, if possible 3 ___ C. Search for foster mother (family) & reunion, if possible ___ D. Other services: _____________________________________________________ Signature of Applicant _______________________ Date ______________________________ Disclosure of Adoption Information (Adoptive Parents’ Consent Form) 1. Applicant(Adopted Person) (Korean name) Adoption Name (Full legal name) agency Age and Date of Sex Adoption Social □ Domestic Security Adoption numbers (Tel) Contact □ Overseas (passport Information Adoption number ․ (E-mail) Foreign Registration Number) Address Country 2. Legal representative (Adoptive parents) Social Security numbers Name (adoptive (passport number ․ father) Foreign Registration Number) Name Social Security numbers (adoptive mother) (passport number 4 ․ Foreign Registration Number) Parent-adopted □ Yes person reside together □ No Address (Tel) Contact Information (E-mail) Legal representatives hereby agree to disclosure of adoption information according to Article 36, Section 1 of the Special Adoption Act. Date: (YR / MM / DD) Applicant: Name Signature (seal) Legal representative: Name signature (seal) Name signature (seal) ☞ details 5 1. This consent form of adoptive parents is required when minor adopted person submits “Petition for Adoption Information Disclosure” according to Special Adoption Act article 36. 2. When adoptive parents request adoption information disclosure of applicant(minor adopted person), adoptive parents(legal representative) must submit the following documents: ① 1 copy of “Petition for Adoption Information Disclosure” which applicant (minor adopted person) person has drafted (Attached Form No.16) ② 1 copy of document to show that applicant(minor adopted person) expressed his/her intention to request adoption information disclosure ③ 1 copy of Identification card which verifies the age of applicant (minor adopted person) ④ 1 copy of a document which certifies family relations of adopted person and legal representatives 6 .