The image shows a document with a form filled out by a person. The document appears to be a form for a government or official purpose, as indicated by the official seal and the text "CHI NHAN CÁN CUOC" which translates to "Official Document" in English. 

The person filling out the form is wearing a white shirt and dark pants. They have short hair and are holding a pen in their right hand. The document itself has several fields with handwritten entries, including dates and other details. The overall appearance suggests a formal and structured environment, possibly related to administrative or legal processes.