香港中文大学（深圳）.doc

香港中文大学(深圳)
THE CHINESE UNIVERSITY OF HONG KONG, SHENZHEN
研究生院
The Graduate School
申请补发毕业证书
Application for Replacement of Graduate Certificate
注意
Note:
1. 申请人递交此申请表时,必须附上以下文件之正本及/或副本,以供查验。
Please present both original(s) / or and the copy(ies) of the documents listed below upon submission of this application.
请在适当位置「ü」
Please ü as appropriate.
A.
□
居民身份证/护照正本
Original of ID card/Passport
□
已验证为正本之身份证/护照正本
A certified true copy of ID card/Passport
B.
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毕业证书(因证书损毁而申请者)
Graduate certificate, for damaged certificate
个人资料
Personal Particulars:
姓名(英文)
Name (in English):
(中文)
(in Chinese):
身份证/护照号码
. Card No./Passport No.:
联络电话
Contact Tel. No.:
电邮
Email Address:
通讯地址:
Correspondence Address:
本人拟申请补发之毕业证书(请为每项申请个别填报表格一份):
I wish to apply for replacement of graduate certificate for (Please submit separate application for each
replacement certificate).:
学号
Student . No.:
于毕业证书上显示之名字
Name appeared on the graduate certificate:
学位/文凭
Degree / Diploma:
课程
Programme:
学制
Mode of Study:
全日
Full- time
兼读
Part-time
颁发学位年份
Conferment Year:
原因
Reason(s):
费用:人民币八佰元正
Fees: RMB¥800
□
前往财务处支付
By Finance
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网上电子转账
By E-banking
声明
Declaration:
本人确知包括补发毕业证书在内,只可同时间拥有由香港中文大学颁发予本人每项学历的毕业证书各一张,如本人随后寻回报失的证书,必须归还补发或原来的证书予大学。就上列第三部份提出补发证书的申请; 本人谨此
I understand that I can be in possession of only one copy, including the replacemen