香港中文学院（深圳）.doc

香港中文大学(深圳)THECHINESEUNIVERSITYOFHONGKONG,SHENZHEN研究生院TheGraduateSchool申请补发毕业证书ApplicationforReplacementofGraduateCertificate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。Pleasepresentbothoriginal(s)/orandthecopy(ies)「ü」Pleaseü.□居民身份证/护照正本OriginalofIDcard/Passport□已验证为正本之身份证/护照正本AcertifiedtruecopyofIDcard/PassportB.□毕业证书(因证书损毁而申请者)Graduatecertificate,fordamagedcertificate个人资料PersonalParticulars:姓名(英文)Name(inEnglish):(中文)(inChinese):身份证/./PassportNo.:.:电邮EmailAddress:通讯地址:CorrespondenceAddress: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):Iwishtoapplyforreplacementofgraduatecertificatefor(Pleasesubmitseparateapplicationforeachreplacementcertificate).:.:于毕业证书上显示之名字Nameappearedonthegraduatecertificate:学位/文凭Degree/Diploma:课程Programme:学制ModeofStudy:全日Full-time兼读Part-time颁发学位年份ConfermentYear:原因Reason(s):费用:人民币八佰元正Fees:RMB¥800□前往财务处支付ByFinance□网上电子转账ByE-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IunderstandthatIcanbeinpossessionofonlyonecopy,includingthereplacementcopy,ofthegraduatecertificateforeachacademicqualificationawardedbyTheChineseUniversityofHongKongandIwouldberequiredtosubmittheextracopy(ies)ofthecertificatetotheUniversityfordestructioniftheoriginalcopy,previouslyreportedlost,