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I HC QUC GIA TP.HCM

TRNG I HC BCH KHOA

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc

S /XN/HBK-CTCT-SV

TP. HCM, ngy thng nm

GIY XC NHN
H v tn sinh vin:...................................
Ngy sinh://..Gii tnh: Nam
N
CMND s: .............................. ngy cp ....../......./......... Ni cp: ......................................
M trng theo hc (m quy c trong tuyn sinh H, C, TCCN):.................
Ngnh hc:.
H o to (i hc, cao ng):
Kho:...Loi hnh o to:.....................
Lp:.MSSV:...
Khoa:......................
Ngy nhp hc:../.../.. Thi gian ra trng (thng/nm):../../.
(Thi gian hc ti trng: .... thng)
- S tin hc ph hng thng:.....................................................ng.
Thuc din:

Thuc i tng

- Khng min gim

- Gim hc ph
- Min hc ph
- M ci
- Khng m ci

- Trong thi gian theo hc ti trng, anh (ch) ....................................................khng b

x pht hnh chnh tr ln v cc hnh vi: c bc, nghin ht, trm cp, bun lu.
Tn ti khon : Trng i hc Bch khoa.
S ti khon: 1940 201 178 555
Ti ngn hng Nng nghip Chi nhnh KCN Hip Phc Phng Giao dch Vn Hnh
TP.HCM.

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