B GIO DC V O TO

CNG HA X HI CH NGHA VIT NAM

TRNG I HC M- A CHT

c lp T do Hnh phc

T KHAI
(In bng tt nghip i hc, cao ng v chng ch GDQP, GDTC)

1. Cc thng tin cn k khai:

H v tn: (ch hoa c du) . Nam/N
Dn tc:..
Ngy sinh thng.... nm..............................................
Ni sinh (khai theo Giy khai sinh):......
Tnh: ..
Lp: KhaM sinh vin:.
H o to:..
Ngnh o to:Chuyn ngnh:.....
Nm tt nghip: 201.
2. in thoi lin h vi sinh vin khi cn thit
Nh ring......Di ng......................
3. Cam kt
Ti xin cam oan li khai trn l ng, m bo chnh xc tuyt i, nu sai cc thng tin
khai trn y Ti xin hon ton chu trch nhim.
(T khai thng tin c nhn khng c nh ngi khc khai h, np km theo 01 bn Giy
khai sinh photo c cng chng).
.., ngy thng..nm 201.
Ngi khai
(K v ghi r h tn)