国立中央大学学生宿舍押金退费申请书-学务处.docVIP

國立中央大學學生宿舍退宿申請表National Central University Application Form for Dormitory Check-out 申請日期Date 學號Student ID 姓名 Name 身份證字號 ARC No. 性別 Gender □男Male □女Female 身分別 Identity □碩博士PHD/ Master □大學部Undergraduate 聯絡電話Phone No. E-mail： 退宿Refundment Application 學年□上學期□下學期 School year □First semester □Second semester 退宿寢室: 舍Dorm 寢Room 退宿原因Reason for Check-out □休退學畢業ransferred (因離校原因申請退宿可依比例退還剩餘住宿費Dorm fee would be returned to students who apply for leaving school reason ) □交換時間結束Transfer period expiring □外宿Housing out of campus □其他自願退宿不退住宿Dorm fee wouldn’t be returned to students who apply for this three reasons.) 退款 帳戶Refund account (2擇1) 郵局局號 Post-office number 郵局帳號Account number 銀行 分行 銀行帳號 注意 事項 Notice 填寫之帳戶人所有，若因帳戶填寫錯誤或帳戶非本人，而導致郵局匯款發生問題，後果自行負責貸款Please do not use others account and assure of the validity of the account numbers. If there is any problem occurred after when post office remits money due to wrong writing and wrong account, the applicant needs to pay all responsibility. Please stick your copy of deposit book cover on paper’s back. 退宿搬遷請於每日9:00~19:00間辦理，以免影響其他住宿生安寧。 Dormitory Check out time for daily is 9:00A.M to 7:00P.M.. 切結書Certifi-cate ?我已完成寢室內公共區域清潔責任，並已經室友確認I have completed the cleaning of public areas in the bedroom responsibility and roommate has been confirmed. 室友簽名Roommate Signature： ?本人已繳納本學期住宿費(含押金)，惟因收據遺失，特此切結。 ?填寫之帳戶確實為本人所有I, who did pay the fee of dorm for this semester now make a certificate here for I lost my receipts, and Im sure the top of the account is correct. 申請人簽名Signature of the applicant: 宿舍管理員 退宿檢查 □寢室財產寢室清潔修改簽：年月 日宿費月元押金________元 退還住宿費元元退還押金_________元 承辦人 生輔組組長 ----------------------------------------------------------------------------------------------------------------------------- 臨時車輛入校證明單：學號：退宿退宿申請人於退宿後搬運物品，憑本聯進出校園，限當日晚上22：00前有效。 Application Form for Dormitory Check-out. Ⅱ:寢室內個