Mu 03-UT

CNG HA X HI CH NGHA VIT NAM

c lp - T do - Hnh phc

N XIN HNG TR CP X HI
Knh gi: - Ban Gim hiu Trng i hc Kinh t
- Phng Cng tc sinh vin
Ti tn l: ...........................................................Sinh ngy: ...............................................
Hin ang hc lp:............................................ Khoa: ......................................................
H khu thng tr ti x (phng):...................................................................................
Huyn (qun): ....................................... Tnh (thnh ph):.................................................
L i tng c hng tr cp x hi theo Thng t s 53/1998/TT-LT/BGD & TBTC-BL TB & XH ngy 25/08/1998 ca lin B Gio dc v o to, B Ti chnh, B
Lao ng -Thng binh & X hi, v ti thuc din:
........................................................................................................................................................
........................................................................................................................................................
Vy, ti lm n ny knh ngh Nh trng xt cho ti c hng tr cp x hi.
Ti xin cam oan nhng li khai trn l ng s tht, nu c g gian di, ti xin chu k lut
ca Nh trng.
XC NHN CA A PHNG

Nng, ngy
thng
Ngi lm n

KIN CA PHNG CNG TC SINH VIN

nm 20

XT DUYT CA BAN GIM HIU

Ghi ch: Sinh vin xin tr cp t ln th 2 tr i, ch cn ghi r i tng v thi gian cp ln u.