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CNG HA X HI CH NGHA VIT NAM

PH LC III
c lp - T do - Hnh phc
(Km theo Thng t lin tch s 29 /2010/TTLT-BGDT-BTCBLTBXH ngy 15 thng 11 nm 2010 ca Lin B GD&T,
B Ti chnh v B Lao ng-Thng binh v X hi)

N NGH CP TIN H TR MIN, GIM HC PH


(Dng cho sinh vin ang hc ti cc c s gio dc ngh nghip v GD i hc cng lp)

Knh gi: Phng Lao ng -Thng binh v X hi (cp huyn, qun)


H v tn: ................................................................... . S CMND:
Ngy, thng, nm sinh: ............................................. . Ni sinh:........................................................
H tn Cha ca sinh vin: ......................................................................................................................
H tn M ca sinh vin: .......................................................................................................................
H khu thng tr (ghi y : s nh, ng...):.................................................................... ............
X (Phng): ......................................... Huyn (Qun): ...............................................................
Tnh (Thnh ph): ..........................................................................................................................
Ngnh hc: ....................................................... M s sinh vin: .................................................
Thuc i tng: (ghi r i tng c quy nh ti Thng t lin tch hng dn Ngh nh 49):
....................................................................................................................................................................
Cn c vo Ngh nh s 49/2010/N-CP ngy 14 thng 5 nm 2010 ca Chnh ph, ti lm n
ny ngh c xem xt, gii quyt c cp tin h tr min, gim hc ph theo quy nh v ch
hin hnh.

TP. H Ch Minh, ngy .... thng .... nm 20..........


Ngi lm n
(K tn v ghi r h tn)
in thoi lin lc:
Sinh vin:.......................................................................
Cha/M ca sinh vin: ..............................................

XC NHN CA TRNG I HC KINH T TP.HCM

Trng: i hc Kinh t thnh ph H Ch Minh.


Xc nhn anh/ch: ................................................................................
Hin l sinh vin nm th .........; Hc k: ............. Nm hc...................; Lp ...............................
Khoa ..................................................; Kha hc................................ ; thi gian kha hc........(nm);
H o to ............................. ca nh trng. K lut: ...................(ghi r mc k lut nu c).
S tin hc ph hng thng: ....................... ng.
ngh phng Lao ng - Thng binh v X hi xem xt gii quyt tin h tr min, gim hc ph cho
anh/ch: ...................................................... theo quy nh v ch hin hnh.

TP. H Ch Minh, ngy ..... thng ..... nm 20........


TL. HIU TRNG
TRNG PHNG QUN L O TO - CTSV