Application Form of Work Permit for Foreign Students,

Overseas Chinese Students and Ethnic Chinese Students

Types of application (Please check one)
Categories of application: (Please check one)
work permit document supplement
foreign students
overseas Chinese students permit re-issue other

ethnic Chinese students

Name of applicant Gender

(Chinese)

Name of applicant
(English) Nationality

Passport number ARC ID number

YMD
Phone number
Date of birth

Day/ Year
School attended Night Faculty

(County) (Town)(Vil.) (Rd.)(Sec.) (Lane)

Mailing address (Alley)(No.)(F.)
(City) (City)(District) (St.)
Y M D Y M D
Application time (valid for six months maximum)

Name Tel
Emergency contact person
(
)
(8 )
(9 )

Signature or stamp of

applicant

Approved by the Dept./Inst.
Stamp is necessary Dep./Inst. Directors

Signature or Stamp


Copy of student ID (front) Copy of student ID (back)

Please Check if pick-up in person (with declaration sheet)

Filing stamp Filing
number

(100 )()()2
(1) ()
00000425 104/08/12 10:28:24 00000425 104/08/12
030118 1A4 578109
(8 )
030118

104 08 12 030118(8 )00000425
(2) ()
000100-6
E-8038482
104.8.18

(9 )E-8038482104 8 18 000100-6