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MEGHATALMAZS

Alulrott ............................................................................................................ (nv, Neptun kd)

[szletsi (lenykori) nv: .....................................................................................................,

szletsi hely, id: ..................................................................................................................

anyja neve ..............................................................................................................................

szemlyazonost okmny tpusa, szma: .............................................................................

lakcme: .................................................................................................................................]

meghatalmazom: ......................................................................................................................... (nv)

[szletsi (lenykori) nv: ...................................................................................................................... ,

szletsi hely, id: ...................................................................................................................................

anyja neve .................................................................................................................................................

szemlyazonost okmny tpusa, szma: ..........................................................................................

lakcme: .................................................................................................................................................... ]

hogy ..............................................................................................................................................

.................................................................................................................................................. gyben
a Kzponti Tanulmnyi Hivatalban a helyemben s nevemben eljrjon.

Kelt: ............................................... , ........... v ............................ h .......... nap

................................................................. .................................................................
meghatalmaz alrsa meghatalmazott alrsa

Elttnk, mint tank eltt:

................................................................. .................................................................
tan alrsa tan alrsa
Nv:

................................................................. .................................................................
Lakcm:

................................................................. .................................................................
Szemlyazonost okmny tpusa, szma:

................................................................. .................................................................

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