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APPLICATION FORM – Erasmus+ exchange students

CONTACT AND PERSONAL INFORMATION. Please type or write legibly.

o Name Bublauskis Martynas

Last First Middle

o Female Male X

o Address 31 Satrijos 14

Street

Skuodas Klaipeda 98109 Lithuania


City State Zip Code Country

o Current Phone and E-Mail


+370 625 03 809 martynas.bublauskis@gmail.com

o Date of Birth 11 / 17 / 1998 /

month, day, year

o Place of birth Lithuania

o EU Health Insurance No.

o Passport No. (+copy) 24043395

o Country of citizenship Lithuania

o ECTS credit degree program 180 ECTS

o Date of higher education entrance qualification 09 / 01 / 2019

Additional we need CV, ID-picture, a copy of your identity card, a copy of


your visa and an overview of your previously attend lectures via post.
With your signature, you agree to FH Wedel using your personal data and
ID-picture for administration purposes.

Date 05/21/2020 Signature

FH Wedel, International Office, Feldstr. 143, D-22880 Wedel


International Office: nha@fh-wedel.de - www.fh-wedel.de

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