Report Loss of Receipt (Certifying copy)
Report Loss of Receipt (Certifying copy)
$
0
Total
Surname (BLOCK letters in English)
*
Given Names (BLOCK letters in English)
*
Full name (in Chinese)
*
Year of Admission
*
Must be a number between
4
and
4
Programme Enrolled
*
Frequently Checked Email Address
*
*
I wish to pay HK$40.00 for a certifying copy of tuition fee receipt (1st installment).
I wish to pay HK$40.00 for a certifying copy of tuition fee receipt (2nd installment).
Method of Despatch (Please tick as appropriate):
*
Method of Despatch (Please tick as appropriate):
I will collect the certifying copy of receipt in person.
The certifying copy of receipt will be collected by the person authorized in the letter attached.
Please send the certifying copy of receipt locally by mail (Hong Kong Post plain letter) or overseas by ordinary air mail. (For mail despatch, please fill in the name and address to which your certifying copy of receipt is to be sent)
Name
Address
Draw your signature into the box below.
Draw
or
Type
I understand this is a legal representation of my signature.
Clear
Full Name
I understand this is a legal representation of my signature.
Notes to the applicants
1. The personal data provided on this form will be used by the Continuing Professional Education, Department of Social Work Hong Kong for the purpose of processing this application.
All information provided, when no longer required, will be destroyed.
2. For correction of or access to the personal data after submission of this form, please contact the Continuing Professional Education, Department of Social Work.
3. Information provided on this form may be transferred to other departments/administrative units within CUHK for consideration and granting approval, where applicable.
Disclaimer
The personal data collected will be used by Continuing Professional Education, Department of Social Work and the authorised personnel for processing captioned purposes only. All personal data you provided will not be disclosed to any third parties unless with your prior consent.