学生证遗失切结书（离校用）.doc

學生證遺失切結書(離校用) 本人學生證因保管不慎而遺失，無法於辦理離校時送交註冊組註記，特填具此切結書以聲明並遵守下列事項： 已確實完成學生證掛失系統之掛失程序。 （至Portal入口，進入〝學生證掛失〞） 原持有學生證為悠遊卡者，已確實辦妥悠遊卡註銷/退費，且已知悉日後學生證若尋獲，將無法繼續使用悠遊卡功能。 (無論是否已經儲值，請先至Portal入口→學生證掛失→申請悠遊卡註銷/退費 選擇以E-mail申請註銷/退費→讀取確認信 選擇以傳真申請註銷/退費→列印申請單，並裝訂於本表後。) 若有尋獲定當自行銷毀，不做為在學證明或其他用途。 如有虛偽不實之情事，具切結書人願負相關法律責任。 此致 國立中央大學教務處註冊組 切結人： 學 號： 系 所： 中華民國 年 月 日 Guarantor Letter of Lost Student ID Card (for school clearance use) My Student ID Card is lost because of my improper care, which makes me unable to return it back to Registrar’s Office for marking as expired when undergoing my school clearance process. I’m writing this as a declaration of intent and will abide by the following: I’ve reported loss of Student ID Card, and I’ve completed all reporting process in the on-line system. (Log in to Portal, and go to “Report of Loss.”) If the lost card is a combination of Student ID Card and EasyCard, make sure the EasyCard function has been deactivated/refunded. Moreover, if the lost card is found in the future, it does not possess any and all EasyCard functions.(Whether the value has been added, please first log in to Portal for Report of Loss, then click EasyCard Deactivation/Refund If the lost Student ID card is found, it should be destroyed and cannot represent as proof of enrollment or for other uses. I’m willing to bear any and all legal liabilities if there are false representations or misleading statements contained in. Guarantor： Student ID No： Department/Institute： _________________________________(yyyy/mm/dd) 103.08.05 Select deactivation/refund application through e-mail, and then check inbox for confirmation letter Select deactivation/refund application through fax, then print application form and attach a copy right after this Letter.