Surname ………………………………
First name ………………………………
Date of birth ………………………………
Citizenship ……………………………..
Student of ………………………. . year
APPLICATION
I apply with a request to be allotted a place in the Students’ House in a single / double room*
for a period from ……………………. to ………………………….
Enclosed, please, find a copy of a confirmation of payment of ………………………………..
I declare that I am familiar with the Rules for the allotment of places in the Students’ House. Simultaneously, I pledge to observe the Rules of Residence in the Students’ House enclosed under separate cover.
In case I am not allotted a place in the Students’ House, please, refund the amount to the following account:
Name of the bank …………………………………………………
Address ………………………………………………….
Account No ……………………………………………….....
Swift code ………………………………………………….
…………………………… ……………………………………
Place and date Legible signature of the Student
* cross out if not applicable
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