İzmir Ekonomi Üniversitesi

72.00.FR.41
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YAZOKULU DERS ÜCRETİ İADE BELGESİ
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SUMMER SCHOOL COURSE FEE REIMBURSEMENT
DOCUMENT
...../.....Öğretim yılı-..../.....academic year
I. ÖĞRENCİ BİLGİLERİ / STUDENT INFORMATION
Adı / First Name :
Soyadı / Surname :
Öğrenci No / Student No:
Fakülte / Faculty:
Bölüm / Department :
Yazışma Adresi / Contact Address :
Tel : (Ev / Home)
GSM :
e-mail :
Yazokulunda Kesin Kayıtlı Olduğu
Dersler/ The Courses Finally
Registered in the Summer School
Adeti/Number
Toplam Kredisi-Saati/
Total Credit-Hour
Ücreti/Fee
Ödediği Yazokulu Ücreti/
Fee that has been paid.
İade Edilecek Tutar/
Fee to be Reimbursed
Öğrencinin İmzası / Student’s
Signature
II. KAYIT-KABUL MÜDÜRLÜĞÜ ONAYI/ REGISTRAR’S OFFICE APPROVAL
Açılmayan dersin ücretinin kendisine iade edilmesi gerekmektedir.
The fee of the courses that are not opened has to be reimbursed.
..............................
(İmza/Signature)
III. MALİ İŞLER MÜDÜRLÜĞÜ/FINANCIAL AFFAIRS DIRECTORATE
ÜCRET İADELERİ İÇİN
(FOR REIMBURSEMENTS)
(MUTLAKA DOLDURULMALI/THIS SECTION HAS TO BE FILLED IN)
BANKA İSMİ/NAME OF THE BANK ...............................................................
IBAN KODU /IBAN CODE……………………………………………………………………………………....
HESAP TÜRÜ/ TYPE OF ACCOUNT :
TL
□
USD
□
NOT: BANKA HESABI ÖGRENCİYE AİT OLMALIDIR. AİLE BİREYLERİNE ÖDEME YAPILABİLMESİ
İÇİN HESAP SAHİBİNİN ADI VE SOYADININ MUTLAKA BELİRTİLMESİ GEREKMEKTEDİR.
NOTE: BANK ACCOUNT SHOULD BELONG TO THE STUDENT. IN ORDER TO BE ABLE TO MAKE A PAYMENT
FOR THE FAMILY MEMBERS, NAME AND SURNAME OF THE OWNER OF THE ACCOUNT MUST BE INDICATED
HESAP NUMARASI KENDİME AİT
□
ACCOUNT NUMBER BELONGS TO ME
HESAP NUMARASI KENDİME AİT DEĞİL
□
ACCOUNT NUMBER DOES NOT BELONG TO ME
HESAP SAHİBİNİN ADI SOYADI …………………………………………………………………………………….…………………………
NAME AND SURNAME OF THE OWNER OF THE ACCOUNT
İade Edildiği Tarih/
Date of Reimbursement

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