v.02/05/2017
Academic year:
URV.E10.10.00
APPLICATION TO ANNUL REGISTRATION FOR PERSONAL REASONS WITHIN 5 DAYS AFTER
COMPLETING THE REGISTRATION PROCESS
PERSONAL INFORMATION
Name:
First surname:
ID/passport number:
Address for written correspondence:
Post code:
Second surname:
Town:
Telephone:
Mobile phone:
URV email address:
That I am a student on the course:
Have you applied for a
Faculty/School:
YES
grant?
Universitat
Rovira i Virgili
NO (annulment of registration also implies annulment of grant application)
I REQUEST: The annulment of my registration for personal reasons within 5 calendar days after completing
the registration process.
NEW STUDENTS:
YES
NO
If yes, indicate one of the following:
I will collect the documents that I submitted for registration:
I wish to receive the documents that I submitted for registration by post:
* Annulment of registration means that you will lose your place on the course. You will have to go through the pre-registration procedure
again if you wish to begin any new university course.
I am aware that once my request has been accepted, the Secretary's Office of the Faculty/School will, if necessary, begins the process of
returning my registration fees to me.
[place]________________________________, [date] ______________________
(signature)
Please specify the account number that should be debited:
The same account number as when I enrolled (data base) (in this case you need not provide any more details)
My account number is the following:
IBAN
Name of bank
Client's account code
Branch
Control
Account number
SWIFT
Account holder
Identity card/passport
number
First surname
Second surname
Name
The student may choose to be notified in one of the two following ways:
By email sent to the student’s URV email address
By collecting the notification in person from the secretary’s office the faculty/school
Mr/Ms, Dean, Director of the Faculty/School - Head of the Secretary's Office
In compliance with Article 5 of Organic Law 15/1999, of 13 December, on Personal Data Protection, we inform you that the data provided by you will be stored and handled in a file held by the
Academic Management Service with the aim of managing your academic record and organizing your tuition and studies. These data will be passed onto the Spanish Ministry of Education, the
University and Research Grants Management Service, the Qualifications Service of the Ministry of Education, the centres affiliated to the URV, the CESCA and the Admissions Guidance Office of the
University. They may also be ceded to third parties in the circumstances specified by the relevant legislation.
The individual responsible for this file is the General Manager of the Universitat Rovira i Virgili, who is based in Tarragona at Carrer de l’Escorxador, s/n. Under the existing law, you have the right to
access, rectify and, if necessary, remove your data and to appeal against their being handled. To exercise this right, you must submit a written request addressed to the Academic Management
Service either in person to the Registry of the URV at Carrer de l'Excorxador, s/n - 43003 Tarragona, or online at https://seuelectronica.urv.cat/registre.html
v.02/05/2017
Academic year:
URV.E10.10.00
Students information
Full name:
Identity card number/passport number:
Address for written correspondence:
Postcode:
Town:
Course:
RESOLUTION OF APPLICATION TO ANNUL REGISTRATION FOR PERSONAL REASONS WITHIN 5
DAYS AFTER COMPLETING THE REGISTRATION PROCESS
Stamp of Faculty/School
Stamp of Faculty/School
The application is declined because:
The student’s registration will be annulled.
The student is not up to date with payments.
The application was presented outside the period.
[place]____________________,
[place]____________________,
[date]__________________________________
[date]__________________________________
The Head of the Secretary's Office
as delegated by the General Manager
The Head of the Secretary's Office
as delegated by the General Manager
This decision is not the end of the administrative process and, should you wish to do so, you can appeal to the rector of the URV within one
month of having been informed of this decision.
STUDENT GRANTHOLDER
Date of reception at SGA: ………………….....................................................................
The student signs this form to demonstrate that he/she has received and understood this resolution.
(signature)...............................................................
_____________ [place], _______ _________ ____________ [date].