生源地

Country/Region

证件类型

Type of certificate

证件号码

Certificate No.

证件有效期

Certificate expiry date

居留证号码（留学生填写）

Residence Permit No.

(international students only)

居留证有效期（留学生填写）

Residence Permit expiry date

(international students only)

本人联系电话

Applicant Tel

本人自愿申请迁往____________________________________________________ __居住。

我将负责自己在校外居住时的人身安全和财务安全，并随时与我校国际学院保持联系，报告居留地址异动的情况。

The applicant volunteered by him/herself to reside at .

I will be responsible for my personal safety when I live outside the school and I am applying to rent apartment by myself with my parent’s permission. I myself will responsible for my personal safety and belongings.

I will always keep in touch with International Education . Report directly on changes in residence address in timely manner.

我保证以上填写的内容真实、准确、完整，并保证在停留居留期间遵守中华人民共和国的法律。

I hereby declarethat the information given above is true, correct and complete. I shall abide by the Chinese laws and regulations during my stay in the People’s Republic of China.

申请人签名： 申请日期：

Applicant signature： Application date：

国际学院意见：

OpinionofInternational College：

备注remarks：

1.现居留地址current residence address：

____________________________________________________________

2.现联系电话Applicant Tel：_______________________

3.拟迁往地址Relocate(new) residence address：

____________________________________________________________

4.房东姓名Name of Landlord：________________

5.房东联系电话Tel No.of Landlord：____________________

6.是否有租房协议Provide Rental contract ：是yes¨ 否no¨

7.是否有《入境人员临时住宿登记表》Registration Voucher of Residence For Visitors From Overseas：是yes¨ 否no¨