EÖTVÖS LORÁND UNIVERSITY

APPLICATION FORMFOR NEW DIPLOMA AND DIPLOMA SUPPLEMENT

DUE TO INCORRECT OR CHANGED BIRTH CERTIFICATE DATA

Reference No.1:

The issuance of a new diploma and diploma supplement due to incorrect or changed birth certificate data is free of charge. ATTENTION: a copy of the document with the correct information must be attached to the application!

Applicant’s data:Name: ________________________________________________________Birth name: ________________________________________________________Date and place of birth:______________________________________________________Mother’s maiden name:______________________________________________________Mailing address: ________________________________________________________Telephone number: ________________________________________________________E-mail address: ________________________________________________________Neptun/EHA code: ________________________________________________________

Applicant’s study programme:Name of the programme:_____________________________________________________Level of study: BA/BSc, MA/MSc, undivided one-tier programme,

vocational training(Please underline the applicable one.)

Type of programme: full-time / part-time / correspondence (Please underline the applicable one.)Beginning and end of student status:_________________________________________

Requested document: diploma / diploma supplement (Please underline the applicable one.)Data of the original document:

Name on the document:______________________________________________________Number and date of the document:___________________________________________Incorrect data: ________________________________________________________Correct data: ________________________________________________________

Date and place:…………………………………………

1 To be filled out by the University.

EÖTVÖS LORÁND UNIVERSITY

…………………….……………….Applicant’s signature