IMPORTANT

nainte de a ncepe completarea cererii, citii cu atenie instruciunile de pe verso-ul paginii, deoarece completarea
incorect a formularului va avea drept consecin ntocmirea greit a diplomei, deci anularea ei.
Read carefully the instructions on the back of the page before filling the request. Any incorect/incomplet information will
lead to writing wrong information on the diploma and therefore to its cacellation.
Avant de remplir cette demande, veuillez lire attentivement les instructions au verso de la page. Toute faute entrainera la
rdaction incorrecte du diplme de licence, donc son annulation.
Completarea diplomei se face pe baza datelor din certificatul de natere
The information on the diploma is based on the birth certificate
La rdaction du diplme se fait en respectant les donnes du certificat de naissance

Ctre,
RECTORATUL UNIVERSITII DE MEDICIN I FARMACIE
IULIU HAIEGANU CLUJ-NAPOCA

Subsemnatul(a)/ Undersigned / Soussign (e):

Nume (Birth Name/Nom )________________________________________________________________
* Nume dup cstorie (Married name/ Nom apres mariage) ____________________________________
Prenume (Given name(s)/Prnoms) ________________________________________________________________
Data naterii (Date of birth/Date de naissance):
Ziua (day/jour)_______________, Luna (month/mois)_______________, Anul (year/anne) __________
Localitatea naterii (Place of birth/Lieu de naissance) __________________________________________________
Judeul (numai pentru studenii romni)____________________________________________________________
ara (Country of birth/Pays) _____________________________________________________________________
Prenumele prinilor (Parents Given Name/ Prnoms des parents):
Tata (Father/Pere)___________________________________Mama (Mother/ Mere) ________________________
C.N.P (pt. cetatenii romani) ______________________________________________________________________
Pentru cetenii strini:
Residence permit / Carte de sjour _________________________________________________________________
Promoia________________________ cu examen de licen n sesiunea ___________________________________
Nr. telefon ______________________E-mail________________________________________________________
V rog s binevoii a-mi aproba eliberarea diplomei de licen/master
Anexez 4 fotografii 3/4 cm. (pe verso-ul fotografiilor se scrie facultatea, numele i prenumele).
{I enclose 4 photos cm (on the back of the photos will be written name of the Faculty, birth name and given
name)}.
{Jattache 4 photos cm (au verso des photos mettez le nom de la Facult, votre nom et prnom)}.
Data (Date)__________________________

Semntura (Signature)_____________________

DECANATUL FACULTII CERTIFIC EXACTITATEA DATELOR DE MAI SUS

Secretar facultate,
Nr. diplom______________________
Nr. registru_______________________
Citii cu atenie instruciunile de completare de pe verso.
{On the back of this request you will find the instructions to fill this form }
{Au verso, vous trouverez les instructions pour remplir cette demande}

Instruciuni de completare:

Cererea se va completa cu litere mari de tipar, corect i complet.

Numele i prenumele se vor scrie conform certificatului de natere; n cazul mai multor prenume, se vor
scrie toate n ordinea de pe certificat .
Studenii romni vor ataa prezentei o copie simpl a certificatului de natere.

* Studentele/Studenii care doresc ca pe diploma de licen s le fie trecut i numele de cstorie, trebuie s depun
spre aprobare la Decanatul facultii o cerere nregistrat, mpreun cu o copie legalizat a certificatului de
cstorie si declaraia autentificat la notariat, c nu vor mai solicita alt act de studii, in cazul modificrii
ulterioare a numelui.

Studenii strini vor ataa prezentei o copie a certificatului de natere i o copie a paaportului valabil.

Cererea se va depune la Decanat pn la data de 1 iulie 2015

Instructions:

The request will be filled with capital letters, correctly and with no omissions.
Write your birth name and your given name, the way they are written in your birth certificate; if you have
several given names, write them all exactly as they are specified in the birth-certificate.
Foreign students will enclose a copy of the birth certificate and a copy of the valid passport.

This request will be sent at the dean's office until the 1st of July 2015

Instructions:

Vous devez remplir cette demande avec majuscules, correctement. Remplissez tous les lignes.
Ecrivez votre nom et votre prnom tel quil apparait dans votre certificat de naissance; en cas de plusieurs
prnoms, mettez - les dans lordre inscrite dans le certificat.
Les tudiants trangers doivent attacher une copie du certificat de naissance et une copie du passeport en
cours de validit.

Vous devez deposer la demande au Decanat jusqu au 1er Juillet 2015