复旦大学奖学金生银行卡信息登记表
Bank Account Registration Form for Scholarship Students
of Fudan
护照名Passport Name 中文名Chinese Name
学生类别Student Type
□本科生Undergraduate □语言生Language student □硕士生Master □普通进修生General advanced □博士生PhD □高级进修生Senior advanced 学号
Student Number
所获得的奖学金Scholarship I receive
□中国政府奖学金Chinese Government Scholarship □上海市政府奖学金Shanghai Government Scholarship □孔子学院奖学金Confucius Institute Scholarship
所在院系
Department
校内住宿房号
Room Number (on campus) 手机号码
Cell Phone Number
校外住宿地址（如住校外）Address (If you live off-campus) 电子邮件
Email
银行卡号（数字写法：1, 2, 3, 4, 5, 6, 7, 8, 9, 0 ）
Bank Card Number (Bank of China)
银行账户名（包括空格或标点）
Bank Account Name (including space or punctuation if any)
（见银行提供对账单上的户名Please refer to the account name on bank statement）银行开户城市
City Where the Account Was Opened
签名Signature: __________________
年year 月month 日date。