Applicant’s name:
Department / Workplace:
Study branch:
Supervisor:
Requested termination of study valid as of:		

Address of doctoral student:

Signature of doctoral student:

	Confirmation of
	Discharge of Obligations and Duties

First name, surname:
Date of birth:

We confirm that the above named does not have any obligations towards our institution.

	stamp, signature	date	
Central Library of the CTU			
Department / workplace			
Service Facilities Administration of CTU Strahov			
College Administrative Building and Student Center (returning the student’s ID card)			
IT Center of FEE
(returning the chip)