<form action="" method="POST">
<p class=MsoNormal align=center style='text-align:center;mso-line-height-alt:
18.0pt;tab-stops:243.0pt'><b style='mso-bidi-font-weight:normal'><span
style='font-size:36.0pt;letter-spacing:3.0pt'>ЗАЯВЛЕНИЕ<o:p></o:p></span></b></p>
<p class=MsoNormal align=center style='text-align:center;mso-line-height-alt:
18.0pt;tab-stops:243.0pt'><b style='mso-bidi-font-weight:normal'><span
style='font-size:36.0pt;letter-spacing:3.0pt'><o:p></o:p>
</span></b><b style='mso-bidi-font-weight:normal'><span
style='font-size:36.0pt;letter-spacing:3.0pt'>
<o:p></o:p>
</span></b></p>
<p class=MsoNormal align=center style='margin-top:6.0pt;text-align:center;
line-height:18.0pt;tab-stops:243.0pt'>от<a name=Names><span style='mso-no-proof:
yes'> : </span></a><span style='mso-spacerun:yes'> </span>
<INPUT TYPE="text" MAXLENGTH="50" SIZE="50" NAME="names"
id=names>
ЕГН: <INPUT TYPE="text" MAXLENGTH="10" NAME="egn" id=egn><span
style='mso-bookmark:EGN'><![if !supportNestedAnchors]><a name=EGN></a><![endif]></span></p>
<p class=MsoNormal align=center style='text-align:center;line-height:18.0pt;
tab-stops:243.0pt'><span style='mso-bookmark:EGN'><span style='mso-bookmark:
EGN'></span>адрес: гр./с<span lang=RU style='mso-ansi-language:RU'>.: </span>
<INPUT TYPE="text" SIZE="20" NAME="town"
id=town>ул./ж.к.: <INPUT TYPE="text" SIZE="100" NAME="address"><span lang=RU
style='mso-ansi-language:RU'><o:p></o:p></span></p>
<p class=MsoNormal align=center style='text-align:center;line-height:18.0pt;
tab-stops:243.0pt'>тел. за връзка: <INPUT TYPE="text" NAME="phone" id=phone><a
name=phone></a><span lang=EN-US style='mso-ansi-language:EN-US'>e</span><span
lang=RU style='mso-ansi-language:RU'>-</span><span lang=EN-US style='mso-ansi-language:
EN-US'>mail</span><span lang=RU style='mso-ansi-language:RU'>:</span><span
lang=RU> </span><INPUT TYPE="text" SIZE="50" NAME="email" id=email><span
style='mso-bookmark:email'><span lang=RU style='mso-ansi-language:RU'><![if !supportNestedAnchors]><a
name=email></a><![endif]><span style='mso-no-proof:yes'> </span></span></span></p>
<p class=MsoNormal align=center style='text-align:center;line-height:18.0pt;
tab-stops:243.0pt'><span style='mso-bookmark:email'> </span></p>
<span style='mso-bookmark:email'></span>
<p class=MsoNormal align=center style='text-align:center;line-height:18.0pt;
tab-stops:243.0pt'><o:p> </o:p></p>
<p class=MsoNormal align=center style='text-align:center;text-indent:45.0pt;
line-height:18.0pt;tab-stops:243.0pt'><span style='font-size:16.0pt'>Г-н
Ректор,<o:p></o:p></span></p>
<p class=MsoNormal align=center style='text-align:center;text-indent:45.0pt;
line-height:18.0pt;tab-stops:243.0pt'>Желая да бъда допуснат(а) до предварителен
кандидат-студентски изпит (тест) в ХТМУ по:<span lang=EN-US style='mso-ansi-language:
EN-US'><o:p></o:p></span></p>
<p class=MsoNormal align=center style='text-align:center;text-indent:45.0pt;
line-height:18.0pt;tab-stops:243.0pt'><span class="MsoNormal" style="text-align:center;text-indent:45.0pt;
line-height:18.0pt;tab-stops:243.0pt">
<label>1.
<select name="select1" id="select1">
<option>------------------------------</option>
<option>химия</option>
</select>
</label>
на д<b style='mso-bidi-font-weight:
normal'>ата</b></span>
<label>
<select name="select6" id="select6">
<option>----------------------------------------</option>
<option>19.12.2009 г. от 9:00 часа</option>
<option>17.04.2010 г. от 9:00 часа</option>
</select>
</label>
</p>
<p class=MsoNormal align=center style='text-align:center;text-indent:45.0pt;
line-height:18.0pt;tab-stops:243.0pt'><span class="MsoNormal" style="text-align:center;text-indent:45.0pt;
line-height:18.0pt;tab-stops:243.0pt">
<label>2.
<select name="select2">
<option>------------------------------</option>
<option>математика</option>
</select>
</label>
на д<b style='mso-bidi-font-weight:
normal'>ата</b></span>
<label>
<select name="select7" id="select7">
<option>----------------------------------------</option>
<option>19.12.2009 г. от 9:00 часа</option>
<option>18.04.2010 г. от 9:00 часа</option>
</select>
</label>
</p>
<p class=MsoNormal align=center style='text-align:center;text-indent:45.0pt;
line-height:18.0pt;tab-stops:243.0pt'><span class="MsoNormal" style="text-align:center;text-indent:45.0pt;
line-height:18.0pt;tab-stops:243.0pt">
<label>3.
<select name="select3">
<option>------------------------------</option>
<option>френски език</option>
</select>
</label>
на д<b style='mso-bidi-font-weight:
normal'>ата</b></span>
<label>
<select name="select8" id="select8">
<option>----------------------------------------</option>
<option>19.12.2009 г. от 13:00 часа</option>
<option>17.04.2010 г. от 13:00 часа</option>
</select>
</label>
</p>
<p class=MsoNormal align=center style='text-align:center;text-indent:45.0pt;
line-height:18.0pt;tab-stops:243.0pt'><span class="MsoNormal" style="text-align:center;text-indent:45.0pt;
line-height:18.0pt;tab-stops:243.0pt">
<label>4.
<select name="select4">
<option>------------------------------</option>
<option>немски език</option>
</select>
</label>
на д<b style='mso-bidi-font-weight:
normal'>ата</b></span>
<label>
<select name="select9" id="select9">
<option>----------------------------------------</option>
<option>19.12.2009 г. от 13:00 часа</option>
<option>17.04.2010 г. от 13:00 часа</option>
</select>
</label>
</p>
<p class=MsoNormal align=center style='text-align:center;text-indent:45.0pt;
line-height:18.0pt;tab-stops:243.0pt'><span class="MsoNormal" style="text-align:center;text-indent:45.0pt;
line-height:18.0pt;tab-stops:243.0pt">
<label>5.
<select name="select5" id="select5">
<option>------------------------------</option>
<option>английски език</option>
</select>
</label>
на д<b style='mso-bidi-font-weight:
normal'>ата</b></span>
<label>
<select name="select10">
<option>----------------------------------------</option>
<option>19.12.2009 г. от 13:00 часа</option>
<option>17.04.2010 г. от 13.00 часа</option>
</select>
</label>
</p>
<p class=MsoNormal style='text-align:justify;text-indent:45.0pt;line-height:
18.0pt;tab-stops:243.0pt'><o:p> </o:p></p>
<div align=center></div>
<p align=center style='text-align:center'>ТАКСА ЗА УЧАСТИЕ В ПРЕДВАРИТЕЛЕН
ИЗПИТ </p>
<p align=center style='text-align:center'>Таксата за участие в предварителен
изпит е <strong>20лв</strong>. за първи изпит и <strong>15лв.</strong> за всеки
следващ. Заплаща се по банков път по сметка на ХТМУ:</p>
<div align=center>
<table class=MsoNormalTable border=1 cellpadding=0 width=296 style='width:222.0pt;
mso-cellspacing:1.5pt'>
<tr style='mso-yfti-irow:0;mso-yfti-firstrow:yes'>
<td width=286 style='width:214.5pt;padding:.75pt .75pt .75pt .75pt'>
<p class=MsoNormal>I<strong>BAN:</strong> BG25 BNBG 9661 3100 1032 01</p>
</td>
</tr>
<tr style='mso-yfti-irow:1'>
<td style='padding:.75pt .75pt .75pt .75pt'>
<p class=MsoNormal><strong>BIC:</strong> BNBG BGSD</p>
</td>
</tr>
<tr style='mso-yfti-irow:2'>
<td style='padding:.75pt .75pt .75pt .75pt'>
<p class=MsoNormal><strong>Банка</strong>: Българска Народна Банка</p>
</td>
</tr>
<tr style='mso-yfti-irow:3'>
<td style='padding:.75pt .75pt .75pt .75pt'>
<p class=MsoNormal><strong>Титуляр:</strong> ХТМУ </p>
</td>
</tr>
<tr style='mso-yfti-irow:4;mso-yfti-lastrow:yes'>
<td style='padding:.75pt .75pt .75pt .75pt'>
<p class=MsoNormal><strong>МОЛ</strong>: Борис Стефанов</p>
</td>
</tr>
</table>
</div>
<p align=center style='text-align:center'>Във вносната бележка за
"задължително лице" се записват ИМЕТО - собствено,бащино и фамилно и
ЕГН на кандидата. За "основание на плащане" се записва ТАКСА ЗА
ПРЕДВАРИТЕЛЕН ИЗПИТ </p>
<p class=MsoNormal align=center style='text-align:center;line-height:18.0pt;
tab-stops:243.0pt'>Уведомен<span lang=RU style='mso-ansi-language:RU'>(</span><span
lang=EN-US style='mso-ansi-language:EN-US'>a</span><span lang=RU
style='mso-ansi-language:RU'>)</span> съм, че с получената оценка мога да
кандидатствам само в ХТМУ за учебната 2010/20<span lang=RU style='mso-ansi-language:RU'>11</span>г. след
подаване на кандидатстудентски документи.</p>
<p class=MsoNormal align=center style='text-align:center;line-height:18.0pt;
tab-stops:243.0pt'> </p>
<p class=MsoNormal align=center style='text-align:center'><INPUT NAME="submit" TYPE="submit" id="submit" VALUE="submit">
<span
lang=EN-US style='mso-ansi-language:EN-US'><o:p></o:p></span></p>
</form>