LLP-ERASMUS 20__/20__
	
 CERTIFICATE of ARRIVAL / DEPARTURE

Student name:		_________________________________________

Sending Institution: 	MEDICAL UNIVERSITY OF WARSAW
PL WARSZAW06

Administrative contact:	Ms. Marta Rutkowska
Tel: +46 22 572 03 60 / Fax: +46 22 572 04 55
Email: marta.rutkowska@wum.edu.pl

Receiving Institution:	_________________________________________
 
				Tel/ Fax:
				Email: 

Part 1

CERTIFICATE of ARRIVAL

Date of arrival: 		_________________________________________
(DD/MM/YYYY)

Name and title: 		_________________________________________

Signature:			_________________________________________

Institutional Stamp: 	_________________________________________

					Part 2

				CERTIFICATE of DEPARTURE

Date of departure: 		_________________________________________
(DD/MM/YYYY)

Name and title: 		_________________________________________

Signature:			_________________________________________

Institutional Stamp: 	_________________________________________