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英文在职证明怎么填写【推荐20篇】

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关于在职证明范文

范文类型:证明书,全文共 223 字

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总领事馆:

兹有我单位____(姓名)_________(护照号码)申请前往贵国旅行。____为我单位____(职务),____(年/月)进入我单位,为单位服务____年,年收入____元。我单位同意____(申请人)于____(月/日)至____(月/日)期间休假,在贵国期间一切费用(包括机票、住宿、医疗保险及其他费用)将由其本人承担。___(申请人姓名)在旅行结束后,将按时回国,继续为我公司服务。 领导签名:

单位名称(并盖公章):

单位电话:

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更多相似范文

篇1:社保离职证明模板「精选」_证明书_网

范文类型:辞职信,证明书,全文共 364 字

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社保离职证明模板「精选」

去社保局退社保需要离职证明,那么离职证明怎么写呢?下面是小编整理的社保离职证明模板精选,欢迎参考!

社保离职证明模板【精选一】

离职证明

我公司员工(身份证号码:)于200*年*月*日入职到200*年*月*日离职,在公司任职职位,后因合同期满原因离职。

特此证明

*有限公司(公章)

管理部

200*年*月*日

社保离职证明模板【精选二】

离职证明

兹证明×××(先生/女士)曾在本公司担任×××部×××一职。劳动合同期限×年,自××××年××月×日至××××年××月×日止。现于××××年××月×日双方共同(√×)解除(√×)终止劳动关系。其在本公司共实际工作×年×月(××××年××月×日至××××年××月×日)。

备注:

本证明一式三份,公司、员工、失业保险机构各持一份

××××××××有限公司(盖章)

××××年××月×日

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篇2:在职研究生自我鉴定短文示例

范文类型:鉴定书,全文共 431 字

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我是一个普通的、默默无闻的但内心充满着理想和抱负的青年。研究生三年的学习生活对我个人来说是受益终生的。导师的谆谆教诲、自己的刻苦攻读都将在未来的人生道路中体现出其应有的价值。

学习上,我是抱着谦虚谨慎、求真求实的态度去钻研课题的。在学习的过程当中,渐渐发现自己还有许多东西需要去学、去领悟,其实这本身也是一个自我提升的过程。我的理论水平、动手实践能力都随着课题研究的不断深入而得到了提高,同时我也学会了如何去分析问题、怎样采取的手段去解决问题。生活上,我比较淡定、豁达。尊重身边的每一个人,在别人遇到困难之时,我会尽我所能去帮助他。生活应该是丰富多彩的,我喜欢听歌、唱歌、打篮球、看电影、看书、和好朋友聊天。

以上都自述了一些本人的优点,缺点和不足也是需要我自己多加反省的。如学习上思想有惰性,生活中容易冲动、不擅言谈等等。作为一个年轻人,我深知自己还有许许多多、方方面面的东西需要去学习、去长进。我会本着孜孜以求、虚怀若谷的精神去做人、做事,为国家、社会多做贡献。

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篇3:优秀的英文自我评价

范文类型:自我评介,全文共 1261 字

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I am a perfectionist with an obsessive pursuit of ideals, but I am more concerned with the pursuit of the ideal than the final result of the hard process. I think gold is always shining. A person, no matter what his current situation, his realm of life can not be completely limited, of course, a persons current talent can not fully determine his future all social contribution. A persons life should be a work hard, and constantly exceeded and breakthrough process!

I am passionate, generous, fluent in English, and pure mathematics and applied mathematics through basic professional skills. In the past three years, I have learned a wide range of modern mathematics courses related to differential geometry, partial differential equations, and topology, with great interest in specialized courses. In the aspect of thinking and cognition, I have carefully studied the basic contents and history of philosophy, science and technology, aesthetics, etc., and have a deep and profound reverence for the wisdom of the sages.

As for my future work, I have a strong ability to work in teams, can withstand stress, and like challenging and creative issues. In particular, in the work I can Chikunailao, humbly communicate with others, continue to learn to forge ahead.

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篇4:研究生英文求职信

范文类型:求职应聘,全文共 656 字

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To Whom It May Concern,

I have learnt fromyesterday’s newspaper that you are employing . I wish to be considered as anapplicant for the position, and beg to state my qualifications as follows:

I am years old, a major student of University / College. During my academic years,I have shown excellent performance and have been awarded first-classscholarship each year. In addition to my educational background, I have therich work experience in the fields of . Therefore, I believe I can be ofvalue to your company.

For furtherinformation please refer to my attached resume. I should be please to attendfor an interview at your convenience.

Yours sincerely,

LiMing

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篇5:日本签证在职证明范本

范文类型:证明书,全文共 222 字

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兹证明先生(小姐/女士)出生于X年XX月XX日,先生(小姐/女士)是我公司在职人员,从X年XX月XX日起在我公司任职至今,职位是X部经理,薪酬为人民币X元/月,赴日签证在职证明。

公司地址:XX市路号XX大厦楼X室

邮政编码:

上级主管领导:先生(小姐/女士)

联系电话:(区号)(固定电话号码)

特此证明!

XX市X有限公司

(上级主管领导签名)

X年XX月XX日

注意:单位在职证明书需要有公司抬头信笺纸打印

没有公司抬头纸或手写证明则须附上单位营业执照复印件

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篇6:改名字学校证明范文标准模板

范文类型:证明书,适用行业岗位:学校,全文共 200 字

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该同学现用名( 名字 ),(性别),(民族),(身份证号码),(户籍住址)。而且在使用现用名期间没有任何违法、犯罪行为,也没有任何不良的社会记录。只因在校期间经常遇到重名的情况,给正常的生活、学习带来许多不便,根据《中华人民共和国民法通则》第99条及《中华人民共和国户口登记条例》第十七、十八条的规定,特向贵局证明将该同学的现用名(现在的名字)更改为(你想改的名

字),望同意为切!

学校公章:

年 月 日

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篇7:儿科医师英文自我评价

范文类型:自我评介,适用行业岗位:儿科,医师,全文共 4097 字

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Since 20xx, as an obstetrician and gynecologist, under the leadership of the higher authorities. In support of the President, the hospital Obstetrics and Gynecology has made certain achievements, now individual work since this year is summarized as follows:

In political thought, always adhere to the partys line, principles, policies, and earnestly study Marxism-Leninism, Mao Zedong Thought and Deng Xiaoping Theory and General Secretary Jiangs "Three Represents" and other important ideas, and always adhere to serve the people wholeheartedly, Reform, development and progress, and constantly improve their political theory. And actively participate in various political activities, to maintain leadership and unity of comrades, has a good professional ethics and professionalism, work hard working, painstaking efforts, many times to the higher level hospital training and learning.During the work, actively around the MCH policy, to improve the management level and operational capacity as the prerequisite to enhance the theoretical knowledge and improve business skills as the basis, adhere to the combination of clinical and social work, and actively cooperate with the hospital staff work together , Hard work, conscientiously completed the work tasks.

At work, I am deeply aware of a qualified Obstetricians and Gynecologists should have the quality and conditions, and strive to improve their level of business, and constantly strengthen the business theory of learning, learning about maternal and child health knowledge, enrich their theoretical knowledge. Often participate in training to listen to the lectures of higher experts and scholars, the first half to the hospital to learn new medical knowledge and medical technology, thus broadening the horizons and expand the knowledge. Always adhere to the new theory and technology applied to the work, to master the common gynecology and obstetrics, frequently-occurring disease and difficult disease diagnosis and treatment techniques, skilled diagnosis and treatment of obstetric diseases, cervical erosion, and other obstetric complications and Complications, skilled diagnosis and treatment of various emergency gynecological, severe, independent of gynecology and obstetrics commonly used surgery and a variety of family planning surgery. Strict implementation of the work of the work system, routine treatment and operating procedures, meticulous treatment of each patient, to the maximum extent possible to avoid misdiagnosis.

Since the obstetrics and gynecology, my diagnosis and treatment of obstetric and gynecological diseases, the accuracy rate of 80% or more, independent completion of several other gynecological surgery, the patient can be discharged on time, from the occurrence of error-free accidents. Really play a business backbone role. During my work, the grid in accordance with the requirements of the work of women and children, carefully developed practical work targets and plans.

Doctor-patient communication in place, mutual understanding and unity of staff, hospitalized delivery of pregnant women, observation of labor closely, patience and well-patient communication for pregnant women and their families understand the process of labor and possible cases, let the psychological, and A psychological preparation and understanding of the process, surgical patients strictly grasp the surgical guidelines for critically ill patients as soon as possible treatment, strict aseptic surgery, no case of puerperal infection.

Strictly abide by their own scheduling system and the first diagnosis is responsible for the development, put an end to the occurrence of medical malpractice. Department of disinfection responsibility clear, regular, timely records

In short, in this year both at work or technical level has greatly improved, there are still many shortcomings, the need to further improve the quality and theoretical level of business, improve the level of writing and overall quality, so that Their successful completion of their work satisfactorily; hope that next years work to make persistent efforts.

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篇8:国贸英文求职信

范文类型:求职应聘,全文共 1378 字

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Dear Sir,

If an ability to learn fast and to work efficiently is important to you, then I may be the right one for the position you offered .Please consider my application for the position.

I am supposed to graduate from Bussniess School of HuBei Uniersity of Tcchnology in international economy and trade in July 20xx. The three -year education endowed me with a general knowledge and good command of professional knowledge,as well as basic computer knowledge. I have passed all the courses and achieved excellent grade. Outside classroom, I was very active and took part in different extracurricular activities. I have been doing many part-time jobs such as sales and others that you can see in my resume. All these experiences contributed much to the development and promotion of my organization and communication ability.

I am a woman who has a strong and creative mind, plus flexibility of cooperation, public relations skills and so on. I would bring a delighted new interest and enthusiasm, and that, of course, would mean more efficient and better work for you. Have you an opening for a young woman who believes that she has something to offer? If you wish to see me, I will be very pleased to come in for an interview. I should esteem it a great favor if you could give me an opportunity to try to serve you in the position.

Thank you for your consideration

Yours sincerely

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篇9:出纳离职证明

范文类型:辞职信,证明书,适用行业岗位:出纳,全文共 316 字

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兹证明自xx年xx月xx日入职我公司担任xx部门岗位,至xx年xx月xx日因原因申请离职,在此工作期间无不良表现,工作良好,同事关系融洽,期间曾被授予“”称号(荣誉)。经公司慎重考虑准予离职,已办理交接手续。 某某先生/女士/小姐自20xx年01月01日入职我公司担任人力资源部人力资源助理职务,至20xx年01月01日因个人原因申请离职,在此间无不良表现,经公司研究决定,同意其离职,已办理离职手续。 _______先生/女士/小姐,自____年__月__日至____年__月__日在我公司担任________(部门)的_______职务,由于_________原因提出辞职,与公司解除劳动关系。以资证明!

-xx年-xx月-xx日

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篇10:关于护士英文求职信

范文类型:求职应聘,适用行业岗位:护士,全文共 1688 字

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Dear leaders:

Hello!

i am a 04 session of hubei medical college senior students, immediately facing the graduate work is about to embark on, which will have a bearing on my future, so i did a careful selection, your hospital has always been my first employment goals, so i decided to submit this self-recommendation and sincere leadership, as the hospital to express their determination! thank you to continue to read my self-recommendation !

as before admitted to the universities to determine their own goals in life to be a "white angel" , so do so as soon as i started to learn medical knowledge, the four-year period in school, i not only completed the outstanding achievements the university of courses, but also other medical knowledge often expo, including nursing, pathology, or microbiology, bacteriology, surgery .... in a series of professional medical knowledge, in order to enrich themselves to faster access to social role, i also participated in a school sponsored organizations have served as chairman of the student experience as i set foot on these jobs provided an important experience, i believe i can unite colleague, and leadership, the patient ... live in harmony!

because i am a fresh graduate, i am well aware that their knowledge remains in the realm of theory, which is why i am even more urgent need for your hospital can give me the opportunity to practice, i have to play their professional for patients the most serious medical services, for your contribution to the development of the hospital my light and heat!

i wish to apply, ma bole know! i hope you can see through this self-recommendation a vibrant, enthusiastic learning "white angel" future!

Sincerely,

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篇11:英文商务邀请函范文

范文类型:邀请函,适用行业岗位:商务,全文共 386 字

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Dear Sirs,

We are staging an important exhibition in Shanghai Exhibition Centre from October l to October 7. We would like to invite your corporation to attend. Full details on the Fair will be sent in a week.

We look forward to hearing from you soon, and hope that you will be able to attend.

Yours faithfully,

敬启者:

我们将于10月1日至7日在上海展览中心举办一次重要的商品展览。我们邀请贵公司参加。展览的详细资料将于一周内发出。

请尽快回复我们,并希望您能参加。

敬上

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篇12:签证邀请函英文

范文类型:邀请函,全文共 725 字

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To: The Chinese Embassy in Indonesia

Dear Sir or Madam:

We are very pleased to invite Mr. come to our factory for visiting and business negotiation. The business trip will start from *to . And because the long business co-operation in future between 对方公司名 and us, they will come to China for many times.

Please note, however, that we don’t assume any legal or financial responsibility whatever regarding the presence of in China. All expenses of Sjourney to/from China, their stay in China as well as health insurance will be borne by their employers.

His personal details below:

Name:

Date of birth:

Citizenship:

Passport:

We send you our kindest regards and best wishes for a pleasant trip.

Yours sincerely,

General Manager signatur

时间

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篇13:单位证明书参考

范文类型:证明书,全文共 785 字

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__同学系___大学科技外语专业的学生,其于__年1月3日~__年2月19日在我酒店实习,期间担任酒店总经理行政助理一职,负责协助总经理解决酒店日常经营管理当中的一些具体事务。下面就魏枫同学在我酒店实习的有关情况说明如下:

为便于准确评价魏枫同学在我酒店实习期间的工作表现和业绩,现就我酒店的基本情况做一简要介绍。我酒店的全称为“____大酒店”,住所地为___市__区___路__号,1995年12月被国家旅游局评定为二星级旅游涉外饭店,主要经营客房、中餐和夜总会。酒店共设有客房53间,大小餐厅及宴会厅18个。__年~__年被内蒙古旅游局评为“全区最佳星级饭店”和“旅游诚信企业”。在当地享有比较高的社会声誉和商业信誉。

__年12月,酒店接到了__同学的实习申请书,其在申请书中称对酒店行业有着浓厚的兴趣,希望能在寒假期间到酒店实践和学习,诚恳要求酒店为其提供一次锻炼的机会。经面试考察,酒店认为魏枫同学热爱酒店行业,而且具有较高的英语口语水平和计算机操作技能,逻辑思维和语言表达能力较强,有一定的管理意识,善于沟通,比较符合酒店的岗位入职要求。于是酒店接受了他的实习申请,安排他担任总经理行政助理。

魏枫同学在工作中表现出很强的团结、合作能力,能主动、快捷、有效的与酒店各部门做好沟通,协调好互相之间的工作关系,搞好配合,主动圆满的完成工作任务,使酒店的管理方针和工作部署落到实处。他还能从酒店的全局出发,注重收集、掌握各部门的工作动态,并通过分析向管理层提出合理化建议,积极发挥行政助理的决策参谋作用。他积极向同事们学习,进步很快,到离店时已基本熟悉和掌握了相关的岗位业务和管理知识,同事和上级对他的表现都很满意。总之,从魏枫同学的工作表现可以看出,他是一个勤于学习,善于思考,充满活力,努力创新的年轻人。__大酒店为曾经有这样的实习生而感到自豪。

单位盖章

年 月 日

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篇14:英文自我介绍信

范文类型:自我评介,介绍信,全文共 1847 字

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Self Introduction

Things about Me I am Andrea. Perhaps the word “average”can best describe me. I am of average height, average weight and of average complexion. I have a thin face, double-lid eyes and a pointed nose. My hair is black, short and straight. I have never worn my hair long. I look like both my mother and my father, but I have inherited their best parts. I am a teacher, and I like my job. I believe her or his students can sometimes teach a teacher. Actually I have learnt a lot from my own teaching experience and my students. One particularly good thing about being a teacher is that I am learning something new each day and thus making progress each day. This is wonderful. Of course the income is modest, but on the other hand, quite stable. I keep growing all the time. I find great rewards both monetarily and mentally. I have many hobbies: reading books, raising pets, making dresses, etc. I like volleyball very much, but I can’t play it very often, because it is a team sport. It is difficult to get enough people to play volleyball with me. It’s a shame. I derive great pleasure from my hobbies.

Generally speaking, I am open, honest and easy-going. I hate hypocrisy and injustice. Fairness is very important to me. I try to be fair in everything I do. I have great appreciation for physical and spiritual independence. I am a bit disorganized and impatient sometimes. I don’t have many friends, but I do have a few. I have both male and female friends. We do sports together, go shopping together; and we exchange our views and ideas and share happiness and sadness. Of course we help each other if necessary.

I always consider myself a lucky person. I am lucky in my family, I am lucky in my career, I am lucky in my friendship, I am lucky in many things. In one word, I am lucky in life. I am really grateful for all these.

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篇15:单位证明书参考

范文类型:证明书,全文共 270 字

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___________________________(单位名称):

______________同志,性别________,政治面貌___________,身份证号:________________________________。于_________年____月____日至_________年____月____日在我公司___________部门从事_________________工作,工作积极,团结同事,遵纪守法,各方面表现优秀。我单位对本证明真实性负责。

特此证明

单位名称: (盖章)

__________年_____月_____日

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篇16:2024年出生证明

范文类型:证明书,全文共 319 字

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现有重庆市________区县____________乡镇_______村 (社区)________组居民(女方姓名)_________(身份证号码___________________)与(男方姓名)__________(身份证号码)___________________)于________年____月____日____时____分,因为_________________________原因,女方未到医疗保健机构分娩,在______________________地生育一(男、女)孩,现取名___________,该小孩出生至今尚未办理《出生医学证明》。

特此证明!

村(居)民委员会主任(签字):

村(居)民委员会(盖章):

年 月 日

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篇17:出国探亲在职证明模板

范文类型:证明书,全文共 242 字

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x x 市x x x x 有 限 公 司

证 明

兹证明先生(小姐/女士)出生于x年xx月xx日,先生(小姐/女士)是我公司在职人员,从x年xx月xx日起在我公司任职至今,职位是x部经理,薪酬为人民币x元/月。

公司地址:xx市路号xx大厦楼x室

邮政编码:

上级主管领导:先生(小姐/女士)

联系电话:(区号)(固定电话号码)

特此证明!

xx市x有限公司

(上级主管领导签名)

x年xx月xx日

(加盖公章)

注意:单位在职证明书需要有公司抬头信笺纸打印

没有公司抬头纸或手写证明则须附上单位营业执照复印件

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篇18:独生子女证证明格式

范文类型:证明书,全文共 403 字

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与_____________(女或男,_____________年______月______日出生)于_________________年__________月______日在_____________省_____________市(县)登记结婚。其配偶_________________于_____________年______月______日死亡。该同志自其配偶_________________死亡后至_____________年______月______日止(或自其配偶_____________死亡后至_____________年__________月__________日离境或去香港、澳门之日)在中国或中国内地居住期间未再登记结婚。

特此证明。

单位填写人:________________(签名)

单位组织(人事)部门盖章:_________________

_____年 _____月____ 日

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篇19:场地租用证明范本_证明书_网

范文类型:证明书,全文共 1989 字

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场地租用证明范本

租用是指支付一定的代价而使用他人的东西,且必须归还他人的一种行为。下面小编为大家精心整理了租赁证明格式范文,希望能给你带来帮助。

场地使用证明范本

场 地 使 用 证 明

房屋使用人 姓名或者名称 身份证号码或资格证明编号

住址 联系电话

房屋位置 深圳市 区

拟经营项目 用作经营场所楼层 层 面 m2

申 请 人 声 明

本人所填写上述内容属实,阅知并遵从以下条款:

(一)此场所使用说明仅作为办理审批登记的场所证明文件,不代表对建筑物合法性的确认。

(二)政府有关部门依法拆除经营场所所在建筑物时,此临时使用证明自动失效,不得作为补偿依据。本企业(个人)会主动办理经营地址变更或办理注销登记。

(三)经营者凭此场所使用证明到市场监督管理部门办理营业执照。

申请人签名: 年 月 日

经审查,该房屋位于 ,共 层,

审查

单位 用作拟经营项目的房屋位于第 层,同意其作为经营场所场地使用。

见 年 月 日 (审查单位盖章)

审查单位联系人:

审查单位联系电话:

这种问题目前你可以找个朋友或者谁愿意出场地给你转移注册(商用房),以后便于年检

但是你既然是注册公司了,搬就搬了,如果没有必要,地址就不要改了,除非你找到商用房.我知道现在很多人提供办公地址的服务,但是会收费的.我去年找了个人帮我搞了下,收了我1000元.而且年检还得给人意思意思.所以不必要就别去工商折腾这个

场 地 证 明

事业单位登记管理局:

兹有我 在 ,有 间,面积 平方米,产权归 所有,现 (拨、借、租)给 作办公用房(产权证、租赁合同附后)。

特此证明

盖章

年 月 日

场 地 证 明

兹有( ) 国际控股股份有限公司拟在东莞市 镇 工业区设立外资企业“东莞*有限公司”,生产和销售(经营范围)。我社以租赁形式提供厂房 平方米、宿舍 平方米给外资企业使用,厂房、宿舍租金每月每平方米 元人民币,使用期限为 年。

特此证明!

东莞市 镇 经济联合社

二00 年 月 日

镇府意见:

二00 年 月 日。

企业登记时的场地使用证明一般是指,自有房产提交产权证复印件;租赁房屋提交租赁协议原件或复印件以及出租方的产权证复印件;未取得房产证的,提交房地产管理部门的证明或者购房合同及房屋销售许可证复印件;出租方为宾馆、饭店的,提交宾馆、饭店的营业执照复印件;租赁房屋为军队空余房地产的,提交军队统一印制的20xx年版《军队房地产租赁许可证》原件和军队统一编号的20xx年版《军队房地产租赁合同》原件。

企业登记时的场地使用证明一般指什么?

1、关于举证责任的分配问题 审查认定股东抽逃出资行为的关键是举证责任的分配。依据“谁主张,谁举证”这一民事诉讼法所规定的举证责任的分配原则,债权人或守约股东主张抽逃出资股东承担责任的,当然应该承担相应的举证责任。由于股东抽逃出资的行为多以隐蔽方式进行,而且其关键证据,如公司的业务往来帐册,包括资产负债表等会计帐目均保存于公司内部,故债权人举证事实上存在障碍和困难,守约股东也是基本处于同样境地。因此,在审理股东抽逃出资的纠纷中,应依据最高院《关于民事诉讼证据的若干规定》第75条的规定,对于股东是否抽逃出资,原则上应当由债权人或者守约股东举证,但不宜过于严苛,只要其能举出使人对抽逃出资的行为产生合理怀疑的初步证据或有关线索即可,此际,法官可要求被诉方提供相关证据,以证明其不存在抽逃的行为如公司与股东间存在合理的对价关系等,否则,可认定有抽逃的行为。

2、关于诉讼时效问题 股东抽逃出资行为发生后,权利人应当在什么时间内对其行使追究权。与其他民事权利的法律保护一样,对抽逃出资股东的请求权,亦应受制于法律时效的限制,以促使权利人积极行使权利,从而有利于稳定社会经济程序并为司法审判减少因时过境迁而带来的调查取证的困难。由于现行法律、法规对抽逃出资之规定极度简约,所以对债权人的追诉时效未有具体规定。为了与其他民事权利的保护相衔接,可以依据现行民法通则的规定,其权利保护时效期间为两年。当然,因股东抽逃出资行为而对权利人的保护与一般民事权利的保护期间有无区别,尚待最高院作出解释。

3、关于防止滥用诉权问题 公司正常有序经营是其顺利发展的基础,因此,立法及司法在赋予对抽逃出资。股东行为予以制裁的同时,亦应防止那些企图破坏公司正常经营的恶意竞争者可能滥用其诉权。有鉴于此,有必要规定一些相应的措施来防止此类滥诉及不正当诉讼行为的发生。如日本和中国台湾公司法中均有类似规定,为防止追诉人出于某种不正当目的对被诉人的诉讼,因此而给被诉人造成的经济上或精神上的损失,可责令追诉人在缴纳诉讼费用的同时,根据被诉人申请再提供一定的担保,以承担因不当诉讼而给公司和股东所造成的损害。诚信经营是我们这个社会赖以发展的基矗我们在关注公司独立人格和股东有限责任在有效聚合社会资源、促进社会财富增加的同时,亦应强调股东及公司的社会责任。

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篇20:误工陪护证明怎么写及范文参考

范文类型:证明书,全文共 281 字

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女方姓名 年龄 周岁 身份证号码:

男方姓名 年龄 周岁 现存子女:□男 □女 病历号:(住院)

孕 次; 产 次; 孕周: 周 死婴性别(14周以上填): 女 男

现住地址: 省(区)_____ 市____ 县(区)______ 乡(镇) 村

户口地址: 省(区)_____ 市____ 县(区)______ 乡(镇) 村

妊娠终止时间: 年 月 日 时 是否清宫:□否 □是

自然流产主要原因: __________________________

自然流产后建议采取: 措施避孕 联系电话:

报告单位(盖章): __________ 报告人:_______ 日期: 年 月

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