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["华南理工大学学生重大疾病爱心基金救助申请表"]
["姓名"," ",null,"性别",null,"出生年月",null,"民族"]
["学院",null,null,"学号",{"$nulls":3},"所患疾病"]
["票据总额（元）",null,null,"票据张数",{"$nulls":3},"申请年度"]
["申请理由"]
[]
[]
[]
["本人承诺以上所述情况属实，如有虚假，后果自负。"]
["学生本人签名：                                              日期："]
["学院意见：\n\n\n\n\n签章：                                                      日期："]
["学生工作部（处）意见：\n\n\n\n\n签章：                                                      日期："]
["爱心基金管理小组意见：\n\n\n\n\n\n\n成员签名：                                                  日期："]

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