Application for exemption from the obligation to pay contributions to

First name, family name
Street, ZIP code, place
Institute:
Matriculation number
E-mail:
Application for exemption from the obligation to pay contributions to
Studentenwerk due to leave of absence in
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
Winter semester 20
Summer semester 20
Please note that the exemption can be applied for one semester only – the application will not be
processed otherwise!
Reason:





Serving the federal volunteer service *
Illness *
Studies abroad or stay abroad beneficial to studies
Pregnancy * / Parental leave *
Internship /traineeship related to studies *
Please provide evidence of the reason for exemption with the application.
* The exemption from the liability to contribution for the reasons marked with * is granted only, if
the student will demonstrably not stay in Leipzig.
Refund of already paid Studentenwerk contribution needs to be applied for on a separate
form, providing the necessary evidence.
I herewith declare that I will not make use of the services provided by Studentenwerk Leipzig
(student restaurants, cafeterias, student halls of residence, social services) for the period of the
exemption. I know that I am not covered by the accident insurance by Studentenwerk Leipzig for
the period of exemption.
Date, signature of applicant
Submit to:
Studentenwerk Leipzig
Abteilung Rechnungswesen
Frau Uta Niedenführ
Goethestraße 6
D-04109 Leipzig
Phone: 0341 9659-665
Fax:
0341 22529823
E-mail: [email protected]
Approved:
Date, stamp, signature of Studentenwerk
Es gilt die deutsche Fassung. / The german version applies.

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