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["郑州大学成人高等教育补办毕业证明书信息表\n\n（请认真填写以下信息，以免造成不必要的失误）"]
["姓  名"]
["性  别"]
["出生年月日"]
["专  业"]
["层  次"]
["形  式"]
["学习期限","至"]
["工作单位"]
["身份证号码"]
["联系电话"]
["原毕业证编号"]
["通讯地址"]
["补证原因及需要说明的情况"]
["备   注"]