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["                                      接 收 预 备 党 员 备 案 表"]
["             年           党支部共接收       等       名同志为中共预备党员。\n"]
["支部","姓名","性\n别","出生\n日期（格式例如1995.03.01）","籍贯","民族","身份证号","学\n历","个人\n身份（填写本科/硕士/博士的年级，例如：硕士一年级）","入党\n介绍人","申请入\n党时间","确定为\n积极分\n子时间","确定为\n发展对\n象时间","接收为\n预备党\n员时间","批准\n时间","联系电话","班级",null,null,"联系电话","QQ号"]
["2013-2015级本科生联合党支部","王五","　女","1995.03.01","广东广州","汉族","44011981…","高中","本科（/硕士）二年级（/毕业年级）","张三、李四","　2013.03.19","　2015．04.01","　2016.04.02","　2016.05.28",null,13511111111]
[]
[]
["基层党支部负责人签名或盖章：                                     "]
["                                                              年    月    日"]

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