perkhidmatan utama putra international (pusat … · (please arrange the document according to the...
TRANSCRIPT
PLEASE USE CAPITAL LETTERS
Name :
Passport No : Expiry Date of passport:
d
d
/
m
m / y y y y
NO. SEMAKAN : 02
NO. ISU : 02 TARIKH KUATKUASA : 25/05/2017 1 drp. 1
PERKHIDMATAN UTAMA
PUTRA INTERNATIONAL (PUSAT ANTARABANGSA)
UNIVERSITI PUTRA MALAYSIA 43400 UPM Serdang, Selangor, Malaysia
Tel:603-89466048/6198E-mail:[email protected]
Kod Dokumen: SOK/PIC/SS02
CHECKLIST FOR NEW STUDENT PASS (ALREADY IN MALAYSIA) APPLICATION
No.
Required Documents (Please arrange the document according to the sequence given)
No of Copy
Tick (If Complete) Office Use
Applicant Help Desk
Counter Staff
1 Checklist for New Application Student Pass In Malaysia (SOK/PIC/SS02) 1 2 Visa & Pass Application Form (UPM/PIC/BR01/APPLICATION FORM) 1 3 Letter of Eligibility (LOE) for Iranian student 2 4 COPY of Latest Registration Slip 2 5 COPY of Offer letter 2 6 COPY of Deferment letter (If deferred) 2 7 COPY of Academic certificate 2 8 COPY of Academic transcript 2 9 ORIGINAL Release Letter (If transfer from previous institution) 1 10 COPY of Release Letter (If transfer from previous institution) 1 11 COPY of Health Insurance cover note 3 12 COPY Medical Report – From University Health Centre, UPM 2 13 COPY Verification letter – From University Health Centre, UPM 2
14 Photo (White Background) Size 3.5 cm x 4.5 cm 3 15 A4 sized COPY of passport (All pages of the passport)
(If latest date entry in old passport, please provide all the pages) *Please write number on each of the pages
2
16 A4 sized COPY of passport – (Details & Pass page) 1
17 ORIGINAL Passport -
18 Receipt of Payment to EMGS (Refer Page 4 for fee information) 2 19 Receipt of Payment to UPM (Refer Page 4 for fee information) 2
Note
1. Documents which DO NOT follow the specifications are deemed incomplete and will be rejected.
2. Pease DO NOT staple your documents and photo. 3. Use a paper clip instead. 4. DO NOT make any travel plans until all application process have been
completed. (Any request to expedite application processing will not be entertained by PIC)
Checked by
Date
SOKONGANPENGURUSANPELAJARDANSTAFANTARABANGSA
PUTRAINTERNATIONALCENTRE
(PUSATANTARABANGSA)KodDokumen:SOK/INT/BR01/VPVISA&PASSAPPLICATIONFORM
NO.SEMAKAN : 00 NO.ISU : 01 TARIKHKUATKUASA : 24/3/2017 1drp.2
TYPEOFAPPLICATION
PLEASETICK(/)NEWSTUDENT STUDENTRENEWAL
SPECIALPASS INVITATION/RELEASE/CLAIM
LETTER
VAL DEPENDENTRENEWAL TRANSFERSTICKER CANCELLATION/SHORTENING
NEWDEPENDENT IKHTISAS/RESEARCHATTACHMENT
STAFF STAFFDEPENDENT
STUDENT’S/STAFF’SPARTICULARS:1.NAME
:
_______________________________________________________________________
2.MATRIC/STAFFNO
:
_________________
GENDER
:
Male
Female
3.NATIONALITY4.PROGRAMME(ForStudentOnly)
:
BachelorMasterPhD
5.PASSPORTNO.
:
________________________________
7.PASSEXPIRYDATE
:
(DD/MM/YYYY)(DD/MM/YYYY)
8.MOBILENO.
:
________________________
9.EMAIL
:
________________________
10.NEARESTMALAYSIAEMBASSY:____________________________________________________(ForVALapplicationonly)
6.EXPIRYDATE:
: _____________________
NO.SEMAKAN : 00 NO.ISU : 01 TARIKHKUATKUASA : 24/3/2017 2drp.2
DEPENDENT’SPARTICULARS:
NAME PASSPORTNO.PASSPORT
EXPIRYDATESOCIALPASSEXPIRYDATE RELATION
IcertifythatallinformationgiveninthisapplicationistrueandIhavealsosubmittedapplicationformeormydependents:student/workingpass/visitpass(New/Renewal/SpecialPass/Shortening/Endorsement)
..……..……………………………... ………..……………………….. Student/Staff’sSignature Date……………………………………………………………………………………………………………………………………………………………………………………FOROFFICEUSEONLYPAYMENTCHECKLIST:(Note:PleasepresenttheoriginalreceiptfromtheBursarCounterandthecopyoftheReceiptuponsubmissionofyourapplicationtotheCounterofVisa&Pass.)
TYPEOFPAYMENT Student/Staff
Dependent1
Dependent2
Dependent3
Dependent4
Dependent5
Dependent6
NEWAPPLICATION:……………………………………
RENEWAL
SPECIALPASS
TRANSFERSTICKER
SHORTENING/CANCELLATION
INVITATIONLETTER/RELEASELETTER/CLAIMLETTER
LATESUBMISSION
OTHERS:……………………………………
TOTALAMOUNT(RM):
………………………………………… ……………………………………Officer’sSignatureandStamp DatePUTRAINTERNATIONALCENTRE
EM
GS
UP
ME
MG
SU
PM
EM
GS
UP
ME
MG
SU
PM
EM
GS
UP
ME
MG
SU
PM
EM
GS
UP
MA
rgen
tina
2
0.15
1,1
93.1
5
270
.00
6
63.1
5
6
0.00
133
.15
60.
00
895.
30
60.
00
2
81.5
5 30
.00
2
58.5
5 30
.00
73.1
5
60.0
0
B
oliv
ia
11.
00
1
,184
.00
2
70.0
0
654
.00
60.
00
1
24.0
0
6
0.00
88
6.15
6
0.00
272
.40
30.0
0
249
.40
30.0
0
64
.00
60
.00
Bra
zil
1
7.00
1,1
90.0
0
270
.00
6
60.0
0
6
0.00
130
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60.
00
892.
15
60.
00
2
78.4
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2
55.4
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70.0
0
60.0
0
B
ulga
ria
21.
90
1
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2
70.0
0
664
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60.
00
1
34.9
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6
0.00
89
7.05
6
0.00
283
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30.0
0
260
.30
30.0
0
74
.90
60
.00
Chi
le
24.
50
1
,197
.50
2
70.0
0
667
.50
60.
00
1
37.5
0
6
0.00
89
9.65
6
0.00
285
.90
30.0
0
262
.90
30.0
0
77
.50
60
.00
Chi
na/S
. Kor
ea
30.
00
1
,203
.00
2
70.0
0
673
.00
60.
00
1
43.0
0
6
0.00
90
5.15
6
0.00
291
.40
30.0
0
268
.40
30.0
0
83
.00
60
.00
Cos
ta R
ica
9.00
1,1
82.0
0
270
.00
6
52.0
0
6
0.00
122
.00
60.
00
884.
15
60.
00
2
70.4
0 30
.00
2
47.4
0 30
.00
62.0
0
60.0
0
C
zech
& S
lova
k
19.
50
1
,192
.50
2
70.0
0
662
.50
60.
00
1
32.5
0
6
0.00
89
4.65
6
0.00
280
.90
30.0
0
257
.90
30.0
0
72
.50
60
.00
Den
mar
k / U
SA
6.00
1,1
79.0
0
270
.00
6
49.0
0
6
0.00
119
.00
60.
00
881.
15
60.
00
2
67.4
0 30
.00
2
44.4
0 30
.00
59.0
0
60.0
0
D
omin
ican
Rep
ublik
1
2.90
1,1
85.9
0
270
.00
6
55.9
0
6
0.00
125
.90
60.
00
888.
05
60.
00
2
74.3
0 30
.00
2
51.3
0 30
.00
65.9
0
60.0
0
E
cuad
or/F
inla
nd
7.
00
1
,180
.00
2
70.0
0
650
.00
60.
00
1
20.0
0
6
0.00
88
2.15
6
0.00
268
.40
30.0
0
245
.40
30.0
0
60
.00
60
.00
Fra
nce
1
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1,1
85.9
0
270
.00
6
55.9
0
6
0.00
125
.90
60.
00
888.
05
60.
00
2
74.3
0 30
.00
2
51.3
0 30
.00
65.9
0
60.0
0
H
aiti
1
6.00
1,1
89.0
0
270
.00
6
59.0
0
6
0.00
129
.00
60.
00
891.
15
60.
00
2
77.4
0 30
.00
2
54.4
0 30
.00
69.0
0
60.0
0
H
unga
ry
21.
45
1
,194
.45
2
70.0
0
664
.45
60.
00
1
34.4
5
6
0.00
89
6.60
6
0.00
282
.85
30.0
0
259
.85
30.0
0
74
.45
60
.00
Indi
a
50.
00
1
,223
.00
2
70.0
0
693
.00
60.
00
1
63.0
0
6
0.00
92
5.15
6
0.00
311
.40
30.0
0
288
.40
30.0
0
10
3.00
60.0
0
In
done
sia
(2ye
ars)
1
5.00
1,4
64.4
0
300
.00
9
34.4
0
120
.00
2
56.0
0
120
.00
890.
15
60.
00
5
52.8
0 60
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2
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68.0
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60.0
0
Ir
an/Ir
aq
20.
00
1
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2
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0
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60.
00
1
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0
6
0.00
89
5.15
6
0.00
281
.40
30.0
0
258
.40
30.0
0
73
.00
60
.00
Italy
9.50
1,1
82.5
0
270
.00
6
52.5
0
6
0.00
122
.50
60.
00
884.
65
60.
00
2
70.9
0 30
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2
47.9
0 30
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62.5
0
60.0
0
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beria
/ Vie
tnam
1
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86.0
0
270
.00
6
56.0
0
6
0.00
126
.00
60.
00
888.
15
60.
00
2
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2
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66.0
0
60.0
0
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exic
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50
1
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2
70.0
0
660
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60.
00
1
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0.00
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2.65
6
0.00
278
.90
30.0
0
255
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30.0
0
70
.50
60
.00
Mya
nmar
1
9.50
1,1
92.5
0
270
.00
6
62.5
0
6
0.00
132
.50
60.
00
894.
65
60.
00
2
80.9
0 30
.00
2
57.9
0 30
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72.5
0
60.0
0
N
iger
ia
20.
00
1
,193
.00
2
70.0
0
663
.00
60.
00
1
33.0
0
6
0.00
89
5.15
6
0.00
281
.40
30.0
0
258
.40
30.0
0
73
.00
60
.00
Pan
ama
1
4.50
1,1
87.5
0
270
.00
6
57.5
0
6
0.00
127
.50
60.
00
889.
65
60.
00
2
75.9
0 30
.00
2
52.9
0 30
.00
67.5
0
60.0
0
P
hilip
pine
s
36.
00
1
,209
.00
2
70.0
0
679
.00
60.
00
1
49.0
0
6
0.00
91
1.15
6
0.00
297
.40
30.0
0
274
.40
30.0
0
89
.00
60
.00
Pol
and
2
6.20
1,1
99.2
0
270
.00
6
69.2
0
6
0.00
139
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60.
00
901.
35
60.
00
2
87.6
0 30
.00
2
64.6
0 30
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79.2
0
60.0
0
P
ortu
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6.50
1,1
79.5
0
270
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6
49.5
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6
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119
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00
881.
65
60.
00
2
67.9
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2
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59.5
0
60.0
0
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audi
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bia
1
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1,1
90.2
0
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6
60.2
0
6
0.00
130
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60.
00
892.
35
60.
00
2
78.6
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2
55.6
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70.2
0
60.0
0
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pain
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84.6
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6
54.6
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6
0.00
124
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75
60.
00
2
73.0
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2
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ri La
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6
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2
76.4
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2
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2
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rugu
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13.
50
1
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2
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656
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1
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88
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274
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30.0
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251
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0
66
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18.
00
1
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2
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60.
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1
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0.00
89
3.15
6
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89
5.15
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0.00
281
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0
258
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EMGS & UPM ACCOUNT DETAILS FOR FEE PAYMENT EMGS Account: Payment can be made through Maybank counter or online payment (CIMB Click/ Maybank2u). Name of Bank : Maybank Account No. : 514057662341 Account Name : Education Malaysia Global Services Recipient Reference : Matric No./ Passport No. Other Payment Details : Based on Type of Application (Renewal/Cancellation/Shortening/Special Pass etc.)UPM Account: Payment can be made through CIMB counter or online payment (CIMB Click/ Maybank2u). Name of Bank : CIMB Account No. : 8002155042 Account Name : UPM Collection Recipient Reference : Matric No./ Passport No. Other Payment Details : Processing Fee Note: *Please make sure you have made the payment before come to the counter. *Please make two copies of each receipt. *Please make sure the reference number of each receipt is clear.
The LOE Application Form-Scientific Counsellor of Iran Embassy in East Asia
*fior E*ch Student. A Sep*r*t* S$rm &.{ust l3e $iubmitte*** l'lvo Conv of this furnr ruusf be sullmitted *ilh a conv of Offer letter alous u'ithcop3, of applic:r{*** {all el**unlezz*s*' {c}py of passp*rti
Name of The University: Name of the Faculty:
Full Name of the Candidate:
Passport Number:
Full Address and Telephone Number (fixed line) of the candidate in lran: .,.,
.,i "
...:., .:3
For Emergency Call in Iran: ;
Name: Direct Phone: ,'.:' .r1"
Candidate Phone (Iran or Malaysia): Candidate Email: '*{''' :ttll''!'
Level of th e Pro gram Applied : (Foundation/B achelor/Nl_aster/PhD, etc)
-i.
Name of the Program Applied with its Major:
The proposed Supervisor/Advisor:Name:Phone:
-,1r... ttn
i. Email
Registration Fee (Getting Offer+qtttr): The Visa Process Fees:
International Students Adrain;Fs65 ; Tuition Fees of the Program:
FIow the UniversiQ, gg?the Student:
Direct Applica.llly{Student ( ) Through the Student Agents ( )
If Agent, Nah-b6f the Aqent: Phone Number of Agent:'ii: :
Any,tgi6 of Grant/Scholarship/financial assistance provided for the Student (pleaseerpk{ih):
PLEASE NUMBER ALL THE COPIES TO AVOID MISSING PAGES AND DELAY AT EMGS
For Example: If Your Passport has 60 pages, then on each page of your photocopy write the
page numbers per total pages, 1-2/60, 3-4/60 … 59-60/60
If Your Passport has 40 pages, then on each page of your photocopy write the
page numbers per total pages, 1-2/40, 3-4/40 … 39-40/40
1-2/60
59-60/60
29-30/60 19-20/60
5-6/60
3-4/60
59-60/60
5-6/60
ACCEPT
REJECT
4.5 CM
3.5 CM
Taken in front of a plain WHITE background only
Clear and sharp
Taken with a neutral facial expression, mouth closed
COLOUR background
-Smiling with teeth showing- Wrong size
Edited picture, toned/pattern background
Blur picture
Face & shoulder not facing forward