INTERNATIONAL STUDENT CENTRE (ISC) APPLICATION OF STUDENT PASS FOR NEW STUDENT A.

CHECKLIST FOR STUDENT PASS Each Documents Must Be Sort Accordingly As In The Checklist Including All The Requirement Below:Application Must Be Made 1 Month Before The Expiry Of The Visa After Registration. Submission can be made ONLY from Tuesday Until Thursday, 8.30am - 12.30pm No. Required Document No. Of Copies 1 2 3 4 5 6 7 8 9 10 Copy Offer Letter From Universiti Kebangsaan Malaysia Copy Stamped Pages Passport Copy Release Letter From Previous University/College Copy Certificate And Transcript of Master Degree or Bachelor Degree Copy of Resignation Letter From Previous Employer (if applicable) Copy Of Registration Slip Copy Of Tuition Fees Receipt Of Payment Copy of Health Examination (Endorsed by UKM Student Medical Centre) Passport Size Photo Completed IM.12 Forms 3 3 3 3 3 3 3 3 3 2

IMM.ISC.2011 FORM Date :

The Director International Student centre Universiti Kebangsaan Malaysia 43600 Bangi, Selangor (Attn: Mdm Raja Aina Raja Hussain Shah, Mr. Muhammad Zaidi, Mdm Fareen Izra) Dear Sir, APPLICATION FOR STUDENT PASS Kindly be informed that of offer letter UKM1.14/________________________ dated ___________________ is referred. This is to make a confirmation that I have accepted the offer to pursue the graduate program. I will register on ___________________. I enclosed herewith the documents as being required for my application. The documents are as such: 1. 2. 3. 4. 5. 6. 7. 8. 9. Thank you. ____________________ Signature Name Address In Malaysia Phone No. Email : : : : Copy Offer Letter From Universiti kebangsaan Malaysia Copy Stamped Pages Pasport Copy Release Letter From Previous University/College Copy Certificate And Transcript of Master Degree or Bachelor Degree Copy of Resignation Letter From Previous Employer (if applicable) Copy Of Registration Slip Copy Of Tuition Fees Receipt Of Payment Copy of Health Examination (Endorsed by UKM Student Medical Centre) Passport Size Photo

PUSAT PELAJAR ANTARABANGSA / INTERNATIONAL STUDENT CENTRE BORANG PERMOHONAN PENYEDIAAN DOKUMEN / DOCUMENT APPLICATION FORM A. SILA TANDAKAN () PADA YANG BERKENAAN PLEASE TICK () IN THE RESPECTIVE APPLICATION

Urusan mendapatkan Pas Pelajar (Pelajar Baru) Application for New Student Pass Melanjutkan Pas Pelajar Student Pass Renewal Melanjutkan Visa Ahli keluarga Visit Pass Renewal For Family/Dependent Surat Pelepasan Pelajar Release Letter Surat Sokongan Kepada Kedutaan / Permohonan Single Entry Visa * Reference Letter to Embassy / Single Entry Visa Application * Lain-lain (Sila Nyatakan) : Other (Please State)

B. MAKLUMAT PELAJAR / STUDENTS DETAILS Nama Name No. Paspot Passport No. Warganegara Nationality Bentuk Pendaftaran Sepenuh Masa / Separuh masa Type of Registration Full Time / Part Time Program Pengajian Doktor Falsafah / Sarjana Program Study Ph.D / Master Fakulti Faculty Alamat di Malaysia Address in Malaysia Tarikh Mula Daftar (Sila rujuk surat Tawaran) Date of Registration (Refer to Offer Letter) Tempoh Tamat Pengajian Expected Semester of Completion Tarikh Date * Catatan Note : Tandatangan : Signature

: Surat Imigresen/Akuan akan disediakan dalam masa 3 hari bekerja dari tarikh permohonan dibuat. : Reference Letter will be ready after 3 working days from the date of application

KEGUNAAN PEJABAT / FOR OFFICE USE ONLY Diterima Oleh (Nama) Received By : Tandatangan : Signature