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PERKHIDMATAN UTAMA PUTRA INTERNATIONAL (PUSAT ANTARABANGSA) UNIVERSITI PUTRA MALAYSIA 43400 UPM Serdang, Selangor, Malaysia Tel: 603-8946 6048 / 6198 E-mail: [email protected] Kod Dokumen: SOK/PIC/SS10 CHECKLIST FOR IKHTISAS APPLICATION PLEASE USE CAPITAL LETTERS Name: Passport No: Expiry Date of passport: d d / m m / y y y y HD Helpdesk CS Counter Staff NO. SEMAKAN : 02 NO. ISU : 02 TARIKH KUATKUASA : 20/04/2017 1 drp. 1 No. Required Documents (Please arrange the document according to the sequence given) No of Copy Tick (If Complete) Office Use Applicant HD CS 1 Checklist for IKHTISAS Application (SOK/PIC/SS10) 1 2 Visa & Pass Application Form (UPM/PIC/BR01/APPLICATION FORM) 1 3 A4 sized COPY of passport (All pages of the passport) *Please write number on each of the pages 2 4 ORIGINAL offer letter from UPM 1 5 Original Offer Letter from Home University/Company. The following information should be mentioned on the Offer Letter: Period of Programme (Start & End) Place of Programme at Universiti Putra Malaysia 1 6 Photo (Standard passport & Blue Background) Size 3.5 cm x 5.0 cm 2 7 IM – 38 form 1 8 IM – 12 form 2 9 Curriculum Vitae (CV)/ Resume 2 10 Copy of Academic Transcript from Home University 1 11 Copy of MoU/ MoA/ LoI between home university & UPM *Memorandum of Understanding (MoU) *Memorandum of Agreement (MoA) *Letter of Intent (LoI) 2 12 Payment of Bank Guarantee Letter – MYR 200 (Only for student from China) 2 13 COPY of Full Schedule (for Internship/Research Attachment only) 2 14 Proof of Professional Pass Approval Letter application payment to UPM (MYR 270) 2 Note 1. Documents which DO NOT follow the specifications are deemed incomplete and shall be rejected 2. Pease DO NOT staple your documents and photo. 3. Use a paper clip instead. Checked by Date

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PERKHIDMATAN UTAMA

PUTRA INTERNATIONAL (PUSAT ANTARABANGSA)

UNIVERSITI PUTRA MALAYSIA 43400 UPM Serdang, Selangor, Malaysia

Tel: 603-8946 6048 / 6198 E-mail: [email protected]

Kod Dokumen: SOK/PIC/SS10 CHECKLIST FOR IKHTISAS APPLICATION

PLEASE USE CAPITAL LETTERS

Name:

Passport No:

Expiry Date of passport:

d

d

/

m

m / y y y y

HD Helpdesk CS Counter Staff

NO. SEMAKAN : 02 NO. ISU : 02 TARIKH KUATKUASA : 20/04/2017 1 drp. 1

No. Required Documents (Please arrange the document according to the sequence given)

No of Copy

Tick (If Complete) Office Use

Applicant HD CS 1 Checklist for IKHTISAS Application (SOK/PIC/SS10) 1 2 Visa & Pass Application Form (UPM/PIC/BR01/APPLICATION FORM) 1 3 A4 sized COPY of passport (All pages of the passport)

*Please write number on each of the pages 2

4 ORIGINAL offer letter from UPM 1 5 Original Offer Letter from Home University/Company.

The following information should be mentioned on the Offer Letter: • Period of Programme (Start & End) • Place of Programme at Universiti Putra Malaysia

1

6 Photo (Standard passport & Blue Background) Size 3.5 cm x 5.0 cm 2 7 IM – 38 form 1 8 IM – 12 form 2 9 Curriculum Vitae (CV)/ Resume 2 10 Copy of Academic Transcript from Home University 1 11 Copy of MoU/ MoA/ LoI between home university & UPM

*Memorandum of Understanding (MoU) *Memorandum of Agreement (MoA) *Letter of Intent (LoI)

2

12 Payment of Bank Guarantee Letter – MYR 200 (Only for student from China) 2 13 COPY of Full Schedule (for Internship/Research Attachment only) 2 14 Proof of Professional Pass Approval Letter application payment to UPM

(MYR 270) 2

Note 1. Documents which DO NOT follow the specifications are deemed incomplete and

shall be rejected 2. Pease DO NOT staple your documents and photo. 3. Use a paper clip instead.

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

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.

Im. 38 - Pin 1/93

PERMOHONAN UNTUK VISANo. F 047643

Borang ini dikenakan bayaran sebanyak RM1.00

Visa No. ...............................

Nama Penuh............................................................................................................................................................

Nama dalam Tulisan Cina(Jika berkenaan - SILA TULIS DENGAN TERANG)

Tarikh Lahir...................................................Negeri Lahir......................................................................................

Loghat............................................................Kerakyatan.......................................................................................

Pekerjaan.................................................................................................................................................................

Alamat di Malaysia..................................................................................................................................................

Alamat di luar negeri...............................................................................................................................................

Pasport No. .............................................................................................................................................................

Kad Pengenalan No. ...............................................................................................................................................

Visa dikehendaki bagi negeri..................................................................................................................................

.................................................................................................................................................................................

Tarikh........................... ............................................

Jantina....................................

Tandatangan Pemohon

(Tempat dikeluarkan) (Tarikh dikeluarkan)

(Tempat dikeluarkan) (Tarikh dikeluarkan)

(Dengan huruf cerai)

(Masukkan nama Kerajaan yang mengeluarkan)

(UNTUK KEGUNAAN PEJABAT)

(Konsol Visa/..................).........................................................................................................................................

(Tarikh Saringan Akhir...........................).................................................................................................................

.................................................................................................................................................................................

.................................................................................................................................................................................

.................................................................................................................................................................................

.................................................................................................................................................................................

.................................................................................................................................................................................

.................................................................................................................................................................................

.................................................................................................................................................................................

.................................................................................................................................................................................

.................................................................................................................................................................................

.................................................................................................................................................................................

.................................................................................................................................................................................

[Borang ini diterjemahkan oleh Peguan Negara, Malaysia menurut Pemberitahu Undangan No. 12 tahun 1964, P.N. 3630/5-1 ; IMM1C197166 (12).]

JD125115 - PNMB..K.L.

JABATAN IMIGRESEN MALAYSIABORANG PERMOHONAN PAS LAWATAN

VISIT PASS APPLICATION FORM PERATURAN-PERATURAN IMIGRESEN, 1963 [Peraturan 11(12) dan 11(15)]

*Jenis Pas Type of Pass *Jenis Permohonan Type of Application

Iktisas Professional

Sosial Social

Berniaga Business

Kerja Sementara Temporary Employment

Baru New

Lanjutan Extension

A. MAKLUMAT PEMOHON PARTICULARS OF APPLICANT

1. Nama Penuh (Huruf Besar) Full Name (Capital Letter)

Gambar Pemohon

Photograph Of Applicant

(3.5 cm 5.0 cm)

2. *Jantina Gender

Lelaki Male

Perempuan Female

3. Tempat/Negara Lahir Place/Country of Birth

4. **Tarikh Lahir Date of Birth

hari bulan tahun day month year

5. Warganegara Nationality

B. MAKLUMAT PASPORT PERJALANAN / DOKUMEN PERJALANANPARTICULARS OF PASSPORT / TRAVEL DOCUMENT

6. Jenis Dokumen Perjalanan Type of Travel Document

7. Nombor Number

8. Tempat / Negara Dikeluarkan Place / Country of Issue 9. **Sah Sehingga

Valid Until hari bulan tahunday month year

C. MAKLUMAT PENGANJUR DI MALAYSIA PARTICULARS OF SPONSOR IN MALAYSIA

IM. 12 – Pin. 1/97

10. Nama Penuh (Huruf Besar) Full Name (Capital Letter) 11. No. Kad Pengenalan NRIC

12. No. Telefon Telephone No.

13. Alamat Address

Negeri State

D. KEPERLUAN VISA VISA REQUIREMENT

14. *Adakah Visa Diperlukan Visa Requirement

Ya Yes

Tidak No

15. *Jenis Visa Type of Visa

Sekali Perjalanan Single Entry

Berulangkali Perjalanan Multiple Entry

Tarikh Date Tandatangan Pemohon / Penganjur

Signature of Applicant / Sponsor

• Borang ini hendaklah ditaip. Tandakan (x) dalam petak yang berkenaan. This form should be typed. Mark (x) in the appropriate box.

** Format Tarikh 99/99/9999 Date Format DD/MM/YYYY

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

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.

EX

AM

PLE

PA

SS

PO

RT

NU

MB

ER

NA

ME

EXAMPLE

PASSPORT NO

TYPE OF APPLICATION