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: 603-8946 6048 / 6198 E-mail: intl@upm.edu.my

Kod Dokumen: SOK/PIC/SS01 CHECKLIST FOR VAL 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 VAL Application (SOK/PIC/SS01) 1 2 Visa & Pass Application Form (UPM/PIC/BR01/APPLICATION FORM) 1 3 Letter of Eligibility (LOE) for Iranian student 1 4 COPY of Offer letter 1 5 COPY of Deferment letter (if deferred) 1 6 COPY of Academic certificate 1 7 COPY of Academic transcript 1 8 COPY of Medical Report 1 9 Photo (White Background) Size 3.5 cm x 4.5 cm 2 10 A4 sized COPY of passport (All pages of the passport)

*Please write number on each of the pages *Minimum passport validity must be 18 months

2

11 Proof of VAL Application Payment to EMGS (ORIGINAL receipt) 1

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

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

EX

AM

PLE

PA

SS

PO

RT

NU

MB

ER

NA

ME

EXAMPLE

PASSPORT NO

TYPE OF APPLICATION