checklist for visa application form and student pass …€¦ · checklist for visa application...

CHECKLIST FOR VISA APPLICATION FORM AND STUDENT PASS (FULL TIME)

Nearest Malaysia Embassy/Consulate Office: (Please provide detail information about the address of the nearest Malaysia Embassy/Consulate Office in your country for collection of Visa Approval Letter [VAL]):

New Application:-

1. IM.14 Form2. HIF.12 Form (duty stamp MYR10)3. HIF.47 Form4. IM.63 Form (3 pages)5. Student Pass Application Form6. Student Offer Letter7. 4 pcs of passport sized picture8. 1 set copy of passport in color (details page only)

Additional Information for Change University

9. Approval or release letter for transferring place of study from previous college / institution10. Application letter for exchange university11. Support letter for transferring university from the Ministry of Higher Education, Malaysia12. Student academic report13. Copy of passport (current student pass)

Upon Arrival:

1. Copy of Student Offer Letter2. 1 set copy of passport (front pages & single entry visa)3. Copy of Insurance Fees (1 set)4. Medical Examination Report

*REMINDER : VISA APPROVAL LETTER WILL TAKE AT LEAST 2 MONTHS TOPROCESS. KINDLY SUBMIT YOU VDR APPLICATION ONCE YOU HAVE RECEIVE YOUR UMS OFFICIAL OFFER LETTER

JABATAN IMIGRESEN MALAYSIA BORANG PERMOHONAN PAS PELAJAR

STUDENT PASS APPLICATION FORM

PERATURAN-PERATURAN IMIGRESEN, 1963 [Peraturan 13(2)]

Jenis Permohonan Baru Type of Application New

A. MAKLUMAT PEMOHONPARTICULARS OF APPLICANT

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

2. *Jantina Lelaki Gender Male

3. Tempat / Negara LahirPlace // Country of Birth

Lanjutan Extension

Perempuan Female

(IM. 14 - Pin. 1/97)

4. **Tarikh LahirDate of Birth

hari bulan tahun day month year

5. WarganegaraNationality

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

6. Jenis Dokumen PerjalananType of Travel Document

7. NomborNumber

8. Tempat I Negara DikeluarkanPlace / Country of Issue

C. MAKLUMAT PENGAJIAN / KURSUSPARTICULARS OF STUDY / COURSE

9. ** Sah SehinggaValid Until


10. Tempoh Belajar /KursusDuration of Study/Course

11. Nama KursusName of Course

bulan months

12. *PeringkatPengajianLevel of Course

13. Nama lnstitusiInstitution Name

14. *Jenis lnstitusiType of institution

Ph. D Ph.D

Kerajaan Government

Sarjana Master

Sarjana Muda Degree

Swasta Private

Diploma Diploma

Sekolah School

15. *Kategori AnakCategory of Child

Anak Warganegara Child of Citizen

Anak Pegawai Dagang Child of Expatriate

Anak Penduduk Tetap Child of Permanent Resident

16. Nyatakan maklumat suami / isteri / ibubapa di Malaysia Specify spouse I parent's information residingin Malaysia

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

*JantinaGender

Lelaki Male

Perempuan Female

17. HubunganRelationship

Warganegara Nationality

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

•· Format Tarikh 99/99/9999Date Format DD/MM/YYYY

1-2

Photograph Of

Applicant (3.5 cm x 5.0 cm)

D. MAKLUMAT PENGANJUR DI MALAYSIAPARTICULARS OF SPONSOR IN MALAYSIA

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

19. No. Kad PengenalanNRIC

21. AlamatAddress

20. No. TelefonTelephone No.

Negeri State

E. KEPERLUAN VISAVISA REQUIREMENT

22. Adakah Visa DiperlukanVisa Requirement

Ya Yes

Tidak No

23. *Jenis VisaType of Visa

Sekali Perjalanan Single Entry

Beru langkali Perjalanan Multiple Entry

Tarikh:………………………………………. Date

Tandatangan Pemohon /Penganjur………………………………. Signature of Applicant/Sponsor

Borang ini hendaklah d I taip. Tandakan (X) dalam petak yang berkenaan. This form should be typed Mark (X) in the appropriate box.

** Format Tarikh 99/99/ 9999Date Format 00/MM/YYYY

2-2

JUNAINAH ISMAIL

790223-12-5492 019-226 5564

PUSAT PENGANTARABANGSAAN DAN PENGLIBATAN GLOBAL (PPPG)ARAS 5, BLOK SELATAN, BANGUNAN CANSELORIUNIVERSITI MALAYSIA SABAH88400 KOTA KINABA

SABAH, MALAYSIA

GOVERNMENT OF MALAYSI A Immigration Ordinance 1959

(F.M. 12 of 1969) Immigration Regulation, 1963

(P.L.N. 228/63) PERSONAL BOND

(Regulation 18)

WHEREAS it is a condition of the issue of a Visit Pass (Temporary Employment) to me/

…………………………………………….. of ……………………………………………… that

there be furnished by me / or on behalf of said ………………………………………………..

security in the sum of RM …………………… as a guarantee that I / the said ……………..

………………………………..………………………….. will comply with the provisions of the

Ordinance and of any Regulations made there under and with any conditions imposed in

Respect of instructions endorsed on such pass.

Now I ……………………………..… NRIC .………………………………………. of

…………………………………………………………………………………………………... do

hereby bind myself that I / the said ……………………………………………………………..

will comply with the provisions imposed in respect of or instructions endorsed on

such Visit Pass (Temporary Employment) and in case of my / the said ………………………

making default therein, I hereby bind myself to forfeit to the Government of Malaysia the

sum of RM…………………. Dated this ………. day of ………………………20 ……………..

at ……………………………………… in the state of ………………………………………….

Signature of the above named

…………………………………..

Signed and executed by the above named ………………………………….. in my presence

Signed of Witness : ……………………………………………………………………..

Full Name of Witness : ……………………………………………………………………..

Address of Witness : ……………………………………………………………………..

……………………………………………………………………..

……………………………………………………………………..

……………………………………………………………………..

Duty Stamp RM10.00

(employee)

(employee)

(address)

(employer)

(employee)

(address)

(employee)

(employee)

JUNAINAH ISMAIL 790223-12-5492

UNIVERSITI MALAYSIA SABAH

CENTRE FOR INTERNATIONALISATION & GLOBAL ENGAGEMENT

LEVEL 5, CHANCELLERY BUILDING, UMS

88400 KOTA KINABALU

SABAH, MALAYSIA

FAIZIE BIN DININ

* Jenis PermohonanType of Application

Dalam Malaysia In Malaysia

Seberang Laut Oversea

IM. 47-P in . 1/97

A. MAKLUMAT PEMOHONPARTICULARS OF APPLICANT

1. · Nama Penuh (Huruf Besar)Full Name (Capital letter)

2. *JantinaGender

3. Tempat/Negara LahirPlace/Country of Birth

Lelaki Male

Perempuan Female

4. **Tarikh Lahir 5. WarganegeraDate of Birth Nationality


6. PekerjaanOccupation

7. AlamatAddress

8. Taraf PerkahwinanMarital Status

Belum Berkahwin Single

Berkahwin Married

B. MAKLUMAR PASPORT PERJALANAN / DOKUMEN PERJALANANPARTICULARS OF PASSPORT / TRAVEL DOCUME NT

9. Jenis Dokumen PerjalananType of Travel Document

11. Tempat / Negara Dikeluarkan Place / Country of Issues

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

10. NomborNumber

12. **Sah SehinggaValid Until

hari Bulan Tahun day month year

Format Tarikh 99/99/9999 Date Format DDIMMIYYYY

JABATAN IMIGRESEN MALAYSIA BORANG PERMOHONAN VISA

VISA APPLICATION FORM

Gambar Pemohon

Photograph of Applicant

(3.5 cm x 5.0 cm)

margaret

Cross-Out

C. BUTIR-BUTIR PENGANJUR DI MALAYSIAPARTICULARS OF SPONSOR IN MALAYSIA

13. Name Penuh (Huruf Besar)Full Name (Capital Letter)

14. No. Kad PengenalanNRIC

15 No. Telefon Telephone N.o.

16. AlamatAddress

Negeri State

D. BUTIR-BUTIR PERMOHONANDETAIL OF APPLICATION

17. Tempoh Tinggal Yang DicadangkanDuration of Proposed Stay

Bulan Month

18. * Tujuan Perjalanan Bercuti Transit Purposed of Journey Holiday Transit

Urusan Perniagaan Urusan Rasmi Business Official Trip

Melawat Saudara Mara/Kawan Persidangan Visiting Friends/Relatives Conference

Bekerja Lain-lain (Nyatakan) Employment Other Specify

Belajar Study

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 99/99/9999Date Format DD/MM/YY

JUNAINAH ISMAIL

790223-12-5492 +6019-226 5564

CENTRE FOR INTERNATIONALISATION & GLOBAL ENGAGEMENTLEVEL 5, CHANCELLERY BUILDING, UMS88400 KOTA KINABALU

SABAH, MALAYSIA

WJD006111-PNMB.. K.L.

KETUA POLIS

(U/P): KETUA C AWANGAN KHAS/E5)

BORANG RUJUKAN IMIGRESEN (lm.63)

(Pindaan 6/87)

Rujukan...............................................

Pejabat Imigresen

IBU P EJABAT KONTINJ EN POLIS.......................................................... ……………………………………

Permohonan untuk suatu.................... ......... ........... ................. ........... telah diterima berkenaan dengan yang te rsebut di bawah

ini yang pada masa ini berada di.........................................................................................................................................................

BUTIR-BUTIR MENGENAI PEMOHON

Nama penuh .............................................................. .......

Nama lain .........................................................................

Nama bapa .............. ............................................ .............

Tarikh lahir ....................................... Tempat Lahir............. ............................ Jantina ...................................................................

Pekerjaa n ...... ..................... ... ... ...................... ...................................... ........ ......……. Loghat ........................................................... ........

K.P.P.N/No. Surat Perjalanan. tarikh dan tempat dike lu arkan ...... .............................................. ... .... ....... .... ... ............ ........... .............

Alamat seka rang ..... ...... ... ........ .... .. ............... .... ........................ ....................... .......... .... .. ... ............................ ..................... ...... ........ ... .

Jika dahulunya tinggal di Sepanjang Malaysia, alamat akhirnya yang diketahui dan tarikh meninggalkan (Untuk Permohonan Permit Masuk sahaja)

Alamat yang dicadang di Sepanjang Malaysia (Untuk Permohonan Permit Lawatan /Visa/Masuk)

BUTIR-BUTIR MENGENAI PIHAK PENGANJUR

Nama ............................................................................................................................... (Jantina )................................

Tarikh lahir.................................... Tempat lahir .................................. (Pekerjaan) …….........................................

Loghat....................................................................................... ...K.P.P.N. No. ............................. ........................

Alamat .....................................................................................................................................................................

Persaudaraan dengan orang yang hendak membuat perjalanan ....... .... ..................... .................... .......... ..... .... .. ....

Melainkan Pejabat ini diberitahu pada atau sebelum ................................................................................................................... bahawa ada bantahan Polis terhadap hal ini. maka bantahan Polis akan dianggap sebagai tiada.

Tarikh......................................... Tandarangan dan cap Pejabat

KEPADA KETUA POLIS NEGARA. (U/P PENGARAH CAWANGAN KHAS/ E5)

*Kelewatan menapis diberitahu kepada Pejabat lmigresen

................................ pada.............................. *Tiada apa-apa halangan. (*Potong jika perlu) ...................... ES. K.C.K...........................

……………………………………………………………………………………………………………………………………………………………………… ( Koyakkan mengikut Garisan bertebuk)

KEPADA PEGAWAI lMIGRESEN,

......... ................................... Rujukan tuan ........................................................................................................ Ada kelewatan menapis.

Harap jangan diberi keputusan sehingga perhubungan lanjut diterima dari Ibu Pejabat Cawangan Khas. Bukit Aman. Kuala Lumpur.

Tarikh........................................ . b/p Ketua Cawangan Khas ..................................... Kontinjen

Nama dengan Tulisan Cina


JUNAINAH ISMAIL FEMALE

23 FEB 1979 TUARAN PEN. PENDAFTAR KANAN

790223-12-5492PUSAT PENGANTARABANGSAAN DAN PENGLIBATAN GLOBAL (PPPG)


KETUA POLIS

(U/P): KETUA C AWANGAN KHAS/E5)


(Pindaan 6/87)

Rujukan...............................................

Pejabat Imigresen





Nama penuh .............................................................. .......

Nama lain .........................................................................

Nama bapa .............. ............................................ .............




Alamat seka rang ..... ...... ... ........ .... .. ............... .... ........................ ....................... .......... .... .. ... ............................ ..................... ...... ........ ... .




Nama ............................................................................................................................... (Jantina )................................


Loghat....................................................................................... ...K.P.P.N. No. ............................. ........................

Alamat .....................................................................................................................................................................











Tarikh........................................ . b/p Ketua Cawangan Khas ..................................... Kontinjen





790223-12-5492

CENTRE OF INTERNATIONALISATION & GLOBAL ENGAGEMENT



(Pindaan 6/87)

Rujukan...............................................

Pejabat Imigresen





Nama penuh .............................................................. .......

Nama lain .........................................................................

Nama bapa .............. ............................................ .............




Alamat seka rang ..... ...... ... ........ .... .. ............... .... ........................ ....................... .......... .... .. ... ............................ ..................... ...... ........ ... .




Nama ............................................................................................................................... (Jantina )................................


Loghat....................................................................................... ...K.P.P.N. No. ............................. ........................

Alamat .....................................................................................................................................................................











Tarikh........................................ . b/p Ketua Cawangan Khas .................................... Kontinjen





790223-12-5492

CENTRE FOR INTERNALIZATION & GLOBAL ENGAGEMENT

BORANG PERMOHONAN PAS PELAJAR (STUDENT APPLICATION)

NO. RUJUKAN: BVP/STU/12011- _____________________________________________________

NAMA PEMOHON (Applicant’s Name)

JANTINA (Sex) : TARIKH LAHIR (Date Of Birth):

TEMPAT LAHIR (Place of Birth):

NO. PASPORT (Passport No) : SAH HINGGA(Valid Till):

TEMPAT DIKELUARKAN: (Place of Issue)

NAMA PENUH (Full Name) :.

NO. KAD PENGENALAN (I/C No):

NO. TELEFON (Telephone No) : H/PHONE NO:

ALAMAT (Address):

NAMA INSTITUSI: (Name of Institution)

KATEGORI PENGAJIAN: (Category of Course)

KATEGORI PELAJAR: a) PRA SPM

b) POST SPM

NAMA KURSUS: (Name of Course)

SILA SERTAKAN SALINAN: (Please enclosed copy of)

1) DOKUMEN PERJALANAN PEMOHON DAN PENGIRING YANG BERADA DI MALAYSIA.(Copy of applicant's document and applicant's guardian if accompanied )

2) SURAT PENGESAHAN DARI INSTITUSI PENGAJIAN.(Letter of Admission /Offer Letter)

3) SALINAN DOKUMEN / KAD PENGENALAN PENGANJUR.. (Document/ Identity Card of Local Sponsor)

(Affix a passport size photo here)

BUTIR-BUTIR PENGANJUR (Particulars of Local Sponsor)

BUTIR-BUTIR PENGAJIAN (Particulars of Course)

JUNAINAH ISMAIL

790223-12-5492

088-232000 ext. 1025 +6019-226 5564



BTK 100

KERAJAAN MALAYSIA) (GOVERNMENT OF MALAYSIA

BAHAGIAN I - BUTIR-BUTIR DIRI PART I - PERSONAL PARTICULARS

1. Nama Penuh:(Full Name) (family) (first) (middle) (last)

2. Lain-lain nama jika ada:(Other name (s), if any)

3. Nama Cina (Jikaberkaitan)(Chinese name if applicable)

Dalam tulisan Cina:(Chinese Characters)

(a) Dalam Kod Perdagangan :(In commercial code)

4. Tarikh Lahir:(Date of Birth)

Hari (Day)

Bulan (Month)

Tahun (Year)

5. Tempat Lahir:(Place of Birth) Daerah

(State) Negeri

(Country) 6. Kewarganegaraan:.

(Citizenship)

7. Alamat Tetap:(Permanent Address)

8. Pekerjaan sekarang:(Present Occupation)

(Affix a passport size photo here)

BORANG MAKLUMAT PERIBADI (PERSONAL PARTICULARS FORM)

9. Majikan sekarang:(Present Employer)

10. Tujuan Lawatan:(Purpose of Visit)

11: Tempoh berada di Malaysia: (Duration of stay in Malaysia)

12. Alamat semasa berada di Malaysia:(Address whilst in Malaysia)

13. Tarikh dan Tempoh lawatan laluke Malaysia ( jika ada ) :(Date and duration of stayof previous visits to Malaysia if any):

BAHAGIAN II - BUTIR-BUTIR DOKUMEN PERJALANAN (PART II- PARTICULARS OF TRAVEL DOCUMENT)

1. Jenis Dokumen :(Type of Document)(a) Passport ( Passport) :

(b) Lain-lain (sila nyatakan) :.(Others [please specify])

2. Nombor pasport:(Passport Number)

3. Tarikh dan tempat dikeluarkan : (Date and place of issue)

4. Pihak berkuasa yang mengeluarkan : (Issuance authority)

5. Tempoh sah laku: (Period of validity)


STUDY


PASSPORT

BAHAGIAN Ill - BUTIR-BUTIR PENGANJUR TEMPATAN (jika berkaitan) (PART Ill - PARTICULARS OF LOCAL SPONSOR (if applicable)

1. Nama dan alamat lnstitusi yang menganjur :(Name and address of sponsoring Institution)

2. Nama Penganjur di Malaysia :(Name of referee in Malaysia )

(a) Dalam tulisan Cina (jika berkaitan) :(in Chinese characters , if applicable)

(b) Dalam kod perdagangan (jika berkaitan) :(in Commercial code, if applicable)

3. Tarikh dan tempat lahir penganjur:(Date and place of birth of referee)

4. Nombor Kad Pengenalan Penganjur:(Identity Card Number of referee)

5. Alamat Penganjur :(Address of Referee):

Tarikh (Date) Tandatangan Pemohon (Signature of applicant)


JUNAINAH ISMAIL

23 FEB 1979 / TUARAN

790223-12-5492

CENTRE FOR INTERNATIONLISATION & GLOBALENGAGEMENTUNIVERSITI MALAYSI SABAH

LAMPIRAN D

FORM 15

MALAYSIA IMMIGRATION REGULATIONS, 1963

STUDENT'S PASS

[Regulation 13 (3)]

Serial No: _

This Pass-

(i) permits .......................................holder of .................................................

Passport / internal travel document No...........................................................

issued at ....................................on..........................................................

to enter and remain in .................................................................. as a student

for the purpose of studying at ..................................................................

(ii) is valid until ............................................................................................

Date: ................................... ……………………………

(Controller of Immigration)

NOTE:

This Pass will cease to be valid if the holder thereof fails to enter or to

be retained as a student in …………………………………………………………………………………………………

checklist for visa application form and student pass …€¦ · checklist for visa application...

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