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/SS08 CHECKLIST FOR SPECIAL PASS APPLICATION
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
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 Special Pass Application (SOK/PIC/SS08) 1 2 Visa & Pass Application Form (UPM/PIC/BR01/APPLICATION FORM)
(If you have more than 1 dependent, fill up this form once only) 1
3 Format A Form - PK(O)IM,G.04/ FQ-01 2 4 TYPED Letter address to Immigration Director Malaysia, Kuala Lumpur –
– explain the reason to apply for special pass 2
5 COPY of Registration Slip/ Deferment Letter/ Withdrawal Letter/ Terminate Letter
2
6 a. LATEST of Family Letter from Embassy (ORIGINAL/ COPY must endorsed by Embassy) b. Translated Marriage Certificate (Endorsed by Embassy)
c. Translated Birth Certificate (Endorsed by Embassy)
2
7 COPY of new offer letter/ flight ticket *Date of flight ticket must be within 30 days from the application submission
2
8 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
1
9 A4 sized COPY of passport (Details & Pass page) *Application for dependant please attached together student details & pass page
1
10 Receipt of Payment to EMGS (Refer Page 4 for fee information) 2 11 Receipt of Payment to UPM (Refer Page 4 for fee information) 2
Note
1. This checklist is for ONE application. ADDITIONAL of other dependent application will require the same number of copies.
2. Documents which DO NOT follow the specifications are deemed incomplete and shall be rejected.
3. Please DO NOT staple your documents and photo. 4. Use a paper clip instead. 5. 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
SOKONGAN
PENGURUSANPELAJARDANSTAFANTARABANGSA
PUTRAINTERNATIONALCENTRE
(PUSATANTARABANGSA)
KodDokumen:SOK/INT/BR01/VP
VISA&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/RESEARCH
ATTACHMENT
STAFF STAFFDEPENDENT
STUDENT’S/STAFF’SPARTICULARS:
1.NAME
:
_______________________________________________________________________
2.MATRIC/STAFFNO
:
_________________
GENDER
:
Male
Female
3.NATIONALITY
4.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
EXPIRYDATE
SOCIALPASS
EXPIRYDATERELATION
IcertifythatallinformationgiveninthisapplicationistrueandIhavealsosubmittedapplicationformeormy
dependents:student/workingpass/visitpass(New/Renewal/SpecialPass/Shortening/Endorsement)
..……..……………………………... ………..………………………..
Student/Staff’sSignature Date
……………………………………………………………………………………………………………………………………………………………………………………
FOROFFICEUSEONLY
PAYMENTCHECKLIST:(Note:PleasepresenttheoriginalreceiptfromtheBursarCounterandthecopyoftheReceiptuponsubmissionofyourapplicationtotheCounterofVisa&Pass.)
TYPEOFPAYMENT Student/
Staff
Dependent
1
Dependent
2
Dependent
3
Dependent
4
Dependent
5
Dependent
6
NEWAPPLICATION:
……………………………………
RENEWAL
SPECIALPASS
TRANSFERSTICKER
SHORTENING/
CANCELLATION
INVITATIONLETTER/
RELEASELETTER/
CLAIMLETTER
LATESUBMISSION
OTHERS:
……………………………………
TOTALAMOUNT(RM):
………………………………………… ……………………………………
Officer’sSignatureandStamp Date
PUTRAINTERNATIONALCENTRE
EM
GS
UP
ME
MG
SU
PM
EM
GS
UP
ME
MG
SU
PM
EM
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UP
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272
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262
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00
1
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90
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291
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268
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0
83
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ta R
ica
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00
884.
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00
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0
72
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60
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Den
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SA
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0
6
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00
881.
15
60.
00
2
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2
44.4
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59.0
0
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0
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omin
ican
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ublik
1
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00
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00
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cuad
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00
1
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00
1
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0
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88
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268
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0
245
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0
60
.00
60
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nce
1
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00
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05
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00
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aiti
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00
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15
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00
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unga
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00
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00
1
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2
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00
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92
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6
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288
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0
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3.00
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0
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done
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15
60.
00
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0
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00
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6
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0
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0
73
.00
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00
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65
60.
00
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and
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GS
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PE
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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.
Lampiran 1
PK(O)rM,G.04/ FQ-01
FORMAT A
FORMAT TINGGAL LEBIH MASAHADIR DI PEJABAT
Nama {Name) :
Jantina (Sex) : ..,.,.,........... .. Warganegara (Citezenship) :
No. Pasport (Passport No) : .,......, Pekerjaan (Profession) :
Majikan (Employer) : ,.......,,........ . Jenis Pas (Type Of Passes) :
Tempoh Tamat Pas (Expired Date Of Pass) :
Sebab-sebab tinggal lebih masa (Kembarkan dokumen sebagai bukti) : (Reason of overstaying, please
enclose oroofl :
Tandatangan (Signature)
Tarikh (Date) :
(UNTUK KEGUNMN PEJABAT / oFFTCE USE ONLY)PERAKUAN PEGAWAI :
Tandatangan
Cop Nama & Jawatan Pegawai
Tarikh {Date) : ..,.,,,.,,,.,..........
KEPUTUSAN:
I I Tidak ada sebab munasabah telah tinggal lebih masa, Rujuk Bahagian Penguatkuasa
Tandatangan
Cop Nama & Jawatan Pegawai
Tarikh (Date) : ......,..,.,,,,,,..,.....
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
EXAM
PLE
PASS
POR
T N
UM
BER
NAM
E
EXAMPLE
PASSPORT NO
TYPE OF APPLICATION
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