8/6/22, 3:52 PM Print Order # E701088850

Order #E701088850
Order Date: 6 August 2022

Billing Address
NANA FITRIANA

SENGOLONG TIMUR DESA PAOKMOTONG KECAMATAN MASBAGIK KABUPATEN LOMBOK TIMUR NUSA TENGGARA BARAT

MATARAM, West Nusa Tenggara, 83661

Indonesia

T: +6281913850801

Payment Method
Telegraphic Transfer (USD Only)

Thank you for selecting telegraphic transfer as your preferred payment option!

1. A telegraphic transfer (TT) is an electronic method of transferring funds to another account

2. Selecting this option will still enable you to create an application, however the application will only be processed once we have

verified that the fee has been credited into our account.

3. You are advised to download your Telegraphic Transfer Notification form which contains guidelines on how to perform a

telegraphic transfer payment. This form is available under "My Account"

Items Ordered

Type of Application SKU Price Qty Subtotal

Student Visa Application Form im14- $331.90 Ordered: 1

$331.90
Institution Type co_english_na-
Public Higher Educational co_duration36-
Institution co_extended3-
Institution Name co_inown-
UNIVERSITI PENDIDIKAN co_nosp6-
SULTAN IDRIS (UPSI) co_ikad_courier1-

Total (excluding Service Tax) $331.90

Service Tax payable @ 6% $18.98

Convenience Fee $47.17

Total Amount Payable $398.05

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8/6/22, 3:52 PM Print Order # E701088850

Type of Application SKU Price Qty Subtotal

Year of Intake co_nomedical-

2022 co_eval-
Month of Intake co_valcourier
October
Course Name
MASTER OF EDUCATION
(EARLY CHILDHOOD
EDUCATION) (FACULTY OF
HUMAN DEVELOPMENT)
Was the last academic
certificate taught and
examined in English?
N/A
Course Duration of Study
(months)
36
Course Level
Master
Applicant Photo (35mm x
45mm)
nana foto visa ok.jpg 190 x
271 px.
Applicant Name as in
Passport MRZ Format
FITRIANA NANA
Applicant Gender
Female
Applicant Place / Country of
Birth
Indonesia

Total (excluding Service Tax) $331.90

Service Tax payable @ 6% $18.98

Convenience Fee $47.17

Total Amount Payable $398.05

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8/6/22, 3:52 PM Print Order # E701088850

Type of Application SKU Price Qty Subtotal

Applicant Date of Birth

(dd/mm/yyyy)
10 Oct 1981
Applicant Nationality
Indonesia
Applicant
Region/State/Province
West Nusa Tenggara
Applicant City
Selong
Passport Country of Origin
Indonesia
Obtain Single Entry Visa from
Indonesia, Jakarta
Travel Document Type
INTERNATIONAL
PASSPORT
Travel Document Number
C9159371
Travel Document Place /
Country of Issue
Indonesia
Travel Document Issued On
(dd/mm/yyyy)
13 May 2022
Travel Document Valid Until
(dd/mm/yyyy)
13 May 2027
Extended Student Pass
(Duration of Student Pass
Sought)

Total (excluding Service Tax) $331.90

Service Tax payable @ 6% $18.98

Convenience Fee $47.17

Total Amount Payable $398.05

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8/6/22, 3:52 PM Print Order # E701088850

Type of Application SKU Price Qty Subtotal

3-year
Insurance
Own Group Insurance
Sticker Pass Fees
JABATAN IMIGRESEN
NEGERI PERAK (payable
directly to Immigration)
Visa Fees
Obtain Student Pass Sticker
from Immigration
iKad
1-year, courier to institute
Medical Screening At
Public University Clinics
eVAL
Processing Fee
Delivery Method
Courier to Institute
Offer Letter
LETER NANA FITRIANA.pdf
Passport Data Page
halaman depan pasport
Nana.pdf
Academic Certificates
Ijazah Nana Fitriana.pdf
Health Declaration
hEALTH nANA.pdf

Total (excluding Service Tax) $331.90

Service Tax payable @ 6% $18.98

Convenience Fee $47.17

Total Amount Payable $398.05

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