Immigration History and risk assessment form cum declaration

A. Do you have Visa Refusal from any country ever? : YES / NO

If yes then provide details :

Country Visa Category Refusal date Refusal letter Submitted

YES/NO
YES/NO
YES/NO
YES/NO

Have you overstayed in any country? : YES/NO

If yes then provide details:

B. Do you have any legal case pending against you (including traffic violation)? If yes then please give
details:
 DECLARATION

I Mr/Ms Mohammed Ibrahim Abdul Rahaman herby confirm the following:

I hereby declare that all the documents submitted by me to SIUK for application and visa purpose are
true and genuine to the best of my knowledge. I also declare that the information given in this form is
true and correct to the best of my knowledge and belief. I understand that the universities have the
right to cancel the admission and withheld any deposit paid if they found at any stage that false
documents/information were provided to get offer letter from them. In case any information
given in this form proves to be false or incorrect, I shall be solely responsible for the consequences
and not SIUK.

Signature & Print Name Date : 13/12/2023

Mohammed Ibrahim