Order #E701011793

Order Date: 24 October 2019

Billing Address
SARIKA FITRI
JL BUKIT BATU 334 RT004/RW013, SIALANGSAKTI, TENAYAN RAYA
PEKANBARU, 28285
Indonesia
T: +6282384590096

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
Total (excluding Service Tax) $529.63
Service Tax payable @ 6% $18.72
Convenience Fee $50.00
Total Amount Payable $598.35
Student Visa Application
Form im14-co_english_na-
co_duration48-co_extended2-
Institution Type co_hlmtsilver_1660_12-co_sp2-
Public Higher Ordered:
co_visa_IDN2- $529.63 $529.63
Educational Institution 1
co_ikad_collect2-
Institution Name co_med_qualitas-co_eval-
UNIVERSITI co_valemgs
MALAYA (UM)
Year of Intake
 Type of Application SKU Price Qty Subtotal
2020
Month of Intake
February
Course Name
MASTER OF
INFORMATION
SCIENCE (LIBRARY
SCIENCE)
Was the last academic
certificate taught and
examined in English?
N/A
Course Duration of Study
(months)
48
Course Level
Master
Applicant Photo (35mm x
45mm)
Sarika Photo BG
White.jpg 217 x 280
px.
Applicant Name as in Passport
MRZ Format
FITRI SARIKA
Applicant Gender
Female
Applicant Place / Country of
Birth
Indonesia
Applicant Date of Birth
(dd/mm/yyyy)
19 Jun 1996
Applicant Nationality
Indonesia
Applicant
Region/State/Province
Riau
Applicant City
Pekanbaru
Passport Country of Origin
Indonesia
Obtain Single Entry Visa from
Indonesia, Pekan Baru
Travel Document Type
INTERNATIONAL
PASSPORT
Travel Document Number
C0848191
 Type of Application SKU Price Qty Subtotal
Travel Document Place /
Country of Issue
Indonesia
Travel Document Issued On
(dd/mm/yyyy)
18 Jul 2018
Travel Document Valid Until
(dd/mm/yyyy)
18 Jul 2023
Extended Student Pass
(Duration of Student Pass
Sought)
2-year
Insurance
HLMT Silver RM20k
12-Month Age 16 to
60
Sticker Pass Fees
EMGS, 2-year Pass
Visa Fees
IDN 2-year
iKad
2-year, self-collect at
EMGS
Medical Screening At
Qualitas Panel Clinics
eVAL
Processing Fee
Delivery Method
Collect at EMGS
Offer Letter
Sarika Fitri_WMB
offer letter.pdf
Passport Data Page
Paspor.pdf
Academic Certificates
Transcript and Cert.pdf
Health Declaration
Declaration Health.pdf