Air Ticket Request Bw3
Air Ticket Request Bw3
Air Ticket Request Bw3
1. The student is requested to fill in part “A” and “B” and submit the form to the Honorary Counsellor / Contact Person.
2. The Honorary Counsellor / Contact Person is requested to fill in part “C” and send the completed form to the IDB for further actions.
A. STUDENT’S PARTICULARS
6. Faculty:
1. ID No.: _____ /_______ /_____ _________________________________
2. Full Name: 7. University:
___________________________________ _______________________________
3. Date of Birth: 8. Date of Joining of the Programme:
________________________________ __________
4. Nationality: 9. Year/Semester (at present):
__________________________________ ________________
5. Place of Study: 10. Expected Date/Year of Graduation:
_______________________________ _________
B. TICKET REQUESTED
The requested ticket is for Academic Year: _______ Please indicate any ticket received last
time: Yes/No: ____
1. For ONE-WAY ticket Destination: From _______________________ to
_______________________
Reasons:
joining the programme.
completion of studies (please attach written evidence from the University)
failure in studies/dismissal by the University
2. For ROUND TRIP/RETURN ticket in the middle of period of studies, ONCE during
duration of study, pass end-of-the-year examination and promoted to next level.
Destination: From ______________________ to
_________________________
Date of departure (to the student’s country):
__________________________
Date of return (to Indonesia): _____________________________
Reasons:
vacation
practical training
other (please specify)
__________________________________________________________________
I hereby declare that the above-mentioned information is correct.