PARENTS STATEMENT LETTER OF FULL SCHOLARSHIP

AWARDEE

I, the undersigned,

Name : .............................................................................................
Nationality : .............................................................................................
Address : .............................................................................................
Mobile Phone Number : .............................................................................................
Home Address : .............................................................................................
Email Address : .............................................................................................

As the parent of student candidate of Politeknik Negeri Malang below:

Name : .............................................................................................
Place/Date of Birth : .............................................................................................
Passport number : .............................................................................................
Expiration
Date: .........................................................................
Department/Study Program : .............................................................................................
Nationality : .............................................................................................
Mobile Phone Number : .............................................................................................
Home Address : .............................................................................................
Email Address : .............................................................................................
Residence Address in Indonesia (after arrival)

Hereby declare that, during the study of my son/daughter in Indonesia, I will cover the
administrative fees (visa), insurance, flight tickets, medical requirements (excluded from the
insurance), books and other study requirements with our own finance. The tuition and
living allowance are supported by Politeknik Negeri Malang for eight (8) semesters (starts
from September 2019). He/she is not a scholarship holder from any scholarship providers.

This letter is made without any constraint.

Sincerely yours, (DD-MMM-YYYY)

Signature

( Fullname )
 PARENTS STATEMENT LETTER OF PARTIALLY FUNDED
SCHOLARSHIP

I, the undersigned,

Name : .............................................................................................
Nationality : .............................................................................................
Address : .............................................................................................
Mobile Phone Number : .............................................................................................
Home Address : .............................................................................................
Email Address : .............................................................................................

As the parent of student candidate of Politeknik Negeri Malang below:

Name : .............................................................................................
Place/Date of Birth : .............................................................................................
Passport number : .............................................................................................
Expiration
Date: .........................................................................
Department/Study Program : .............................................................................................
Nationality : .............................................................................................
Mobile Phone Number : .............................................................................................
Home Address : .............................................................................................
Email Address : .............................................................................................
Residence Address in Indonesia (after arrival)

Hereby declare that, during the study of my son/daughter in Indonesia, I will cover
living costs, administrative fees (visa), insurance, flight tickets, medical requirements
(excluded from the insurance), books and other study requirements with our own finance.
The tuition is supported by Politeknik Negeri Malang for eight (8) semesters. He/she is not a
scholarship holder from any scholarship providers.

This letter is made without any constraint.

Sincerely yours, (DD-MMM-YYYY)

Signature

( Fullname )
 STATEMENT LETTER OF
PRIVATE STUDENTS (NON-SCHOLARSHIP)

I, the undersigned,

Name : .......................................................................................................

Nationality : .......................................................................................................
Address : ...................................................................................................
....
Mobile Phone Number
: .......................................................................................................
Home Address
: .......................................................................................................
Email Address : .......................................................................................................

As the parent of student candidate of Politeknik Negeri Malang below:

Name : .......................................................................................................
Place/Date of Birth : .......................................................................................................
Passport number : .......................................................................................................
Expiration
Date : .......................................................................................................
Department/Study Program : .................................................................................................
Nationality : .......................................................................................................
Mobile Phone Number
: .......................................................................................................
Home Address
: .......................................................................................................
Email Address : .......................................................................................................
Residence Address in Indonesia (after arrival): ......................................................................

Hereby declare that, during the study of my son/daughter in Indonesia, I will cover
tuition, living allowance, administrative fees (visa), insurance, flight tickets, medical
requirements (excluded from the insurance), books and other study requirements with our
own finance. He/she is not a scholarship holder from any scholarship providers.

This letter is made without any constraint.

Sincerely yours, (DD-MMM-YYYY)

Signature

( Fullname )