INSTITUT TEKNOLOGI BANDUNG

SCHOOL OF BUSINESS AND MANAGEMENT 

Jalan Ganesha 10, School of Business Management Building, Bandung 40132 
Tel: +6222 2531923 Fax: +6222 2504249 www.sbm.itb.ac.id 

OUTGOING STUDENTS

STATEMENT OF FINANCIAL SUPPORT

DOUBLE DEGREE/ EXCHANGE PROGRAM

I, the undersigned below:

Name : Ahmad Gunawan

Occupation: State-owned enterprise employee
Address: Bukit Golf Cibubur, Riverside Residence I Blok A5/5
Bojong Nangka, Gunung Putri, Kab. Bogor, Jawa Barat
Phone Number 0818476223

will be providing the student below with full financial support during his/her (Double Degree/
Exchange program) abroad.

Name: Rizky Multazam Ahmad

Student ID Number: 19019312

Relationship (Circle): Child / Sibling / Relative / Other (Mention: ___________)

I have adequate funds to support his/her participation in the (Double Degree/ Exchange Program).

I fully understand that before she/he starts the semester abroad, I will ensure that the tuition starting
from Semester 1 through Semester 7 have been paid to SBM ITB.

Bandung, …………………………………20..

[Materai 6000]
[signature]

[Name]