STATEMENT LETTER

I, the undersigned:

Name :
Student Number :
Faculty / Department :
Place, Date of Birth :
Address :

hereby declare that:

1. I am willing to take the class/classes held by UPT Bahasa seriously;

2. I will not neglect the obligation to attend the class/classes unless it is indeed experiencing
unbearable pain, in this case, I will contact the Person in Charge for the Course to inform
my situation;
3. I will fulfill at least 50 % of attendance;
4. I am willing to be excluded from the participation of this class/these classes if violating
the statement;
5. If I however violate the term stated, I will be banned from every event held by UPT
Bahasa Universitas Siliwangi (e.g.: TELP Test, English Courses, etc).

Thus, this statement is made truthfully and to be used accordingly.

Tasikmalaya, January 2023

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