STATEMENT LETTER

I, the undersigned, do hereby confirm the information below:

Name : ………………………………………………………...……,
Citizenship : ………………………………………………………...……,
Passport Number : ………………………………………………………...……,

and state that I have understood and agreed with the regulations of the BIPA LBI
FIB UI Program on resignation.

If I resign from the BIPA LBI FIB UI Program:

1) The registration fee will not be returned.
2) The telex fee that has been processed will not be returned.
3) The tuition fee will be cut by 5% for the administration costs of the BIPA
program when I resign at least one week before the classes start. (*)
4) The tuition fee will be cut by 40% for the administration costs of the BIPA
program when I resign after the studying period has begun for at least one
week, but I have not joined the classes. (*)
5) The tuition fee will not be returned when I have already attended classes
or the studying period has lasted for more than one week.

In witness whereof, this letter is signed by me.

Date ………………………….

Participant ………………………….

Note:
* Excluding the return transfer fee