PERSONAL STATEMENT

Complete name : Hesham Wahib Mohammed Ali Esmail

Sex : □ Male □ Female
Place, date of birth : Yemen – Aldhalea / 2003-02-03
Nationality : Yemeni
Passport number : 09616604
Marital status : □ Married □ Unmarried
Address in home country
Street name, : Alkhussaf street
street number, 12
house number 14

Village/district : Aden / Alkhussaf street

City : Aden
Province/state : Aden
Zip/postal code : 00000
Major/Department : Medicine
Period of Study : From 2023………. to …2028…………
Phone/WhatsApp :
(with country code)

I certify that during my study in Universitas Sebelas Maret Surakarta, I will obey the
university regulations as follows:
1. I will attend lectures in an orderly manner and will not engage in any activities which
have no relevance to my education/program.
2. I will register myself to the academic system every semester depending on my study
permit.
3. I will not get involved in any political organization or movement.
4. I will not work during my study in UNS.
5. I will obey Indonesian law and other relevant regulations.
These statements are made truthfully. If any of them is proven untrue, or I deny the statements
in the future, I will be responsible to take any sanction that may be put on me.

…., …2022/09/2……… *place, date of letter

*sign here

(…Hesham Wahib Mohammed Ali ….)*name