Info lengkap silahkan baca hal. 3.

(Tolong dibaca ya, jangan malas )

Please refer to page 3 for more information. (Please read )

Nama sesuai ARC

1

()

No. ARC
A C 1
2
Tgl
lahir
(Taiwan
year)
Pas foto 2 inch. tempel sini

0 7 7

0 2

2 9

200 ( 1 )
()

()

Ponsel a.k.a hape

02-2730-11180988123456

1 0 6

43

Jangan
ttd di
sini!

:1.
200

2.

3.

4.

()
()

()

200

102.06

Copy ARC depan (tempel di sini)

Copy ARC belakang (tempel di sini)

14
8

0800-030-598

02-21912006
10041 15 1 5
10099 30 200
03-4339111
32005 3 525
04-22583988
40709 66
06-2245678
70006 96
07-3233123
80706 157
03-8332111
97049 36

How to fill your application form : (Check the yellow highlighted boxes with blue number on the form)

#1 to #6 fields are on page 1.

#7 to #8 fields are on page 2.
1. Applicants name : Fill it as shown on your ARC card, if it is Chinese, filled in Chinese and if it is
alphabet then filled in alphabet.
2. Applicants ARC number.
3. Applicants birthday : Tick this ( : Taiwan year) characters. To convert into Taiwan year, substract
your birth year with 1911, e.g. 1988-1911 077; 1991-1911 080.
The format is : YYY MM DD, for example the birth date is 29th February 1988.

V
4. Applicants photo, 2 inch size (this size is similar to the one you submit for ARC application). Black &
White or Color does not matter. Please kindly paste it on the form before submission.
5. Applicants cellphone : Fill the field right to these characters.
6. Applicants signature : Do not forget to sign in the box below #6 (highlighted in yellow rectangle).
7. Applicants ARC copy front side. (on 2nd page) Please kindly paste it on the form before submission.
8. Applicants ARC copy back side. (on 2nd page) Please kindly paste it on the form before submission.

(An)Other required document(s) :

1 more ARC copy (front side and back side) on one page A4 paper, DO NOT FORGET TO WRITE YOUR
STUDENT NUMBER, CELLPHONE NUMBER, AND EMAIL ON THIS COPY.