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Deluxe corporation
03/24/2014

Department of Homeland Security – Form I-901 Application – Confirmation

Student and Exchange Visitor Program: SEVIS I-901 Payment Confirmation
OMB 1653-0034 (Expires 1/31/2015)
Please print the Payment Confirmation for your records. Reference the confirmation number BBB1416597630 on all inquiries related to your I-901 status. You may be required to produce your payment confirmation for your visa issuance, admission to any United States port of entry, for any change of non-immigrant status, or other United States immigration benefits.
When you go to the Consulate for your visa, you should bring your payment confirmation to prove you have paid the SEVIS fee. If you paid by credit card, this transaction will appear on your credit card bill as “US STUDENT & EV I901 FEE 800-375-5283 VT”
Department of Homeland Security
U.S. Immigration and Customs Enforcement

Notice of Action
UNITED STATES OF AMERICA

CONFIRMATION NUMBER:
BBB1416597630

CASE TYPE:
I-901 Fee Remittance Form for F-1, F-3, M-1, M-3 and J-1 NonImmigrants.

PAYMENT DATE:
Mar 14, 2014

APPLICANT:
CHOKCHAI CHOMCHUENTANACHOK

NAME AND ADDRESS:
CHOKCHAI CHOMCHUENTANACHOK
242 CURT SMITH ROAD
SOUTHBURY
CT
USA
06488

NOTICE TYPE:
Receipt Notice

CHOKCHAI CHOMCHUENTANACHOK
Your Form I-901 Application and Fee have been received. Please notify us immediately if any of the above information is incorrect.
This fee payment is valid only for your particular course of study or program. If you fall out of status, apply for a new F-1, F-3, M-1, M3 or J-1 Non-immigrant visa, or if you want to change your Non-immigrant category to an F-1, F-3, M-1, M-3 or J-1, you may be required to pay another fee.
APPLICANT STATUS: J-1
DATE OF BIRTH: Jun 23, 1991
PROGRAM NUMBER: P305708
EXCHANGE VISITOR CATEGORY: SUMMER WORK/TRAVEL
AMOUNT RECEIVED: $35.00
SEVIS IDENTIFICATION NUMBER: N0011118101
THIS ELECTRONIC RECEIPT SHALL BE USED AS EVIDENCE OF PAYMENT
I-901 Student/Exchange

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