Emergency Self-Quarantine Application

1
Emergency Self-Quarantine.

Please prepare ARC or passport.
(This will goes to gverment system only)

It will take about 1 mins.

Thanks in advance:)
2
Name* This field is required.
Based on your passport
3
University
Please write down your university's name in Korea
4
Emergency Contact* This field is required.
Kakaotalk ID
Instagram ID
Korean Phone Number
5
ID or Phone Number* This field is required.
Please write down ID or number we can contact with you
6
Please upload your RC(외국인등록증) or passport picture.* This field is required.
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
7
Email* This field is required.
example@example.com
Email Verified
The verification code has been sent to some@email.com
Please check your mailbox and paste the code below to complete verification
••••
Didn't receive verification code? or
Receiving the email may take a few minutes, thank you for your patience!
8
Check the information about the payment!

Price: 650,000KRW for 5 nights
Transportation to the quarantine place: 100,000KRW
Meal plan: 250,000KRW (optional)

Bank Account Info.:
1. Bank Name : KEB HANA BANK
2. Bank Address : 35, EULJI-RO, JUNG-GU, SEOUL, SOUTH KOREA, 04523
3. Bank Swift Code : KOEXKRSE
4. Recipient's Hana Bank Account Number (KRW ACCOUNT) : 201-910028-74704
5. Recipient's Name in English : HIREDIVERSITY
6. Recipient's Email : official@aird.kr
7. Recipient's Address: #B1-136, 363 SAMILDAERO, JUNG-GU, SEOUL, SOUTH KOREA, 04541
8. TAX ID : 774-81-01735
9. Phone No.: +821044368026

You have to attach screenshots about your payment on next page,
Please finish the payment before move to next :)
9
Upload the proof of payment completionMake sure that the image should include the exact name of your account's owner
Drag and drop files here
Select files to upload
Max. file size: 10.6MB
Cancelof
10

Name {ltstronggtnameltstronggt}

Email {ltstronggtemailltstronggt}

University {univ}

Emergency Contact {ltstronggtemergencyContactltstronggt}

ID or Phone Number {ID_NO}
Should be Empty:

Name	{ltstronggtnameltstronggt}
Email	{ltstronggtemailltstronggt}
University	{univ}
Emergency Contact	{ltstronggtemergencyContactltstronggt}
ID or Phone Number	{ID_NO}