Application Form

Medical Elective Study in Bali

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Personal Information

Full Name:

Date of Birth:

Nationality:

Gender:

Male
Female
Other

Passport Number:

Email Address:

WhatsApp Number:

Emergency Contact: (Name)

Emergency Contact: (Status)

Emergency Contact: (WhatsApp Number)

Academic & Medical Background

Current University / Institution:

Field of Study:

Medicine
Nursing
Dentistry
Other

Year of Study:

Previous Clinical Experience:

Elective Preferences

Preferred Start Date:

Learning Goals:

Describe what you aim to achieve during the elective

Accommodation & Services

Accommodation Preference:

Shared Room
Private Room
Arrange Myself

Health & Safety

Do you have any medical conditions or allergies?

COVID-19 Vaccination Status

Vaccinated
Not Vaccinated

Health Insurance:

Upload proof if available. (Max file's size 2MB) .jpg, .pdf

Supporting Documents (File Uploads)

Curriculum Vitae (CV)

(Max file's size 2MB) .jpg, .pdf

Motivation Letter

(Max file's size 2MB) .jpg, .pdf

Passport Scan (valid for at least 6 months)

(Max file's size 2MB) .jpg, .pdf

Student ID or University Enrollment Letter

(Max file's size 2MB) .jpg, .pdf

Consent & Declaration

Confirm

I confirm that the information provided is true and accurate.

Consent

I consent to the processing of my data for the purpose of this application.

Terms & Conditions

I have read, understood and agree to the Terms & Conditions *

Terms & Conditions:
1. Introduction
Welcome to NAE Bali. By accessing or using www.naebali.com (“the Site”), you agree to be bound by these Terms & Conditions. If you do not accept them, please do not use the Site or services.

2. Services Overview
NAE Bali provides educational programs, travel packages, cultural experiences, and related services in Bali and Indonesia. Descriptions, prices, availability, and terms are subject to change.

3. Booking & Payment
All bookings must include accurate personal information. Deposit or full payment may be required to secure bookings. NAE Bali accepts payment exclusively via bank transfer. Services are not confirmed until payment is received. Unless otherwise stated, prices are in IDR.

4. Cancellations & Refunds
Cancellation by you may incur fees depending on timing. Refunds (if any) are processed per policy. NAE Bali reserves the right to cancel or reschedule services due to weather, regulatory changes, or other force majeure, with full refund or alternate arrangements offered.

5. Travel Documentation & Eligibility
It is your responsibility to secure valid passport, visa, insurance, and health documents required for travel and program participation.

6. Code of Conduct & Liability
Participants must comply with local laws, safety instructions, and respect cultural norms. NAE Bali is not liable for personal injury, illness, or property loss, except where resulting from gross negligence. Travel insurance is highly recommended.

7. Intellectual Property
All content on the Site—text, images, branding—is owned by NAE Bali or licensed. You may not copy, reproduce, or distribute it without prior written permission.

8. Limitation of Liability
NAE Bali’s maximum liability is limited to the total amount you paid. Under no circumstances is NAE Bali liable for indirect, incidental, or consequential damages.

9. Amendments
NAE Bali may update these Terms at its discretion. Continued use after amendments implies acceptance. The “Effective Date” will be noted on the website.

10. Governing Law & Dispute Resolution
These Terms are governed by Indonesian law. Any disputes will be resolved in the courts of Bali.

11. Contact Information
For questions or concerns:
NAE Bali (Nusa Akshaya Enterpro)
Email: ask@naebali.com
Address: Bali, Indonesia

I have read, understood and agree to the Privacy Policy *

Privacy Policy
1. Introduction
NAE Bali collects and processes personal information to deliver educational, travel, and cultural services. We are committed to protecting your privacy under Indonesian law and international best practice.

2. Information We Collect
Personal Details: name, address, date of birth, nationality, passport and visa details, emergency contacts
Travel Info: program of interest, booking dates, payment information
Communications: email, phone, messaging history with NAE Bali
Website Usage: cookies, IP address, device/browser type, site analytics

3. How We Use Your Data
Data is used for booking confirmation, travel logistics, payments, customer support, legal compliance, security, and occasional feedback or marketing messages (with your consent).

4. Data Sharing
We may share your information with partners (e.g. hotels, transport companies, dive operators, cultural sites) solely for service delivery. We never sell personal data. We may disclose data if required by law or to protect rights, property or safety.

5. Cookies & Tracking
The Site uses cookies and similar technologies for analytics, functionality, and improving user experience. You can disable non-essential cookies via your browser but this may limit functionality.

6. Data Security & Retention
We implement industry-standard safeguards to protect your data. We retain personal information only as long as necessary to fulfill services or legal requirements (typically up to 5 years after last contact).

7. Your Rights
You have the right to access, correct, or request deletion of your personal data. To exercise these, or to withdraw consent for marketing, contact us at our official email.

8. Minors
Our services are meant for individuals aged 18+. If you are under 18, participation must be supervised through responsible adult enrolment.

9. Changes to Policy
We may update this Privacy Policy. Updates will be posted at www.naebali.com/privacy with the “Effective Date” clearly stated.

10. Contact Info
If you have any questions or requests regarding how we handle your data, reach out to: ask@naebali.com .