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belize

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I have big confusion, that some people submit landing fee with medical and some people submit after medical why is that? I mean if someone fail in security or medical clearance what they do they refund they money, for my understanding landing fee apply once they 100% sure for visa issuance am I right? please explain me and when really security clearance and verification start.. I read the Qorax thread but still confusing.
 
Those who get rejected will get a refund of landing fee.