Visa Application Form - Embassy Of The Republic Of Indonesia Page 2
ADVERTISEMENT
1
2III. PASSPORT INFORMATION
III. PASSPORT INFORMATION
Passport/Travel Document Number
:
Place of Issue
:
Date of Issue
:
(DD-MM-YYYY)
Date of Expiry/Valid Until
:
(DD-MM-YYYY)
Type of Passport*
:
Personal
Family
Please complete this section if your children included on your passport/travel document are travelling with you :
No
Relatives
Sex
Date of birh (DD-MM-YY)
Name
2. Wife
3. Child
Please use this code:
Relation(s)
:
1. Husband
2. Wife
3. Child
Sex
:
F : Female
M: Male
IV. SPONSORSHIP IN INDONESIA
IV. SPONSOR IN INDONESIA (IF ANY)
Type of sponsor
:
Individual
Government
International Institution
Company
NGO
Others
Name of Person/Institution
:
Address
:
City
:
Province/State
:
Province/State
:
Phone Number
:
V. OTHER INFORMATION
V. MISCELLANEOUS
Have you ever been to Indonesia before ?
Yes
No
Are you in possesion of any others countries's travel documents?
Yes
No
Do you have previous visa to enter Indonesia?
Yes
No
Have your visa application been denied before?
Yes
No
Have you ever been forced to leave Indonesia?
Yes
No
Have you ever been committed a crime or any offence?
Yes
No
Airline Company
:
Place of Issue of airticket
:
Date of Issue of airticket
:
(DD-MM-YYYY)
Date of Expiry of air ticket
:
(DD-MM-YYYY)
I hereby declare that the statements given above are true and I understand that even if granted a visa,
the admission at the airport remains the discretion of the immigration authorities in Indonesia
Applicant's Signature
Prague,
(DD-MM-YYYY) Date
Important Note :
*To be completed with one original photograph attached (passport size)
*Applicant's original signature is required
*Passport must be valid for at least six month on arrival in Indonesia
ADVERTISEMENT
0 votes
Related Articles
Related forms
Related Categories
Parent category: Business