Indonesia Visa Application Form Page 2
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Complete Indonesia Visa Application Form with your personal data - all interactive fields are highlighted in places where you should type, access drop-down lists or select multiple-choice options.
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1
2Occupation / Position
Professional
Government
Sales
Student
Housewife
Others
Name of Company
Address
City
Country
Phone Number
Cell Ph.
III
PASSPORT INFORMATION
Passport/Travel Document No
Place of Issue (city)
Date of Issue
Expiry
Type of Passport
Ordinary
Diplomatic
Service
IV
SPONSORSHIP IN INDONESIA
Type of Sponsor
Individual
Government
Reg/Intl. Organization
Company
NGO
Others
Name of Company
Address
City
Province
Phone / Cell Phone Number
E-mail
V
MISCELLANEOUS
Have you ever been to Indonesia before ?
Yes
No
Do you have a previous visa to enter Indonesia ?
Yes
No
Has your Visa application been rejected before ?
Yes
No
Have you ever been forced to leave Indonesia before ?
Yes
No
Have you ever been convicted of a crime or an offence ?
Yes
No
Flight Name & No.
I hereby declare that the statements given above are true and I understand that if granted a visa,
admission at the airport remains at the discretion of the Immigration authorities in Indonesia
Date Today
Signature
*
To be completed with 2 (two) photograph attached.
* Passport must be valid at least 6 (six) months
FOR OFFICIAL USE ONLY
Telah diberikan Visa atas kuasa sendiri :
Macam Visa
: ......................................................................................
Nomor Visa
: ......................................................................................
Lama diijinkan tinggal : ......................................................................................
Dubai, ......................................................................
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Parent category: Business