"Indonesian Visa Application Form - Consulate General of the Republic of Indonesia" - Dubai, United Arab Emirates

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Download "Indonesian Visa Application Form - Consulate General of the Republic of Indonesia" - Dubai, United Arab Emirates

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CONSULATE GENERAL OF THE REPUBLIC OF INDONESIA
DUBAI - U.A.E
Al Mina Road Street No.2 A Villa No.1 Community 322 Bur Dubai U.A..E
Upload your
Tel.+97143985666 Fax. +97143980804 www.indonesianconsulate.ae
Photos here
E-mail: indocons@emirates.net.ae
I
GENERAL
Length of Stay in Indonesia
Day(s)
Month(s)
Year(s)
Date of Entry
Port of Entry into Indonesia
Transit (go to "A")
Single Visit (go to "B")
Type of Visa
Multiple Visit (go to "B")
Limited Stay (go to "C")
A
For Transit Purpose
Country of Destination
Port of Departure
Flight No / Vessel Name
B
For Visit Purpose
Tourism
Convention
Family Visit
Sports
Type of Visa
Study
Arts
Commercial
Others
Place of Visit
Flight No / Vessel Name
C
For Limited Stay Purpose
Purpose of Limited Stay
Address in Indonesia
City
Province
Phone Number
Cell Ph.
II
PERSONAL DATA
First Name
Middle Name
Last Name
Sex / Marital Status
Male
Female
Married
Unmarried
Place & Date of Birth
Nationality
Address
City / Post Code
Country
Phone /Cell Phone Number
E-mail
CONSULATE GENERAL OF THE REPUBLIC OF INDONESIA
DUBAI - U.A.E
Al Mina Road Street No.2 A Villa No.1 Community 322 Bur Dubai U.A..E
Upload your
Tel.+97143985666 Fax. +97143980804 www.indonesianconsulate.ae
Photos here
E-mail: indocons@emirates.net.ae
I
GENERAL
Length of Stay in Indonesia
Day(s)
Month(s)
Year(s)
Date of Entry
Port of Entry into Indonesia
Transit (go to "A")
Single Visit (go to "B")
Type of Visa
Multiple Visit (go to "B")
Limited Stay (go to "C")
A
For Transit Purpose
Country of Destination
Port of Departure
Flight No / Vessel Name
B
For Visit Purpose
Tourism
Convention
Family Visit
Sports
Type of Visa
Study
Arts
Commercial
Others
Place of Visit
Flight No / Vessel Name
C
For Limited Stay Purpose
Purpose of Limited Stay
Address in Indonesia
City
Province
Phone Number
Cell Ph.
II
PERSONAL DATA
First Name
Middle Name
Last Name
Sex / Marital Status
Male
Female
Married
Unmarried
Place & Date of Birth
Nationality
Address
City / Post Code
Country
Phone /Cell Phone Number
E-mail
Occupation / 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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