VISA APPLICATION FORM

EMBASSY OF THE REPUBLIC OF INDONESIA

ISLAMABAD-PAKISTAN

Phone:92(51) 2832017-20

Fax:92(51) 2832017-20

Web:https://kemiu.go.id/islamabad

Email:info@indonesian-embassy.pk

Address:Diplomatic Enclave I, Street 5
G-5, Islamabad

Date

:

-

-

Application Number

:

Authorization Number

:

1. GENERAL

Length of Stay in Indonesia

:

(Days)

(Months)

Type of Visa

:

Diplomatic

Service/Official

Visit

Category of Visit

:

Single

Multiple

Limited Stay

Purpose of Visit

:

Posting

Working

Business

Family

Tourist

Social

Point of Departure

:

Port of Entry in Indonesia

:

Flight/Carrier Name and Number

:

Date of Entry

:

-

-

(DD-MM-YYYY)

Date of Departure

:

-

-

(DD-MM-YYYY)

Destination Address in Indonesia

:

City

:

Province

:

Phone/Mobile Number

:

-

-

Previous Country Visited

:

II. PERSONAL DATA

First Name

:

Middle Name

:

Family/Surename

:

Sex

:

Male

Female

Marital Status

:

Married

Single

Place of Birth

:

Date of Birth

:

-

-

(DD-MM-YYYY)

Nationality

Address

:

City

:

Province

:

State/Country

:

Mobile Number

:

-

-

Father's name

:

Occupation

:

Mother's name

:

Occupation

:

Occupation

:

Current Position/Designation

:

Name of Institution/Company

:

Address

:

City

:

Province

:

State/Country

:

Phone Number

:

-

-

III. Passport Information

Type of Visa

:

Diplomatic

Service

UNLP

Ordinary

Passport Number

:

Place of Issue

:

Date of Issue

:

-

-

(DD-MM-YYYY)

Date of Expiry

:

-

-

(DD-MM-YYYY)

IV. Sponsorship Information

Sponsorship in Indonesia

:

Individual

Government

Company

Other

:

Institutions

International Organization

NGO

Name of Individual

:

Current Position

:

Name of Institution/Company/Hotel/International Organization/NGO

:

Address

:

City

:

Country

:

Mobile/Phone Number

:

-

-

V. MISCELLANEOUS

Have you ever been to Indonesia before ?

:

yes

No

If "Yes" date of visit

:

-

-

(DD-MM-YYYY)

Purpose of Visit

:

Are you in possesion of any countries 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 been forced to leave Indonesia?

:

yes

No

Have you ever been committed a crime or any Offence?

:

yes

No

Do you have health problem condition ?

:

yes

No

If "Yes" give detail

:

Do you have fully vaccinated Covid-19/Booster?

:

yes

No

Have you been previously posted abroad?

:

yes

No

If "Yes" give detail 2 previous posting

:

1

2

Return ticket of the Airline Company

:

place of Issue

:

Date of Issue

:

-

-

(DD-MM-YYYY)

Date of Expiry

:

-

-

(DD-MM-YYYY)

I, hereby declare that the statements given above are true and I understand that even if granted a visa,
prerequites checked administration at the airport remains the discreation of the Immigration authorities in Indonesia

Applicant`s signature and name

-

-

(DD-MM-YYYY)

"Passport must be valid not least than 6 (six) months before departure"