Consulate General of The Republic of Indonesia Davao City: Attention
Consulate General of The Republic of Indonesia Davao City: Attention
DAVAO CITY
Ecoland Subd. Melati St. Phase IV Davao City
Tel. (082) 299-2930 to 34 Fax. (082) 2973462
..
(DD-MM-YYY)
Photo
Of
Applicant
(Size: 1 x 1 )
GENERAL
Length of Stay in Indonesia
Type of Visa
Day(s)
Month(s)
Transit
Year(s)
Single Visit
Multiple Visits
Limited Stay
Port of Departure
Flight/Vessel Name
Country of Destination
Place of Visit
Flight/Vessel Name
Tourism
Convention
Study
Arts
Family Visit
Commercial
Sports
Others:
Address in Indonesia
City
Province
Phone Number
Work
Joint Family
Social
(DD-MM-YYYY)
Others:
II.
III.
PERSONAL DATA
First name
Middle Name
Family / Surname
Sex
Male`
Female
Marital Status
Married
Single
Place of Birth
Date of Birth
Nationality
Address
City
Province /State
Phone Number
Occupation/ Position
Name of Company
Address
City
Province/State
Phone Number
(DD-MM-YYYY)
Professional
Student
Government
Housewife
Sales
Others: _________
PASSPORT INFORMATION
Passport/ Travel Document Number :
Place of Issue
Date of Issue
Date of Expire
Type of Passport
Personal
Family
Name:
IV.
SPONSORSHIP IN INDONESIA
Type of Sponsor
:
Individual
Institution
Company
Name of Company
V.
Government
International
NGO
Others: ___________
Address
City
Provincial/State
Phone Number
MISCELLANEOUS
Have you ever been to Indonesia before?
:
No
Are you in possession of any other countries travel document? :
No
Do you have previous visa to enter Indonesia?
:
No
Have your visa application been denied before?
:
No
Have you ever been forced to leave Indonesia?
:
No
Have you ever been committed a crime or any offense?
:
No
Return/ Throught ticket/ Airline Company
Place of Issue
:
Date of Issue
Date of Expire
:
Yes
Yes
Yes
Yes
Yes
Yes
:
:
(DD-MM-YYYY)
(DD-MM-YYYY)
I hereby declare that the statements given below are true and I understand that even if
granted a visa, admission at the airport remains the discretion of the immigration
authorities in Indonesia.
Applicants signature
Manila,
(DD-MM-YYYY)
(Date of Application)
To be complete in duplicate with two photographs
attached.
Passport must be valid at least six months (for
transit/visitors visa) or 18 months (for
multiple/limited stay visa)