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Consulate General of The Republic of Indonesia Davao City: Attention

This document contains a visa application form for individuals applying for a visa to enter Indonesia. The form requests information about the applicant's personal details, passport information, purpose and duration of the visit to Indonesia, any sponsors or previous visits, and a declaration by the applicant certifying that the information provided is accurate. It instructs applicants to fill out the form in capital letters and notes requirements such as submitting two photos and ensuring the passport is valid for the duration of the intended stay.

Uploaded by

Del Ricafort
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
78 views

Consulate General of The Republic of Indonesia Davao City: Attention

This document contains a visa application form for individuals applying for a visa to enter Indonesia. The form requests information about the applicant's personal details, passport information, purpose and duration of the visit to Indonesia, any sponsors or previous visits, and a declaration by the applicant certifying that the information provided is accurate. It instructs applicants to fill out the form in capital letters and notes requirements such as submitting two photos and ensuring the passport is valid for the duration of the intended stay.

Uploaded by

Del Ricafort
Copyright
© © All Rights Reserved
Available Formats
Download as DOCX, PDF, TXT or read online on Scribd
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CONSULATE GENERAL OF THE REPUBLIC OF INDONESIA

DAVAO CITY
Ecoland Subd. Melati St. Phase IV Davao City
Tel. (082) 299-2930 to 34 Fax. (082) 2973462
..

VISA APPLICATION FORM


-------------------------------------------------------------------------------------------------------------------------------------------------------------------ATTENTION: Fill out all headings using CAPITAL LETTERS. Your application shall not be processed in case of error or omission. No.
Date
I.

(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

A. For Transit Purpose


Country of Destination

Port of Departure

Flight/Vessel Name

B. For Visit Purpose


Purpose of Visit

Country of Destination

Place of Visit

Flight/Vessel Name

Tourism

Convention

Study

Arts

Family Visit
Commercial

Sports
Others:

C. For Limited Stay Purpose


Purpose of Limited Stay

Address in Indonesia

City

Province

Phone Number

Work

Joint Family

Social

Port of entry into Indonesia :


Date of Entry

(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

Fill, If Type Passport Family:


No.
Relative(s):
Sex:
v

Date of Birth (DD-MM-YYYY):


-

(Relative(s): 1 = Husband, 2= Wife, 3= Child)

(DD- MM- YYYY)


(DD- MM- YYYY)

Family
Name:


IV.

(Sex: F=Female, M=Male)

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)

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