Embassy of the Republic of Indonesia

Islamabad - Pakistan

Phone

: +92(51) 2832017-20

Fax

: +92(51) 2832013

Website : http://www.kbri-islamabad.go.id

Application No.: 28910/12/2016

VISA APPLICATION FORM

Address : Diplomatic Enclave I Street 5
Ramna G-5/4,Islamabad-Pakistan
Email : indonesianembassyisb@gmail.com

Date: 10-12-2016

I. GENERAL
Duration of Stay in Indonesia

:

Type of Visa

:

30

Day(s)
Transit

X Single Visit

Multiple Visit

For Transit Visa
Country of Destination

:
:

Place of Departure

:

Flight/Vessel Name

:

For Visit Visa
Purpose of Visit

:
:

X Tourism
Study

Limited Stay

Convention

Family Visit

Sports

Arts

Commercial

Others

Flight/Vessel Name

:

MILANDO AIRWAYS (OD) 318

Date & Port of Entry

:

26-12-2016 JAKARTA

Place to Visit

:

JAKARTA PUSAT

For Limited Stay Visa
Purpose of Limited Stay

:
:

Address in Indonesia

:

City

:

Province

:

Phone Number

:

Port of Entry into Indonesia

:

Date of Entry

:

Work

Joint Family

Social

Others

II. PERSONAL DATA
First Name

:

Middle Name

:

SHAHNAWAZ

Family/Surname

:

ASIM

Sex

:

X Male

Female

Marital Status

:

X Married

Single

Place of Birth

:

MANSEHRA KPK PAKISTAN

Date of Birth

:

07-05-1956

Nationality

:

PAKISTAN

Home Address in Pakistan

:

ADVOCATE SHAHNAWAZ ASIM
(SUPREME COURT) COURT ROAD
MANSEHRA KPK 21300

City

:

MANSEHRA

Province/State

:

KPK 21300

Phone Number

:

929-973-01297, , 033-359-57648

Email

:

Shahnawaz.asim@yahoo.com

Occupation/Position

:

X Professional

Name of Company/Institution

:

SHAHNAWAZ LAW CHAMBER

Type of Business

:

Company Address

:

PINE SHED OFFICE NO:34
SHAHNAWAZ ASIM

Phone Number / Email

:

033-359-57648

Government

Sales

Student

Housewife

Other

.III......... Applicant Signature: SHAHNAWAZ ASIM .... being engaged in any occupation or institution paid or paid. MISCELLANEOUS Have you ever been to Indonesia before? : Yes X No Are you in possesion of any other countries travel documents? : X Yes No Do you have previous visa to enter Indonesia? : Yes X No Has your visa application been denied before? : Yes X No Have you ever been forced to leave Indonesia? : Yes X No Have you ever been committed a crime or any offence? : Yes X No Type of Ticket (Return/Through) : RETURN Ticket/Airline Company : MILANDO AIRWAYS (OD) 318 Place of Issue : ISLAMABAD PAKISTAN Date of Issue : 28-11-2016 Date of Expiry : 07-01-2017 I hereby declare that the statements given by me are true and correct and I realize that even though I possess a valid visa to Indonesia..... SPONSOR IN INDONESIA Type of Sponsor : Individual Government International Institution Company NGO Others Name of Person/Institution : NGO Address : YUDIT YUHANA.. 3.. If I fail to comply with the above mentioned requirements..... During my visit to Indonesia I will refrain from: a../. 2. PASSPORT INFORMATION Passport/Travel Document Number : CL1851652 Place of Issue : ABBOTTABAD Date of Issue : 19-11-2015 Date of Expiry : 18-11-2020 Type of Passport : I ORDINARY Please mention if your husband/wife/children are accompanying you and have been entered in your travel document No. IV. * To be completed in duplicate with two photographs attached * Passport must be valid for at least 18 months 28910/12/2016 ....... b../20.RT006 RW 02 JAKARTA City : JAKARTA PUSAT Province/State : DAERAH KHUSUS IBUKOTA Contact Person : YUDAT YUHANA Phone Number : 628-128-0009073 V. Over staying........ Relative(s) Sex Place of Birth Date of Birth Name 1. I am liable to prosecution and expulsion. permission for entry remains at the discretion of the Immigration authorities in Indonesia....... I am also aware that: 1. 2..... JALAN PUSANGAN LAMA 3..

.... : CL1851652 Application for : Single Entry Visa Application No.Islamabad-Pakistan Phone: +92519246571..... Facs:+92512832013 E-mail: indonesianembassyisb@gmail...000 for business and US$ 2..........30 pm to 4......Collecting time : 02.... * For checking your visa application status...... please visit : http://evisa.... Tanggal Embassy of the Republic of Indonesia Islamabad . please tick (V) in the list below to ensure the requirements are complete. Request letter from company.... Original national passport with validity not less than 18 months from the date of travel & previous passport must be attached....... Limited Stay & Social Visa Applicant are asked to submit the document in 2 (two) duly set. detail with the purpose of visit to Indonesia.....30 am to 11.Wednesday Thursday ...... Incomplete application shall not be entertained).30 pm Monday .id/login ** Submission time : 09...000 for other purposes.... institution/department of the applicant...Applicant No.. Authorization letter with NIC copy of the authorized person or agent (if visa will be collected by other)./... individual. Copy of business registration certificate & recommendation letter from the Chamber of Commerce or business Association (for business visa only).. Note: # The Embassy of the Republic of Indonesia reserves the right to request additional documents if needed..go./20. Copy of valid/latest national identity card (NIC)..Pakistan Paraf Petugas Diplomatic Enclave I Street 5 Ramna G-5/4.. Invitation letter from Indonesian sponsor (business partner... # The Multiple..... Consular Section . along with the copy of previous Indonesia visa (if any).. Copy of hotel reservation (issued by the concerned hotel)..30 am ..com ACKNOWLEDGE RECEIPT Received from : SHAHNAWAZ ASIM A Passport No... institution/department) mentioning the purpose of visit clearly . Copy of return/onward ticket (attested by the airline/ticketing agent)...... Bank statements for the last 6 months with the minimum balance equal to US$ 10...Friday . : 28910/12/2016 Date of Submission : / /20 Date of Delivery : / /20 Fee should be paid : Islamabad....kbri-islamabad. Two visa application forms must be signed and filled completely along with two latest color photographs.. Copy of page 1-3 national passport. : 28910/12/2016 Check List: (Before submitting application.