KEMENTERIAN HUKUM DAN HAK ASASI MANUSIA

REPUBLIK INDONESIA
KANTOR WILAYAH JAWA TENGAH
KANIM KELAS II NON TPI PEMALANG
JL. PERINTIS KEMERDEKAAN NO. 110

IZIN TINGGAL TERBATAS ELEKTRONIK

ELECTRONIC LIMITED STAY PERMIT

NIORA : IM2TCK32721
Permit Number : 2C11LF0277-T
Stay/Multiple Entries Permit Expiry : 20-09-2020
Stay Permit Index : IB

Full Name : DAIKI OSHITA

Place / Date of Birth : JAPAN / 25-11-1988
Passport Number : TS3969687
Passport Expiry : 23-07-2029
Nationality : JEPANG
Gender : MALE
Address : JLN URIP SUMOHARJO NO.6A RT.2 RW.5, KELURAHAN
SAMBONG, BATANG
Occupation : MECHANICAL ADVISOR
Status : WORK

DISCLAIMER :
1. According to Article 71 Act Number 6 Year 2011 concerning Immigration, every changes of civil status, citizenship,
occupation, Guarantor, or change of address must be reported to Local Immigration Office in an immediate period of
time.
2. This Limited Stay Permit (online) must be attach to the bearer’s Passport at all times
3. For further information please do not hesitate to contact Local Immigration Office or do visit our website
www.imigrasi.go.id.

Pemalang, 20-09-2019
Head of Kanim Kelas II Non Tpi Pemalang Immigration Office.