DI PRINT DI ATAS KOP SURAT PERUSAHAAN/TOKO

Balikpapan, tanggal
To :
Embassy of Japan
Visa Section
Surabaya

Dear Sir/Madam,
I the undersigned,
Name : (nama karyawan kantor yang tidak berangkat)
Position : (posisi di perusahaan)

Herewith certify that :

Name :
No Passport :
Position :

Name :
No Passport :
Position :

He/She/They will be traveling to Japan from ... until ... for holiday. All the expenses cost including return air ticket,
accommodation etc will be born by herself/himself/themselves. I guarantee that as soon as the trip is over,
He/She/They will be back to Indonesia without seeking for any kind of employment and promise to obey every
regulation concerning to your country. Therefore, I would be grateful if you could issue d the visa for him/her/them at
your earliest convenience.
Thank you for your kind attention and good cooperation.

Sincerely Yours,

(TTD DAN STAMP PERUSAHAAN/TOKO)

(Nama Karyawan)
Posisi