KEMENTERIAN HUKUM DAN HAK ASASI MANUSIA

REPUBLIK INDONESIA
KANTOR WILAYAH BALI
KANIM KELAS I KHUSUS TPI NGURAH RAI
JALAN PERUMAHAN TAMAN
JIMBARAN NO. 1 MUMBUL

IZIN TINGGAL TERBATAS ELEKTRONIK

ELECTRONIC LIMITED STAY PERMIT

NIORA : IM2UAE98399
Permit Number : 2C12E12037-V
Stay/Multiple Entries Permit Expiry : 21-07-2023
Stay Permit Index : IC

Full Name : CONRAD JAMES JOHNSTON

Place / Date of Birth : KALAMUNDA / 30-03-1998
Passport Number : PB4652270
Passport Expiry : 07-04-2030
Nationality : AUSTRALIA
Gender : MALE
Address : JL. PANTAI BATU BOLONG NO. 34B DESA CANGGU KEC. KUTA
UTARA KAB. BADUNG
Occupation : INVESTOR
Status : INVESTMENT
Guarantor Name : CRYPTO KINGS BALI, PT.

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
4. This Electronic Limited Stay Permit is generated automatically by the Immigration Information Management System

Denpasar, 21-07-2021
Head of Kelas I Khusus TPI Ngurah Rai Immigration Office.