No. 6 Special Visit with Certificate of Eligibility Name Email Contact ‘Sr |__ Required Documents/evidence Detail Special Original | Copy 1 | Passport With aplicnt’s gitre epoca s 3 | visa a underage or with ay, the parents can en A colour photo taken within 6 months(4.Smm x 3 | 1x Photograph 4.5mm, clear image without background) IP Front side copy 4 | KITAS/ TTAS online print out If you are non-indonestan applicant oe Evidence of visit to ‘Hotel or Flight booking confirmation, etc. (only 5 | Fukushima/Miyagi/ Iwate prefecture | you visit mentioned locations} 6 | COE (Certificate of Etigibity) Original and Copy Consent letter with Visa applicant als ae can Only # application is submitted on behalf of representative ID copy 8 | Other (only optional) *Visa Fee Waiver Di thereby acknewiedge that | have submitted all the documents ticked and/or described hereinbefore, any false document or inaccurate statement thereof, intentionally or negligently, may result in refusal of visa, and issuance of visa, including conditions thereof, If given, is subject to solo discretion of the Embassy of Japan in indonesia. 1 understood that all support document submitted above except from Passport cannot be returned after visa assessment. (C21 understood that even if | have submitted all documents as per the checklist above, there Is a possibility that the ‘Embassy of Japan might ask for additional documents that are not listed above. Applicant Signature Date____f___~