Please Indicate the Type of Visa Requested

Please attach 2 Diplomatic Visa

Official Visa
photographs taken Courtesy Visa
within the last 6 Non-Immigrant Visa
Tourist Visa
months
(3.5x4.5 cm.)
APPLICATION FOR VISA Transit Visa
Number of Entries Requested Entry (s)
ROYAL THAI EMBASSY, JAKARTA

Mr. Mrs. Miss

(Please Use BLOCK Letters) First Name Middle Name Family Name
Former Name (If any) Countries for which travel document is valid
Nationality
Nationality at Birth Proposed Address in Thailand
Birth Place Marital Status
Date of Birth
Type of Travel Document Name and Address of Local Guarantor
No. Issued at
Date of Issue Expiry Date
Occupation (specify present position and name of employer) Tel./Fax.
Name and Address of Guarantor in Thailand

Current Address
Tel./Fax.
Tel. E-mail I hereby declare that I will not request any refund from my paid
Permanent Address (if different from above) visa fee even if my visa application has been declined.
Signature Date
Attention for Tourist and Transit Visa Applicants
Tel. I hereby declare that the purpose of my visit to Thailand is for
Names/dates/places of birth of minor children (if accompanying) pleasure and transit only and that in no case shall I engage
myself in any profession or occupation while in the Country.
Date of Arrival in Thailand Signature Date
Traveling by FOR OFFICIAL USE
Application/Reference No.
Length of Proposed Stay Visa No.
Date of Previous Visit to Thailand Type of Visa: Diplomatic Visa Official Visa Courtesy Visa
Non-Immigrant Visa Tourist Visa Transit Visa
Purpose of Visit to Thailand: Category of Visa:
Tourism Transit Business Number of Entries: Single Double Multiple Entries
Diplomatic/Official Date of Issue Fee
Others (please specify) Expiry Date
Documents Submitted
Authorized Signature and Official Seal