KEMENTERIAN HUKUM DAN HAK ASASI MANUSIA

REPUBLIK INDONESIA
KANTOR WILAYAH NUSA TENGGARA TIMUR
KANIM KELAS II TPI LABUAN BAJO
JLN.FRANS NALA LABUAN
BAJO, MANGGARAI BARAT NTT

IZIN TINGGAL
KUNJUNGAN ELEKTRONIK
ELECTRONIC VISIT STAY PERMIT

NIORA : IM2XCH17720
Permit Number : 2B11X30027-A
Stay Entries Permit Expiry : 04-05-2024
Stay Permit Index : II A

Full Name : ZELIA DE JESUS DA SILVA

Place / Date of Birth : FATUBOLU / 19-07-1998
Passport Number : 0150141C
Passport Expiry : 05-12-2028
Nationality : TIMOR LESTE
Gender : FEMALE
Address : JALAN NASUTION, NEKANG, KELURAHAN WATU
Occupation : MONK
Status : KELUARGA/SOSIAL

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 Visit 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 Visit Stay Permit is generated automatically by the Immigration Information Management System

Manggarai Barat, 16-02-2024

Head of Kelas II TPI Labuan Bajo Immigration Office