Form Data Pribadi

( harap diisi lengkap untuk aplikasi visa)

Nama lengkap ( sesuai paspor ) :....................................................................................................................................

Alamat rumah sekarang :....................................................................................................................................
....................................................................................................................................
Kode pos ....................................................................................................................................
Telephone Rumah :....................................................................................................................................
Kantor :....................................................................................................................................
Handphone :....................................................................................................................................
Email :....................................................................................................................................
Lama Tinggal :....................................................................................................................................
Nama Perusahaan tempat kerja :....................................................................................................................................
Alamat tempat kerja :....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
Jabatan / Posisi :....................................................................................................................................
Tgl Bln Thn mulai bekerja :....................................................................................................................................
Penghasilan per bulan :....................................................................................................................................
Nama Perusahaan sebelumnya :....................................................................................................................................
Alamat tempat kerja :....................................................................................................................................
....................................................................................................................................
....................................................................................................................................
Jabatan / Posisi :....................................................................................................................................
Tgl Bln Thn mulai bekerja :....................................................................................................................................
Status pernikahan : single / nikah / cerai / pisah / cerai mati /partner
Nama Suami / Istri :....................................................................................................................................
Tempat & tgl lahir suami/istri :....................................................................................................................................
Nama Ayah :....................................................................................................................................
Tempat & tgl lahir ayah :....................................................................................................................................
Nama Ibu :....................................................................................................................................
Tempat & tgl lahir ibu :....................................................................................................................................
Jumlah Uang yang Dibawa :....................................................................................................................................
Bepergian dalam rangka :....................................................................................................................................
Alamat di luar negri :....................................................................................................................................
....................................................................................................................................
History traveling dalam 05 tahun :....................................................................................................................................
No KTP :....................................................................................................................................

Pertanyaan Tambahan Khusus UK

Details pekerjaan lainnya selain pekerjaan utama (jika ada) :..........................................................................................

Pendapatan lainnya selain pekerjaan utama (Sebutkan darimana sumbernya dan jumlahnya)
:...............................…...........................................................................................................................................................................
......................
Biaya yang dikeluarkan setiap bulannya untuk Pribadi :..................................................................................................
Biaya yang dikeluarkan setiap bulannya untuk Keluarga:................................................................................................
Biaya Ticket Pesawat :....................................................................................................................................
Biaya Penginapan :....................................................................................................................................
Nama dan hubungan yang akan pergi bersama-sama ke UK : .........................................................................................
......................................................................................................................................................................................................
Nama Pengundang/Perusahaan :
Alamat Pengundang :
Telephone Pengundang :
Pertanyaan Tambahan Khusus USA

History sekolah :

SMP
Nama sekolah :..............................................................................................................
Alamat sekolah dengan kode pos :..............................................................................................................
Periode sekolah :..............................................................................................................

SMA
Nama sekolah :..............................................................................................................
Alamat sekolah dengan kode pos :..............................................................................................................
Periode sekolah :..............................................................................................................

University
Nama University :..............................................................................................................
Alamat University dengan kode pos :..............................................................................................................
Periode University :..............................................................................................................

Tanda tangan

(...........................................................)