CONSULATE GENERAL THE REPUBLIC OF INDONESIA KARACHI

NUMBER DATE I. GENERAL Duration of Stay in Indonesia Type of Visa Day(s) Month(s)

Phone Fax Address

(92-21) 5874623, 5874619 (92-21) 5874483 E/1-5, Shahrah-e-Iran, Clifton Karachi

(DD-MM-YYYY) Photograph Year(s) Passport size

Transit Multiple Entries

Single Entry Limited Stay

For Transit Visa Country of Destination Place of Departure Flight/Vessel Name For Visit Visa Purpose of Visit

Tourism Study

Convention Arts

Family Visit Commercial

Sports Others

Country of Destination Place of Visit Flight/Vessel Name For Limited Stay Visa Purpose of Limited Stay Address in Indonesia City Province Phone Number Port of Entry into Indonesia Date of Entry II. PERSONAL DATA First Name Middle Name Family/Surname Sex Marital Status Place of Birth Date of Birth Nationality Home address in Pakistan City Province/State Phone Number Profession Type of Business Name of Company/Institution Address in Pakistan

Work

Joint Family

Social

Others

(DD-MM-YYYY)

Male Married
-

Female Single
(DD-MM-YYYY)

Student

Professional Government Businessman

Housewife

Others

City Province/State Phone Number

Ill. PASSPORT INFORMATION Passport/Travel Document Number Place of Issue Date of Issue Date of Expiry Type of Passport

(DD-MM-YYYY) (DD-MM-YYYY)

Personal

Family
Name

Please mention if your husband/wife/children are accompanying you and have been entered in your travel document

No. Relative(s) Sex Date of Birth (DD-MM-YYYY)

Relation Sex

(s)

1 F

Husband Female

2 M

Wife Male

Child

IV. SPONSOR IN INDONESIA (IF ANY) Type of Sponsor

Individual Company

Government NGO

International Institution Others

Name of Person/Institution Address City Province/State Phone Number V. OTHER INFORMATION Have you ever been to Indonesia before? Are you in possesion of any other countries'travel documents ? Do you have previous visa to enter Indonesia? Has your visa application been refused before? Have you ever been deported from Indonesia? Have you ever committed a crime or any offence? Retum/Through Tickeffirline Company Place of Issue Date of Issue Date of Expiry

Yes Yes Yes Yes Yes Yes

No No No No No No

(DD-MM-YYYY) (DD-MM-YYYY)

I hereby declare that the statements given above are true and I understand that even if granted a visa the admission at the airport remains the discretion of the Immigration authorities in Indonesia Applicant's Signature

*Passport must be valid for at least six months

(DD-MM-YYYY)

*To be completed in duplicate with two photographs attached

FOR OFFICE USE ONLY Index Visa Lamanya Izin Tinggal di Indonesia Kuasa Perwakilan / Ditjenim Hari/Bulan Karachi, a.n. Kepala Perwakilan RI