Phone : +92 (51) 2832017-20

Embassy of the Republic of Indonesia Fax : +92 (51) 2832013

Website : http://www.kemlu.go.id/islamabad
Address : Diplomatic Enclave I Street 5
Ramna G-5/4, Islamabad-Pakistan
Application No.: VISA APPLICATION FORM Email : islamabad.kbri@kemlu.go.id

Date:

I. GENERAL

Duration of Stay in Indonesia : Day (s)

Type of Visa : Transit Single Visit

: Multiple Visit Limited Stay

For Transit Visa :

Country of Destination :
Place of Departure :
Flight/Vessel Name :

For Visit Visa :

Purpose of Visit : Tourism Convention Family Visit Sports

: Study Arts Commercial

Others (specify)
Flight/Vessel Name :

Date & Port of Entry :

Place to Visit :

For Limited Visa :

Purpose of Limited Stay : Work Joint Family Social Others

Country of Destination :
Place of Departure :
Flight/Vessel Name :
Country of Destination :
Place of Departure :
Flight/Vessel Name :
II. PERSONAL DATE
First Name :
Middle Name :
Family/Surname :
Sex : Male Female
Marital Status : Single Married
Place of Birth :
Nationality :
Home Address in Pakistan :
City :
Province/State :
Phone Number :
Email: :
Occupation/Position : Professional Government Sales Student Housewife Other
Name of Company/Institution :

Type of Business :
Company Address :
Phone Number/ Email :
III. PASSPORT INFORMATION

Passport/Travel Document Number :

Place of Issue :
Date of Issue :
Date of Expiry :
Type of Passport :

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

No. Relative (S) Sex Place of Birth Date of Birth Name

1.
2.
3.

IV. SPONSOR IN INDONESIA

Type of Sponsor : Individual Government International Institution

Company NGO Others

Name of Person/Institution :
Address :
City :
Province/State :
Contact Person :
Phone Number :
V. MISCELLANEOUS
Have you ever been to Indonesia before? : Yes No
Are you in possession of any other countries travel documents? : Yes No
Do you have previous visa to enter Indonesia? : Yes No
Has your visa application been denied before? : Yes No
Have you ever been forced to leave Indonesia? : Yes No
Have you ever been committed a crime or any offence? : Yes No

Type of Ticket (Return/Through) :

Ticket/Airline Company :
Place of Issue :
Date of Issue :
Date of Expiry :

I hereby declare that the statements given by me are true and correct and I realize that even though I possess a valid visa to Indonesia,
permission for entry remains at the discretion of the immigration authorities in Indonesia.

I am also aware that:

1. During my visit to Indonesia I will refrain from:

a. Being engaged in any occupation or institution paid or paid.
b. Over staying
2. If I fail to comply with the above mentioned requirements, I am liable to prosecution and expulsion.

Applicant Signature:

……………………………/………/20…………..

 To be completed in duplicated with two photographs attached (3x4 cm, white background)
 Passport must be valid for at least 18 months
Check List:

(Before submitting application, please tick (√) in the list below to ensure the requirements are complete.
Incomplete application shall not be entertained).

Original national passport with validity not less than 18 months from the date of travel & previous passport must be
attached.
Two visa application forms must be filled and signed completely along with two latest color photographs.
Copy of page 1-3 national passport, along with the copy of previous Indonesia visa (if any).
Copy of valid/latest national identify card (NIC).
Copy of return ticket and hotel reservation.
Covering letter from the hotel/travel tour from Indonesia.
Bank statements for the last 6 months with the minimum balance equal to US $ 10, 000 for business and US $ 1.500 for
other purposes.
Copy of business registration certificate & recommendation letter from the Chamber of Commerce and industry or
business Association (for business visa only).
Invitation letter from Indonesian sponsor (business partner, individual, institution/department) mentioning the purpose
of visit clearly.
Authorization letter with NIC copy of the authorized person or agent (if visa will be collected by other).
Request letter from company, institution/department of the applicant, detail with the purpose of visit in Indonesia.
Police character certificate.

Note:

#. The Embassy of the Republic of Indonesia reserves the right to request additional documents if needed.
#. The Multiple, Limited stay & Social Visa Applicant are asked to submit the document in 2 (two) duly set.

Tanggal Paraf Petugas

Embassy of the Republic of Indonesia

Islamabad-Pakistan

ACKNOWLEDGE RECEIPT

Received from :
A passport No. :
Application for :
Application No. :
Date of Submission : / /20
Date of Delivery : / /20
Fee should be paid :

Islamabad,…………./……./20………….
Consular Section

………………………………………………………………

*. For checking your visa status please call: +92 (51) 2832017 at 9:30 am to 11:30 am *. Submission time: 09:30 am to 11:30 am, Mon-Fri (Office Hours)
Collecting time: 02:30 pm to 3:30 pm, Mon-Fri (Office Hours)

Embassy of the Republic of Indonesia ACKNOWLEDGE RECEIPT

Islamabad-Pakistan

Application No. :
Passport No. :
Date of Submission : / /20
Date of Delivery :

Islamabad,…………./……./20………….
Consular Section

…………………………………………………….