Visa Form – Wisma Bahasa

Social Cultural Visa Form

Your Full Name(required)
Mr.Mrs.Ms.
Place of Birth:(required)
Birth date: (Tahun/Bulan/Tanggal)(required)
Passprt No.:(required)
Nationality:(required)
Marital status/Civil status:
SingleMarriedWidowWidower
Email address:(required)
Phone #:(required)
Occupation:(required)
Name of Family Abroad:(required)
Address of Family Abroad:(required)
Date of Entry to Indonesia: (Tahun/Bulan/Tanggal)(required)
Indonesian Embassy/Consulate address:(required)
Accommodation Address in Yogyakarta:(required)
Please upload the required documents for visa sponsorship requirements.. File format using *.JPEG or *PDF in color, Size 500 Kb up to 1 Mb per sheet of the document.
Scan/copy of Passport cover (front and back):(required)
Scan/copy of Passport biodata/Identity pages:(required)
Flight ticket (especially return ticket or through ticket):(required)
Scan/copy of your savings account book with a minimum balance equal to USD2000 (min from the past three/3 months):(required)
Coloured photo (size: passport photo; Personal photos must not result from image processing of other passport documents. The photo must be taken in the last six months)(required)
Scan/copy of Immigration Document (Visa page when you last visited Indonesia. If you have never been to Indonesia, please scan a blank page).(required)
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VISITOR VERIFICATION: