公司担保或社会团社担保 Name : 名称 Address: 地址
职业/职务
If Working in Indonesia
Tel .电话
如果你在印尼工作
Office Addres
办公地址
.电话 Home Addres 家庭住址
Place of work: 工作地点 Position: 身份 Home address: 家庭住址 .电话
DATE OF ENTRY 入境日期
Tel .电话 PURPOSE OF JOURNEY TO INDONESIA 到印尼的目的
5. Number 号码
FAMILY MEMBERS ACCOMPANYING AND INCLUDING IN PASSPORT OF APPLICANT Full Name Relationship with Applicant 姓名 关系
PLEASE TURN OVER ( 请转后页 )
TelY DECLARE THAT: 我谨此申明: 1. THE STATEMENTS GIVEN ABOVE ARE TRUE AND CORRECT 上述各项均属实情 2. I REALIZE THAT EVEN THOUGH POSSESING A VALID VISA TO INDONESIA, PERMISSION FOR ENTRY REMAINS AT THE DISCRETION OF THE IMMIGRATION AUTHORITIES IN INDONESIA 我虽然获得印尼入境签证,但登陆或入境之许可权仍由印尼移民局定夺.
Beijing,
Signature: 签名:
For official use only
052002
3.
PROFESSION/OCCUPATION 职业/职位
NAME & ADDRESS OF FIRM OR COMPANY 公司名称及地址
HOME OR TEMPORARY ADDRESS 住宅或暂时地址
4.
LENGTH OF INTENDED STAY 停留天数
Tel .电话 PORT OF ENTRY 拟由何处入境
PLACE & DATE OF BIRTH Place & Country 何国何地
出生地点及日期 Day 日 Month 月 Year 年
Sex 性别 Male 男性 Female 女性
PASSPORT MUST BE VALID FOR AT LEAST ANOTHER 18 (EIGHTEEN) MONTHS AFTER DATE VISA ISSUED 护照在入境签证后须仍有最少十八个月之有效期 2. NATIONALITY 国籍 Type 种类 Number 号码 PASSPORT / TRAVEL DOCUMENT Place of Issue 签发地点 护照或旅游证件 Date 日期 Valid Until 有效期
VISA APPLICATION FORM FOR LIMITED STAY
临时在印度尼西亚共和国居留签证申请表
1. FULL NAME (IN CAPITAL) Surname 姓 申请者姓名(请用大写拼音字母填写) Given names 名 CHINESE CHARACTER AND CODE NUMBER 姓名(用中文填写)及密码
THE EMBASSY OF THE REPUBLIC OF INDONESIA BEIJING
Dong Zhi Men Wai Da Jie No.4 Chaoyang District Beijing, 100600 P. R. China Tel. No.(86-10) 65325486-88 Fax No.65325368, 65326279
在申请者护照内伴随之家属 Place & date of Birth Sex 出生地点及日期 性别
6.
Personal
私人担保 Name: 姓名 Nationality: 国籍 Profession /Occupation:
Passport No.: 护照号码
SPONSOR IN INDONESIA 在印尼之担保人 Company or Institution