Embassy of the Republic of Indonesia

Islamabad - Pakistan

Phone

: +92(51) 2832017-20

Fax

: +92(51) 2832013

Website : http://www.kbri-islamabad.go.id

Application No.: 25480/05/2016

VISA APPLICATION FORM

Address : Diplomatic Enclave I Street 5

Ramna G-5/4,Islamabad-Pakistan
Email : indonesianembassyisb@gmail.com

Date: 17-05-2016

I. GENERAL
Duration of Stay in Indonesia

Type of Visa

30

Day(s)
Transit

X Single Visit

Multiple Visit

For Transit Visa

Country of Destination

:
:

Place of Departure

Flight/Vessel Name

For Visit Visa

Purpose of Visit

:
:

X Tourism
Study

Limited Stay

Convention

Family Visit

Sports

Arts

Commercial

Others

Flight/Vessel Name

MALINDO AIR OD 0316

Date & Port of Entry

19-06-2016 JAKARTA CGK

Place to Visit

JAKARTA SELATAN

For Limited Stay Visa

Purpose of Limited Stay

:
:

Address in Indonesia

City

Province

Phone Number

Port of Entry into Indonesia

Date of Entry

Work

Joint Family

Social

Others

II. PERSONAL DATA

First Name

Middle Name

MUHAMMAD IRFAN

Family/Surname

ZAFAR

Sex

X Male

Female

Marital Status

X Married

Single

Place of Birth

LAHORE, PAKISTAN

Date of Birth

23-01-1983

Nationality

PAKISTAN

Home Address in Pakistan

House # 1050/3, Street # 77,

Khrass Mohallah, Sadar Bazar, Lahore Cantt, Pakistan. 54000

City

LAHORE

Province/State

PUNJAB

Phone Number

009-233-44377545, , 009-233-44377545

Email

irfan.zafar@yahoo.com

Occupation/Position

X Professional

Name of Company/Institution

WORLDCALL TELECOM LIMITED

Type of Business

Company Address

Government

Sales

Student

Housewife

Other

WORLDCALL TELECOM LIMITED

HR OFFICE:
IBRAHIM TRADE CENTRE, 1-AIBAK BLOCK, NEW GARDEN TOWN, LAHORE.
PAKISTAN
FAX: +92 42 35846921

HEAD OFFICE:
67-A-C-III, GULBERG III,
LAHORE, PAKISTAN
TEL: +92 42 3587 2636 - 38
FAX: +92 42 35755231
Phone Number / Email

009-242-35872636

III. PASSPORT INFORMATION

Passport/Travel Document Number
: AS5521202
Place of Issue

PAKISTAN

Date of Issue

18-01-2013

Date of Expiry

16-01-2023

Type of Passport

I ORDINARY

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

FEMALE LAHORE, PAKISTAN

02-06-1982

Name

1.

WIFE

2.

DAUGHTERFEMALE LAHORE, PAKISTAN

19-02-2011

ABEEHA IRFAN

3.

SON

MUHAMMAD HASHIR IRFAN

MALE

LAHORE, PAKISTAN
27-09-2014

SABA IRFAN

IV. SPONSOR IN INDONESIA

Type of Sponsor

Individual

Government

International Institution

Company

NGO

Others

Name of Person/Institution

PT. NESTLE INDONESIA

Address

HOME
KRISTAL. ROOM NO 1901 TOWER 1.
JALAN TEROGONG RAYA CILANDAK BARAT
OFFICE
PT. NESTLE INDONESIA
5TH FLOOR, WISMA NESTLE, PERKANTORAN HIJAU ARKADIA, JLN. T.B.
SIMATUPANG KAV. 88

City

JAKARTA SELATAN

Province/State

DAERAH KHUSUS IBUKOTA

Contact Person

MUHAMMAD IKRAM ZAFAR

Phone Number

081-136-21115

V. MISCELLANEOUS
Have you ever been to Indonesia before?

Yes

X No

Are you in possesion of any other countries travel documents?

Yes

X No

Do you have previous visa to enter Indonesia?

Yes

X No

Has your visa application been denied before?

Yes

X No

Have you ever been forced to leave Indonesia?

Yes

X No

Have you ever been committed a crime or any offence?

Yes

X No

Type of Ticket (Return/Through) :

RETURN

Ticket/Airline Company

MALINDO AIR OD 0316

Place of Issue

LAHORE, PAKISTAN

Date of Issue

30-04-2016

Date of Expiry

16-07-2016

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:

MUHAMMAD IRFAN ZAFAR

............................,......./....../20.........
* To be completed in duplicate with two photographs attached
* Passport must be valid for at least 18 months

25480/05/2016

Applicant No. : 25480/05/2016

Check List:
(Before submitting application, please tick (V) 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 signed and filled 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 identity card (NIC).
Copy of return/onward ticket (attested by the airline/ticketing agent).
Copy of hotel reservation (issued by the concerned hotel).
Bank statements for the last 6 months with the minimum balance equal to US$ 10,000 for business
and US$ 2,000 for other purposes.
Copy of business registration certificate & recommendation letter from the Chamber of Commerce 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
to Indonesia.
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

Embassy of the Republic of Indonesia

Islamabad - Pakistan

Paraf Petugas

Diplomatic Enclave I Street 5

Ramna G-5/4,Islamabad-Pakistan
Phone: +92519246571, Facs:+92512832013
E-mail: indonesianembassyisb@gmail.com

ACKNOWLEDGE RECEIPT
Received from

MUHAMMAD IRFAN ZAFAR

A Passport No.

AS5521202

Application for

Single Entry Visa

Application No.

25480/05/2016

Date of Submission

/20

Date of Delivery

/20

Fee should be paid

:
Islamabad,.........../........../20...........
Consular Section
............................................................

* For checking your visa application status, please visit : http://evisa.kbri-islamabad.go.id/login

** Submission time : 09.30 am to 11.30 am - Collecting time : 02.30 pm to 4.30 pm
Monday - Wednesday
Thursday - Friday