(/) CONSULAR OFFICE OF THE REPUBLIC OF INDONESIA IN THE UNITED STATES OF AMERICA (/) Layanan Kekonsuleran Elektronik (/) e-consular Services (/)

(/) CONSULAR OFFICE OF THE REPUBLIC OF INDONESIA IN THE UNITED STATES OF AMERICA (/) Layanan Kekonsuleran Elektronik (/) e-consular Services (/) Electronic Visa Application for Visit Visa - Business to Indonesia INSTRUCTION Start Application (genid.html) Retrieve My Application (retrieve. Welcome to the Electronic Consular Service Instructions Page. This online Form Visa Application can be completed to initiate the application process. What you need: 1. 128-bit encryption support 2. JavaScript must be enabled 3. Internet Explorer version 10 and higher, Mozilla Firefox version 2.0 or higher, or Chrome version 16 or higher Note: The time to download each page may vary depending on the speed of your Internet connection. Please be patient. Instructions for completing the online form: 1. Enter the information requested into the appropriate spaces on each page. Please answer all questions. Your answers must be in English and must use English characters. Letters like ñ, é, ü, ç are not recognized by the system. Please enter names like Muñoz and Sémonin as Munoz and Semonin. 2. Review the information you entered for accuracy. 3. Print the confirmation page. Note : This process requires an applicant to sign and submit his or her own visa application. Although the applicant may receive assistance from a third party in preparing the application, the applicant is required to click the Sign and Submit button at the end of the application. The applicant's failure to sign the application may result in a termination of the application. Copyright 2015 CONSULAR OFFICE OF THE REPUBLIC OF INDONESIA IN THE UNITED STATES OF AMERICA (http://www.embassyofindonesia.org/)

(/) CONSULAR OFFICE OF THE REPUBLIC OF INDONESIA IN THE UNITED STATES OF AMERICA (/) Layanan Kekonsuleran Elektronik (/) e-consular Services (/) Application Information for Visit Visa - Business Please record your Registration Code in a safe and secure place. If there are technical issues with the system, or you want to complete your application some other time, you can save your work and later, start where you left off. In order to access your application later, however, you will need: (1) your Application ID, and (2) the answer to the security question that you will choose on this page. To choose a security question, pick the one you like the best from the dropdown list, type your answer to that question in the box below, and click Continue. Remember: In order to access your application later, you will need to know the answer exactly as you wrote it on this page. You can also use your Registration ID and security question to retrieve your Confirmation Page after you have submitted your application, or to check your application status. State or County where you live Help Choose State or County Security Question Help Choose Your Security Question Answer Help Jawaban dari pertanyaan rahasia Continue Cancel (/visa/dsv/getstarted.html) Copyright 2015 CONSULAR OFFICE OF THE REPUBLIC OF INDONESIA IN THE UNITED STATES OF AMERICA (http://www.embassyofindonesia.org/)

(/) CONSULAR OFFICE OF THE REPUBLIC OF INDONESIA IN THE UNITED STATES OF AMERICA (/) Layanan Kekonsuleran Elektronik (/) e-consular Services (/) Application Information for Visit Visa - Business Please record your Registration Code in a safe and secure place. If there are technical issues with the system, or you want to complete your application some other time, you can save your work and later, start where you left off. In order to access your application later, however, you will need: (1) your Application ID, and (2) the answer to the security question that you will choose on this page. To choose a security question, pick the one you like the best from the dropdown list, type your answer to that question in the box below, and click Continue. Remember: In order to access your application later, you will need to know the answer exactly as you wrote it on this page. You can also use your Registration ID and security question to retrieve your Confirmation Page after you have submitted your application, or to check your application status. Your Registration Number : UZ5P5EN-6 Category of Visit : Visit Visa - Business Input Date 03-Dec-2016 Office Location

(/) CONSULAR OFFICE OF THE REPUBLIC OF INDONESIA IN THE UNITED STATES OF AMERICA (/) Layanan Kekonsuleran Elektronik (/) e-consular Services (/) Visit Visa - Business Application Form Application ID : UZ5P5EN-6 GENERAL PERSONAL PASSPORT OTHER PHOTO SIGN Purpose of Visit * Visa Type * Length of Stay in Indonesia * Day(s) Point of Entry Into Indonesia * Help: Retirement visa will be issued base on purpose of visit to Indonesia.Please choose the closest one of your purpose visit. Help: Choosing visa type single or multiple will reflect in your amount of money order. Help: Point of entry is seaport or airport where you entering Indonesia.Please refer to your itinerary. Date of Entry * yyyy-mm-dd Flight/Vessel name and Number * Flight/Vessel Name and Number Date of Departure * yyyy-mm-dd Port of Departure in Indonesia * Help: Choose seaport or airport where leaving

Indonesia.Please refer to your itinerary. Address in Indonesia Address in Indonesia * Address in Indonesia City * City of Destination Address Province Select Province Zip Code Zip Code of Destin Help: Leave the zip code if information is not available. Phone Number in Indonesia * +62 (XXX)XXXXXXX Sponsorship Information Sponsor Type * Select Sponsor Type Organization / Government Name * Name of Instituion Contact Name * Contact Name Position/Title * Position/Title Address * Address

City * City Province * ZIP Code * Zip/Postal Phone Number * +62 (XXX)XXXXXXX Cancel : Main Menu Save Next : Personal Copyright 2015 CONSULAR OFFICE OF THE REPUBLIC OF INDONESIA IN THE UNITED STATES OF AMERICA (http://www.embassyofindonesia.org/)

Help: Your nationality can be different to country you were born.choose your citizenship as nationality. Home Address in USA Address * Address in USA City * City State * ZIP Code * Kode Zip/Postal Phone Number * +1 (XXX)XXXXXXX Email * email CURRENT EMPLOYMENT Job Interest Select Job Interest Profession * Current Position * Current Position Name of Institution *

Company Name Address * Address of The Institution City * City of The Address of Institution State * Country * Zip Code * Zip Code of The A Phone * +1 (XXX)XXXXXXX Previous : General Save Next : Passport Copyright 2015 CONSULAR OFFICE OF THE REPUBLIC OF INDONESIA IN THE UNITED STATES OF AMERICA (http://www.embassyofindonesia.org/)

(/) CONSULAR OFFICE OF THE REPUBLIC OF INDONESIA IN THE UNITED STATES OF AMERICA (/) Layanan Kekonsuleran Elektronik (/) e-consular Services (/) Visit Visa - Business Application Form Application ID : UZ5P5EN-6 GENERAL (/visa/genv/bvv/general.html) PERSONAL (/visa/genv/bvv/personal.html) PASSPORT OTHER PHOTO PASSPORT Type of Passport * Diplomatic Service UNLP Others/Regular Passport Passport Number * Pasport Number Place of Issue * Place of Issue Help: If You hold regular passport, please choose Others/Regular Passport Option. SIGN Country of place of Issue * Help: It depends on where your passport was issued.please refer to your passport document. Date of Issue * yyyy-mm-dd Date of expired * yyyy-mm-dd Category of Passport * Personal Family Previous : Personal Save Next : Others

(/) CONSULAR OFFICE OF THE REPUBLIC OF INDONESIA IN THE UNITED STATES OF AMERICA (/) Layanan Kekonsuleran Elektronik (/) e-consular Services (/) Visit Visa - Business Application Form Application ID : UZ5P5EN-6 GENERAL (/visa/genv/bvv/general.html) PERSONAL (/visa/genv/bvv/personal.html) OTHER Have you ever been to Indonesia before? Yes No Are you in possesion of other countries travel documents? Yes No PASSPORT (/visa/genv/bvv/passport.html) Do you have previous visa to enter Indonesia? Yes No Have your visa application been denied before? Yes No OTHER Have you ever been forced to leave Indonesia? Yes No PHOTO Have you ever been commited a crime or any offence? Yes No SIGN Return/Through Ticket Return/Through Ticket Place of Issue Place of Issue Date of Issue/Expired yyyy-mm-d yyyy-mm-d Back : Passport Save Next : Photo Copyright 2015 CONSULAR OFFICE OF THE REPUBLIC OF INDONESIA IN THE UNITED STATES OF AMERICA (http://www.embassyofindonesia.org/)

If taken using a digital camera: Image File Format: The image must be formatted Joint Photographic Experts Group (JPEG) Image File Size: The maximum image file size is 300 kilobytes (300 KB). Resolution / File Image Dimensions: Minimum dimensions are 600 pixels (length) x 600 pixels (width). Pixel square image should be dimensionless (length and width must be the same size). Image color depth: 24-bit color [Note: Photos must be in color. Black and white images can not be accepted.] If Scanned: Scanner Resolution: Pictures are scanned using a minimum resolution of 150 dots per inch (dpi). Image File Format: The image must be formatted Joint Photographic Experts Group (JPEG). Image File Size: The maximum image file size is 300 kilobytes (300 KB). Resolution / File Image Dimensions: Minimum dimensions are 600 pixels (length) x 600 pixels (width). Pixel square image should be dimensionless (length and width must be the same size). Image color depth: 24-bit color [Note: Photos must be in color. Black and white images can not be accepted.] Copyright 2015 CONSULAR OFFICE OF THE REPUBLIC OF INDONESIA IN THE UNITED STATES OF AMERICA (http://www.embassyofindonesia.org/)

(/) CONSULAR OFFICE OF THE REPUBLIC OF INDONESIA IN THE UNITED STATES OF AMERICA (/) Layanan Kekonsuleran Elektronik (/) e-consular Services (/) Visit Visa - Business Application Form Application ID : UZ5P5EN-6 GENERAL (/visa/genv/bvv/general.html) PERSONAL (/visa/genv/bvv/personal.html) PASSPORT (/visa/genv/bvv/passport.html) OTHER (/visa/genv/bvv/other.html) PHOTO (/visa/genv/bvv/photo.html) SUMMARY AND SIGN General Click to change your data :: General (/visa/genv/'. $kodevisa. '/general.html) # Field Data 1 Purpose of Visit Business/Convention 2 Visa Type SINGLE 3 Length of Stay in Indonesia 20 days 4 Destination Address in Indonesia defray 5 City dasfdf SIGN 6 Province East Nusa Tenggara 7 Zip Code 95112 8 Phone Number in Indonesia 99999989999 9 Flight/Vessel name and Number 249 10 Port of Departure 11 Date of Departure 2016-12-20 12 Point of Entry Into Indonesia 13 Date of Entry 2016-12-15

14 Previous Country Visited Personal Data Passport Sponsorship Other Photo Sign and declaration statement : If you are the person who help the applicant fill up the form,you have to fill the following information with your data. System and or operator will contact you by email or phone to verify data regarding this application. I hereby declare that the statement given above are true and correct. Completed at (City Name) * Georgia Signature Name (Type your full name) * Bob Dylan Verification Method Email Email Address evan@augsfam.com Verification Number Code Re-send verification number by email Previous : Photo Submit and Sign Copyright 2015 CONSULAR OFFICE OF THE REPUBLIC OF INDONESIA IN THE UNITED STATES OF AMERICA (http://www.embassyofindonesia.org/)

(/) CONSULAR OFFICE OF THE REPUBLIC OF INDONESIA IN THE UNITED STATES OF AMERICA (/) Layanan Kekonsuleran Elektronik (/) e-consular Services (/) Complete Application ID : UZ5P5EN-6 GENERAL SUBMIT AND SIGN (FINISH) : PERSONAL PASSPORT OTHER PHOTO SIGN Congratulations, you have finished filling out Visit Visa - Business Application Form form. You Must Print this confirmation page and submit it within 2 (two) weeks. Your Visa application will be processed starting at the day the Embassy/Consulate receive this confirmation page and other supporting document. You must bring the following document: 1. A passport with at least 6 months validity for single entry or 18 months for multiple entry, from the date of entry into Indonesia, which has at least one blank page for visa (amendment and endorsement pages cannot be used for visa). 2. Two recent color photographs (passport size) with white background on picture-quality paper.note: Do not staple or affixed the photographs on the form. 3. Invitation letter from counterparts in Indonesia, describing the purpose of the visit, guaranteeing all transportation and living expenses that will incur in Indonesia. 4. Copy of inbound and outbound travel itinerary 5. For Non-US citizen: Please provide a copy of US Permanent Residence/Visa/Valid I-20 from schools/universities. Applicant with B1/B2 visa could not apply an Indonesian visa in the United State. Such applicant must apply for the visa from their respected country of origin. 6. Inoculation is recommended but not mandatory, and is required only if applicant had previously traveled to areas/ countries infected by yellow fever. 7. Payment in money order, companys check or cashiers check. 8. Foreign citizen from certain countries is required to have authorization approval letter from the Directorate General of Immigration in Jakarta, prior to applying for a visa. Those countries are : Afghanistan, Cameroon, Guinea, Israel, Liberia, Niger, Nigeria, Democratic People's Republic of Korea, Pakistan, Somalia. Applicant must contact the employer/company/sponsor in Indonesia to obtain such letter, through : Directorate General of Immigration, Ministry of Law and Human Rights. Address : Jalan HR Rasuna Said Kav. X-6, Kuningan, Jakarta Selatan, Indonesia, Phone : +62215224658 9. Visa application by mail should enclosed a self-stamped/pre-paid return envelope by Express Mail or UPS or FedEx (NO Fedex Ground, PLEASE) with a tracking number. Visa application by mail will not be processed unless there is an enclosed a self-stamped/pre-paid return envelope. The Embassy/Consulate is not responsible for any applications or passports that are lost in transit. Download Declaration Data (download/uz5p5en-6_deklarasi.pdf) Download Confirmation Document (download/uz5p5en-6_confirm.pdf)

Exit and Finish (startover.html) If it is deemed necessary, The Embassy/Consulate reserves the right to interview the applicant during the process. Back to main menu (https://consular.embassyofindonesia.org/) Copyright 2015 CONSULAR OFFICE OF THE REPUBLIC OF INDONESIA IN THE UNITED STATES OF AMERICA (http://www.embassyofindonesia.org/)

Online Application Form for Visit Visa - Business KJRI SAN FRANCISCO # Field Data 1 Purpose of Visit BUSINESS/CONVENTION 2 Visa Type SINGLE 3 Length of Stay in Indonesia 20 DAYS 4 Destination Address in Indonesia DEFRAY 5 City dasfdf 6 Province East Nusa Tenggara 7 Zip Code 95112 8 Phone Number in Indonesia 99999989999 9 Flight/Vessel name and Number 249 10 Port of Departure in Indonesia MALAHAYATI 11 Date of Departure 2016-12-20 12 Point of Entry Into Indonesia KUALA LANGSA 13 Date of Entry 2016-12-15 14 Previous Country Visited # Field Data 1 First Name BILL 2 Middle Name 3 Family Surename GATES 4 Sex MALE 5 Marital Status SINGLE 6 Born Place 01011983 6 Born Place Country UNITED STATES 7 Birth Date 1966-12-16 7 Citizenship UNITED STATES Home Address in USA 8 Address 342 9 City asdfdsf 10 State California 11 ZIP Code 88998 12 Phone Number 0000000000 CURRENT EMPLOYMENT 14 Job Interest TOURISM 13 Current Occupation BUSINESS PERSON 14 Current Position CEO 15 Name of Institution CEO 16 Address 1213 17 City DSAFDSF 18 State CALIFORNIA 18 Country UNITED STATES 19 Zip Code 98765 20 Phone 9909099999 # Field Data 1 Type of Passport OTHERS 1 / 3

Online Application Form for Visit Visa - Business KJRI SAN FRANCISCO 2 Passport Number 778887890 3 Place of Issue USA 3 Issue Place Country UNITED STATES 4 Date of Issue 2006-12-09 5 Expired Date 2026-12-20 6 Category of Passport P # Field Data 1 Sponsorship in Indonesia COMPANY/INSTITUTION 2 Organization / Government Name STAFF 3 Contact Name ADS 3 Position/Title ADSDASF 4 Address 234324ASDRE 5 City ASDF 6 Province EAST JAVA 7 ZIP Code 96378 8 Phone Number 99999999999 Field Data Have you ever been to Indonesia before? No Are you in possesion of other countries travel documents? NO Do you have previous visa to enter Indonesia? NO Have your visa application been denied before? NO Have you ever been forced to leave Indonesia? NO Have you ever been commited a crime or any offence? NO Return/Through Ticket Place of issue: Date of Issued: 0000-00-00 Date Expired: 0000-00-00 2 / 3

Powered by TCPDF (www.tcpdf.org) Online Application Form for Visit Visa - Business KJRI SAN FRANCISCO DECLARATION AND DIGITALLY SIGN APPLICATION FORM I hereby declare that the statement given above are true and correct. Electronically apply in: GEORGIA Sign and Submit by : BOB DYLAN 3 / 3

Powered by TCPDF (www.tcpdf.org) Online Application Form for Visa Consulate General of The Republic of Indonesia SAN FRANCISCO U Z 5 P 5 E N - 6 Online Visit Visa - Business Application Confirmation This is confirmation letter of your visa application PLEASE BRING THIS DOCUMENT TOGETHER WITH YOUR PASSPORT Full Name : GATES,BILL Location/City Birth Date : 16 December 1966 CONSULATE GENERAL OF Born Place : 01011983,UNITED STATES THE REPUBLIC OF Sex : MALE INDONESIA SAN FRANCISCO Citizenship : United States Passport Number 778887890 Visit Purpose : GENERAL VISA(VISIT VISA - BUSINESS - BVVCOV) Completed Date : 03 December 2016 Application Number : UZ5P5EN-6 You Must Print this confirmation page and submit it within 2 (two) weeks. Your Visa application will be processed starting at the day the Embassy/Consulate receive this confirmation page and other supporting document. You must bring the following document: A passport with at least 6 months validity for single entry or 18 months for multiple entry, from the date of entry into Indonesia, which has at least one blank page for visa (amendment and endorsement pages cannot be used for visa). Two recent color photographs (passport size) with white background on picture-quality paper.note: Do not staple or affixed the photographs on the form. Invitation letter from counterparts in Indonesia, describing the purpose of the visit, guaranteeing all transportation and living expenses that will incur in Indonesia. Copy of inbound and outbound travel itinerary For Non-US citizen: Please provide a copy of US Permanent Residence/Visa/Valid I-20 from schools/universities. Applicant with B1/B2 visa could not apply an Indonesian visa in the United State. Such applicant must apply for the visa from their respected country of origin. Inoculation is recommended but not mandatory, and is required only if applicant had previously traveled to areas/ countries infected by yellow fever. Payment in money order, companys check or cashiers check. Foreign citizen from certain countries is required to have authorization approval letter from the Directorate General of Immigration in Jakarta, prior to applying for a visa. Those countries are : Afghanistan, Cameroon, Guinea, Israel, Liberia, Niger, Nigeria, Democratic People's Republic of Korea, Pakistan, Somalia. Applicant must contact the employer/company/sponsor in Indonesia to obtain such letter, through : Directorate General of Immigration, Ministry of Law and Human Rights. Address : Jalan HR Rasuna Said Kav. X-6, Kuningan, Jakarta Selatan, Indonesia, Phone : +62215224658 Visa application by mail should enclosed a self-stamped/pre-paid return envelope by Express Mail or UPS or FedEx (NO Fedex Ground, PLEASE) with a tracking number. Visa application by mail will not be processed unless there is an enclosed a self-stamped/pre-paid return envelope. The Embassy/Consulate is not responsible for any applications or passports that are lost in transit. If it is deemed necessary, The Embassy/Consulate reserves the right to interview the applicant during the process. 1 / 1