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GOVERNMENT OF PAKISTAN
VISA APPUCATION FORM
(Please read these instructions carefully beforc filling in the application fom)
'1. No column should be left blank. lncomplete forms with vague entries shall not be
accepted. Where applicable copies of supportive documenls should be submitted
along with the application form.
2. Applicants may use extra sheets, in case of insufficient space in the columns of the
visa form.
3. Two (02) passport size photographs should be attached with the visa form.
4. Normal processing time for visa is 4-6 weeks.
5. Applicants could be asked to appear for interview if required.
6. On arrival, immigratron formalities are mandatory. (Police registratlon is applicable in
certain cases)-
7. Attach blank statement for business visit.
8. Applicants family" includes spouse, son, daughter, father, mother,.
PART - I
1. Tvoe of visa aoolied for:
Diplomatic E omciat E Military n E Tourist !
Business
Family E Transit n Journalist E othersfl (Specify_
2. Purpose of Visit:
TABLIGH VISA
J. Duration of Stav: ,( navs
4. Visa reouired for: Less than 01 Month fl 06 Months E ot year E oz years n 05 Years E
5- Tvpe of visa: Single Entry !f Double Entry ! Multiple Entry !
Port of Entry LAHoRE ii. Port of DepartureJAKARfA
I Places to be visited in Pakistan:
A.LAHORE b. .C
6 SECIT{)},I I (APPLICAHT,S I}ETALSI
t Name as in Passport: RoE AiIINU
First Middle Last
ii. Date ol Birth:
ls2 ls4
'12
dd/mm/yy
iii. Place of Birth: City: RIAU Country: INDONESIA
iv. Sex: Male Z Female tr V.Blood Group:
Marital Status: Single I Married tr
II ldentification Mark: viii. Native Language: INDONES|A
Nationality : (a) Present INDONESIA (b) Previous (c) Dual
Religion: MoSLEM
PASSPORT DETAILS:
Type of passport:: Diplomatic ! Officiat / Service ! OrOinary !l
IJN Travel Documents tr
PassPort Num6g1 86929513 place of lssue: KARAWANG
Date of lssue: 0411212017
DaleotExpiry:041 2o22
issuing Authority: IMMIGRATION OF KARAwANG
xii. ADDRESS & EMAIL:
Abroad i Country of Origin. WIDORO rcDUL, 004/003 DESA BENDUNG
KEC. SEMIN KAB. GUNUNG KIDUL. YOGYAKARTA
Telephone: (i) Home : (ii) Work:_ (lll) Celt +62812 4341 1872
In PaKiSKn. MADRASSAH ARABIA RAIWIND - LAHoRE
Telephone: (i) Home : (ii) Work: _ (ttt) Cett
Email:
ls your visit sponsored? Yes n Z
lfyes, give details.
llame ofSponsor Address Contect numbt
Home:
Work:
Cell:
xv- DETAILS OF PROFESSION
a. Profussion (Please specifi Rank / Service, in case of Armed Forces / Unfform personnd):
BUSINESS
Note: ln case of military services, Please fill in the attached performa.
b. Employeis / Sponsor's details ( in pakistan / Abroad (if Applicable)
Telephone No. Email
Name Address
Home Office Gellular Address
PAST:
OETAILS OF JOBS HELD IN THE
b. Department:
a.
to) d.
c. Duration (from -
e. Address & Phone No.
colleague:
of immediate boss/head and any other
f: Name, address and contract numbers
(use extra sheet lf required)
Are you applying visa from a third country?
Yes tr No Z
vrotk pelmit of that country'
It yes, phase provide mpy of tesklence /
7 SECTION II (FAMILY DETAILS
GIYANTI ll Nationality of Mother lNDoNEslA
I Name of Mother
WANTA Nationality of Father lNDoNEslA
llr Name of Father.
Spouse details:
NationalitY
Name
Date and place of birth
Profession
of employer of spouse (if any)
Name, Address and contact number
Do you have anY children?
yesnNoZ.
your child'
lf yes, please provide details for each of
irame
(
)
with you t0
person / family member (including children) traveling
vlt. Please list any of accompanying
Pakistan.
Passport Number (if anY) Address
of Bidh,
t
Full Name, Date
( s )
Do you have any bank account in
Pakistan?
vll.
NCNumber Address Veifier details
BankName Branch
/(
\.\ 1 )
)
8 TRAVEL HISTORY:
I Have you ever visited Pakistan during last five years? Yes tr No g if yes, please
Provide details.
Date Destination / Address Puryose
1.
2.
3.
4.
5.
Details of other countries visited, during last two years.
Date Destination / Address Purpose Duration
l
2.
3.
4.
5.
I. Have you ever been refused a visa for any country, including Pakistan? Yes f] No g
iv Have you ever been refused entry on arrival to Pakistan? Yes ENo g
lf yes, please provide details of refusal.
Have you ever been deported, removed or otherwise required to leave any country, including Pakistan?
Yes tr No il lfyes, please provide details.
Date Country Reason Reference Number (for Pakistan)
5
Do you have any criminal convictions or charged in any country? Yes tr No a
Country
\J
Date Offence Sentence
DECLARATION: I declare that the information given in this form is correct to the best of my knowledge
and belief and if any of the particulars furnished above are found to be incorrect or
withheld the visa is liable to be rejected / cancelled at any time
Dated:
(Signature of Applicant)
PART - II
1. Date of receipt of Msa Application:
2. Registration Number:
3. Visa fee received:
4. Additional Documents received:
a.
documents'
F Particulans ofoficial who checked he visa form for its conectness and supporting
a- Name b. Designation-
b. Date c. Signatule
Details of clearance received from Minisfy of lntedor-
Dated
7. Decision by ofiicer in+harge.
a. Accepted tr
c.
d. Duration
e. Single Entry tr f. Multiple Entry !
Dated:
(Signature of Visa lssuing Authority)
