Visa Application Form
Visa Type
eVisa B211A visit
Spousal KITAS (married to an Indonesian national)
Dependent KITAS (children/married to a foreigner KITAS 312/314 holder)
Investor KITAS
Given name
Last name
Email
Mobile number / Whatsapp
Please attach your portrait photo / headshot in colour
Please attach your passport cover photo
Please attach your passport main page photo
Do you have criminal records?
Yes
No
Emergency contact full name
Emergency contact number
Please fill in the health insurance coverage form and upload it
Please fill in the health compliance form and upload it
Please attach your COMPLETE covid-19 vaccination certificate or card photo
Your agent's name
Pick Your Agent Name
Monica
Dodo
Greta
Send
health insurance coverage form download link
health compliance form download link
