Single entry application

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Personal information

Name*

First name*

Last name*

Country of birth*

Day*

Month*

Year*

Gender*

Male

Female

Nationality*

Marital Status*

Current address in your country*

Address in Indonesia (accommodation address, Hotel, Villa etc)*

Your email*

Please make sure the email is correct. We will send the visa to this email.

Mobile phone number*

WhatsApp number

Travel document

Type of travel document*

Passport

Other Travel Document

Travel document number*

Date of issue

Day*

Month*

Year*

Day*

Month*

Years*

Country of issue*

Emergency contact details (family member, etc)

Relationship with the emergency contact*

Full name*

Address:*

Phone number*

WhatsApp number

Email address*

Supporting documents

Description of your activity in Indonesia

Have you ever been deported from Indonesia?*

Yes

Have you ever overstayed in Indonesia?*

Yes

Visit period

Arrival date*

Departure date

Upload documents
In order to process your request faster, please upload the required documents. Here is the recap of what you need to upload:

Scan of passport's cover (view example)
Scan of passport's first page - minimum validity 18 months
Return flight ticket (The dummy one)
Bank statement (last 3 months) min USD $1500
Personal insurance
A health certificate stating you are free from COVID-19
Quarantine statement (to download click here)
Health monitoring statement (to download click here)

Upload or drag and drop the files here (pdf,jpg,png,gif only). Maximum total file size - 20mb*

Confirmation

Payment option
For the moment we accept only bank transfers. After we receive and review your application request, we will send you by email an invoice along with the payment instructions.

We will process your application once the funds are cleared in our account.

Terms and conditions apply. We follow the Immigration of Indonesian policy and regulation.
No refund if cancellation during the process.
Visa Refusal will be refunded 100%

(Due to the number of people applying and for the safety and security of your personal information, we ask that all communication be through emails unless urgent). Due to confidentiality and privacy, we cannot discuss any application process or progress with a third party, unless given written approval from the applicant themselves. Or if you are making an application on behalf of a minor under 18 years of age.

Statement Letter

I declare that all data and documents that I have provided are genuine and correct. I am following the law in Indonesia and will take full responsibility for any wrong information I provide.
I will not receive payment of any kind whilst visiting Indonesia.
I am visiting Bali, Indonesia for Specific purposes only on the application I will take full responsibility for my personal Financial needs and any criminal activities I perform within Indonesia.
I hereby state that, I am willing to quarantine and / or get treatment by my own expense for the quarantine facility or health service facility designated by government, if the result of the PCR examination by Indonesian Healthy Center gives positive at the entrance of the country or there are clinical symptoms of COVID-19 based on the protocol and health statutory provisions.

I believe that the facts stated in the witness statement are true

Yes, I agree

This field should be left blank

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