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REPUtIL!l( llrJ DCIN [.S l;1 REPUALIC OF INDO LSIA PASPOR PASSPORI IDN B?87$156 ZAINAL ABIDIN
REPUtIL!l(
llrJ DCIN [.S
l;1
REPUALIC
OF INDO LSIA
PASPOR
PASSPORI
IDN
B?87$156
ZAINAL ABIDIN
INDONESIA
22 MAY t99t
t/M
MAROS
07 AUG 2017
a7 AUG 20?2
NrKrM1.tOt29s{4558
1A13F82619CRPX
MAKASSAR
87 E7 6156<7 7DNg105229n??08073730904?20 5 oOO2 52
GOVERNMENT OF PAKISTAN VISA APPUCATON FORM (Please read these instructions carcfully before filling in the
GOVERNMENT OF PAKISTAN
VISA APPUCATON FORM
(Please read these instructions carcfully before filling in the application fom)
1.
No column should be left blank. Incomplete forms with vague entries shall not be
accepted. Where applicable copies of supporlive documents 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.
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.
b.
On anival, immigration formalities are mandatory. (Police registration is applicable in
certain cases).
7.
Attach blank statement for business visit.
8. Applicant's family" includes spouse, son, daughter, father, mother,.
PART. I
1. Type of visa aoplied for:
Diplomatic I
officiat E
tv]ititary n
Business n
Tourist E
(speciS-
Family E Transit E Journalist f] Othersg
2. Purpose of Visit:
TABLIGH VISA
3. Duration of Stay: 45 DAys
4. Visa required for: Less than 01 l\4onth E 06 Months !
Ot Vear I
OZ Years E 05 years E
5. Tvpe of Visa: Single Entry !l
Doubte Entry !
Muttipte Entry !
Port of Entry LAHoRE
ii. Port of DepartureJAKABIA
Places to be visited in Pakistan:
a.laHQBE
b.
. C
d.
6 SECTION I (APPLICANT'S DETAILS}
I Name as in Passport: ZAINAL
First
M ddle
Last
ii. Date of Birth:
22 /95
191
dd/mm/yy
iii. Place of Birth:
MAROS
City:
Country: INDONESIA
iv. Sex:
Male fl
Female tl
V.Blood Group:
vi. MaritalStatus: Single Z l\ilarried tr viii. Native Language: tNDoNES|A Nationality: (a) Present INDONESIA (b)
vi. MaritalStatus:
Single Z
l\ilarried tr
viii. Native Language: tNDoNES|A
Nationality: (a) Present INDONESIA (b) Previous
(c) Dual
Religion: MoSLEM
PASSPORT DETAILS:
Type of passport:: Diplomatic !
Official i Service !
OrOinary [
UN Travel Documents tr
87876156
Passport Number:
place of lssue: MAKASSAR
Date of lssue: 07lOAl2O17
Date of Expiry: o7108/2022
IMMIGRATION OF MAKASSAR
lssuing Authority:
ADDRESS & EMAIL:
JL. TAQWA DESA BAJU BANDAN
a. Abroad / Country of Origin.
KAB. MAROS - SULAWESI SELATAN
Telephone: (i) Home :
(ii)Work:
(lll) Csll +62812 4341 1877
b. ln Pakistan. MADRASSaH aRABla RAIwlND - LAHoRE
(ii) Work:
Telephone;
(i) Home :
(lll) Cell
Email:
tr
Z
ls your visit sponsored?
Yes
lf yes, give details.
/Vame of Sponsor
Iddress
Contect numbet
Home:
Work:
Cell:
xtv.
DETAILS OF PROFESSION
a. Profession (Please specify Rank / Service, in case of Armed Forces / Uniform Personnel):
BUSINESS
Xglgi ln case of military services, Please fill in the atrached Performa.
b. Employer's / Sponsor's details ( in Pakistan / Abroad (if Applicable)
Telephone No.
Email
Name
Address
Home
Office
Cellular
Address
xv, DETAILS OF JOBS HELD IN THE PAST: a. Designationl b. Department: c. Duration (ftom
xv,
DETAILS OF JOBS HELD IN THE PAST:
a.
Designationl
b. Department:
c.
Duration (ftom
-
to)
d. Duties:
e.
Address & Phone No.
f:
Name, address and contract numbers of immediate boss/head and any other colleague:
(use extra sheet if required)
No
Z
xvr.
Are you applying visa from a third country? Yes tr
lf yes, please provide copy of residence / work permit of that country.
7. SECTION II ( FAMILY DETAILS}
i,
Name of [4other HASUN
I Nationality of l\4other tNpoNESlA
iii. |11smg 61Ps1661. MASSE
Nationality of Father tNDoNEStA
Spouse details:
Name
Nationality
Date and place of birth
Profession
Name, Address and contact number of employer of spouse (if any)
vi. Do
YestrNoZ
you have any children?
lf yes, please provide details for each of your child.
Name
Date of Birth
vii. Please list any of accompanying person i family member (including children) traveling with you to
Pakistan.
Full Name, Date of Bitth,
Passport Number (if any)
Address
tr
Z
Do you have any bank account in Pakistan?
Yes
No
Bank Name Branch
AlC Number Address
Verifiet details
I TMVEL HISTORY: tr g I Have you ever visited Pakistan during last five years?
I TMVEL HISTORY:
tr
g
I Have you ever visited Pakistan during last five years? Yes
No
if yes, please
Provide details.
Date
Desfination / Address
Purpos e
Dwation
1.
)
3.
4.
5.
Details ofother countries visited, during last two years,
Date
Destination / Address
Purpos e
Duration
1.
)
3.
4.
5.
ENo U
t. Have you ever been refused a visa for any country, including Pakistan? Yes
lNo Z
iv Have you ever been refused entry on arrival to Pakistan?
Yes
lf yes, please provide details of refusal.
Have you ever been deported, removed or otherwise required lo leave any country, including Pakistan?
Yes n
No
A
Ifyes, please provide details.
Date
Country Reason
Reference Number (for Pakistan)
tr
Z
Do you have any criminal convictions
or charged in any country?
Yes
No
Date
Country
Offence
Sentence
DECLAMTION:
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 i cancelled at any time
Dated:
(Signature of Applicant)
PART- II PROCESSING CERTIFIGATION 1. Date of receipt of Visa Application: 2. Registration Number: J.
PART- II
PROCESSING CERTIFIGATION
1. Date of receipt of Visa Application:
2. Registration Number:
J.
Visa fee received:
4.
Additional Documents received:
a.
b.
d.
( Particulars of ofiicial who checked the visa form for its conectness and supporting documents.
a. Name
b. Designation
b. Date
c. Signature_
Details of clearance received from Ministry of lnterior.
Dated
7. Decision by officer in-charge.
a.
Accepted
tr
b.
Regretted
c.
Type of Visa issued.
d.
Duration
e.
f.
Single Entry
Multiple Entry
Dated:
(Signature of Visa lssuing Authority)