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    Form Visa Dhaffa Gilang

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    Dhaffa GA
    This document is a visa application form to enter Japan. It requests information such as the applicant's name, date of birth, passport details, purpose and duration of visit, accommodation arrangements, employment, criminal history, and consent to provide personal information to Japanese authorities. The applicant declares that the information provided is true and will be used appropriately under Japanese law.

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    © All Rights Reserved
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    Form Visa Dhaffa Gilang

    Uploaded by

    Dhaffa GA
    16 views2 pages
    This document is a visa application form to enter Japan. It requests information such as the applicant's name, date of birth, passport details, purpose and duration of visit, accommodation arrangements, employment, criminal history, and consent to provide personal information to Japanese authorities. The applicant declares that the information provided is true and will be used appropriately under Japanese law.

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    © © All Rights Reserved

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    This document is a visa application form to enter Japan. It requests information such as the applicant's name, date of birth, passport details, purpose and duration of visit, accommodation arrangements, employment, criminal history, and consent to provide personal information to Japanese authorities. The applicant declares that the information provided is true and will be used appropriately under Japanese law.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    16 views2 pages

    Form Visa Dhaffa Gilang

    Uploaded by

    Dhaffa GA
    This document is a visa application form to enter Japan. It requests information such as the applicant's name, date of birth, passport details, purpose and duration of visit, accommodation arrangements, employment, criminal history, and consent to provide personal information to Japanese authorities. The applicant declares that the information provided is true and will be used appropriately under Japanese law.

    Copyright:

    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    You are on page 1of 2

    VISA APPLICATION FORM TO ENTER JAPAN

    (Paste photo here)

    45mm ×35mm
    Official use only
    or 2in x 1.4in

    Surname (as shown in passport) RAMADHAN


    Given and middle names (as shown in passport) DHAFFA GILANG
    Other names (including any other names you are or have been known by)
    NONE
    Date of birth 21/11/2001 Place of birth BLITAR JAWA TIMUR INDONESIA
    (Day)/(Month)/(Year) (City) (State or Province) (Country)
    Sex: Male Female Marital status: Single Married Widowed Divorced
    Nationality or citizenship INDONESIA
    Former and/or other nationalities or citizenships NONE
    ID No. issued to you by your government 3505182111010003
    Passport type: Diplomatic Official Ordinary Other Passport No. E2852769
    Place of issue BLITAR Date of issue 26/04/2023
    (Day)/(Month)/(Year)
    Issuing authority IMMIGRATION OFFICE Date of expiry 26/04/2033
    (Day)/(Month)/(Year)
    Certificate of Eligibility No.
    WORK AS SPECIFIED SKILLED WORKER
    Purpose of visit to Japan/Status of residence
    Intended length of stay in Japan 1 YEAR Date of arrival in Japan 27 JULY 2023
    Port of entry into Japan NARITA Name of ship or airline SCOOT
    Names and addresses of hotels or persons with whom applicant intends to stay
    Name YAIMA PLANNING CO LTD Tel. 098-891-6244
    329 NAKACHI TOMIGUSUKU SHI OKINAWA
    Address
    Dates and duration of previous stays in Japan -
    Your current residential address (if you have more than one address, please list them all)
    DSN SUMBERURIP RT 004 RW 001 SUMBERURIP DOKO BLITAR JAWA TIMUR
    Address
    Tel. - Mobile No. 085156173499
    E-Mail nget.onget77@gmail.com
    Current profession or occupation and position
    Name and address of employer

    Name Tel.

    Address
    (Note)Partner's profession/occupation (or that of parents, if applicant is a minor):
    -
    Guarantor or reference in Japan(Please provide details of the guarantor or the person to be visited in Japan)
    Name MASANORI MURATA Tel. 098-891-6244
    329 NAKACHI TOMIGUSUKU SHI OKINAWA
    Address
    Date of birth - Sex: Male Female
    (Day)/(Month)/(Year)
    Relationship to applicant EMPLOYER
    Profession or occupation and position CEO
    Nationality and immigration status JAPAN NATIONAL
    Inviter in Japan(Please write 'same as above' if the inviting person and the guarantor are the same)
    Name SAME AS ABOVE Tel.

    Address
    Date of birth Sex: Male Female
    (Day)/(Month)/(Year)
    Relationship to applicant
    Profession or occupation and position
    Nationality and immigration status
    (Note)Remarks/Special circumstances, if any
    Have you ever:
    ● been convicted of a crime or offence in any country? Yes No
    ● been sentenced to imprisonment for 1 year or more in any country?(Note 2) Yes No
    ● been deported or removed from Japan or any country for overstaying your visa or violating
    any law or regulation? Yes No
    ● been convicted and sentenced for a drug offence in any country in violation of law
    concerning narcotics, marijuana, opium, stimulants or psychotropic substances?(Note 2) Yes No
    ● engaged in prostitution, or in the intermediation or solicitation of a prostitute for other
    persons, or in the provision of a place for prostitution, or any other activity directly
    connected to prostitution? Yes No
    ● committed trafficking in persons or incited or aided another to commit such an offence? Yes No
    (Note 2) Please tick “Yes” if you have received any sentence, even if the sentence was suspended.
    If you answered “Yes” to any of the above questions, please provide relevant details.

    “I hereby declare that the statement given above is true and correct. I understand that immigration status and period of stay to
    be granted are decided by the Japanese immigration authorities upon my arrival. I understand that possession of a visa does not
    entitle the bearer to enter Japan upon arrival at port of entry if he or she is found inadmissible.”
    “I hereby consent to the provision of my personal information (by an accredited travel agent, within its capacity of representing
    my visa application) to the Japanese embassy/consulate-general and (entrust the agent with) the payment of my visa fee to the
    Japanese embassy/consulate-general, when such payment is necessary.”

    Date of application Signature of applicant


    (Day)/(Month)/(Year)
    (Note)It is not mandatory to complete these items.

    Any personal information filled in this application form as well as additional personal information submitted for the visa
    application (hereinafter referred to as "Retained Personal Information?) will be handled appropriately by the Ministry of Foreign
    Affairs of Japan (including Japanese overseas establishments) in accordance with the Act on the Protection of Personal
    Information (Act No. 57 of 2003, hereinafter, ?the Act?). Retained Personal Information will only be used to the extent necessary
    for the purpose of processing the visa application (including providing personal information to the transportation company
    which you are going to travel with, or the alternative transportation company which you are going to travel with due to
    unforeseen circumstances), immigration control, international cooperation and for other purposes in compliance with Article 69
    of the Act.

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