New Registration Form for Limited Stay Foreigner Extension

Data of applicant

Applicant
Format : bulan/tanggal/tahun (month/date/year)
Format : bulan/tanggal/tahun (month/date/year)
Format : bulan/tanggal/tahun (month/date/year)
Format : bulan/tanggal/tahun (month/date/year)
Format : bulan/tanggal/tahun (month/date/year)
Format : bulan/tanggal/tahun (month/date/year)

if it exceeds the reporting deadline that has been set, it will be subject to an administrative fine of Rp.500,000, - by transferring to the Bank Jatim account number 011.125.5728 a.n Bend.Pnrm.Capil


Type of file (*jpg) and file size 200kb