FORM VISA AUSTRALIA

Nama Lengkap : ............................................................................................................

Alamat Rumah : ............................................................................................................
.............................................................................................................
No Telpon Rumah : ............................................................................................................
No HP (aktif) : ............................................................................................................
Email : ............................................................................................................

Data Pekerjaan / Sekolah / Kuliah

Nama Perusahaan / Sekolah : ............................................................................................................
Alamat : ............................................................................................................
.............................................................................................................
No Telpon : ............................................................................................................
Jabatan / Kelas / Jurusan : ............................................................................................................
Bekerja / Bersekolah sejak (tahun dan bulan) : .....................................................................................

Data Perjalanan
- Apakah sebelumnya pernah punya visa Australia ? (jika ya, mohon lampirkan visa lama nya)
- Apakah sebelumnya pernah bepergian ke Australia ?
- Rencana tanggal keberangkatan dan kepulangan dari Australia :
- Tujuan Perjalanan ke Australia :
- Apakah sebelum nya pernah ditolak saat pengajuan visa ? Jika Ya, sebutkan visa apa)

Data Keluarga di Indonesia

Apakah ada keluarga kandung (ayah, ibu, kakak / adik) yang tidak ikut pergi ke Australia?
Jika Ya, mohon diisi : ......................................................................................................................
Nama Lengkap Ayah : ......................................................................................................................
Tanggal Lahir Ayah : ......................................................................................................................

Nama Lengkap Ibu : ......................................................................................................................

Tanggal Lahir Ibu : ......................................................................................................................

Nama Lengkap Kakak : ......................................................................................................................

Tanggal Lahir Kakak : ......................................................................................................................

Nama Lengkap Adik : ......................................................................................................................

Tanggal Lahir Adik : ......................................................................................................................

Data Saudara di Australia

Apakah mempunyai Saudara yang tinggal di Australia ?
Jika Ya, mohon lampirkan data Saudara di Australia :
- Copy paspor
- Copy ijin tinggal
- alamat lengkap, no telpon, dan email
- Bukti hubungan dengan peserta (seperti akte lahir, akte nikah)
- surat undangan