Zoe Adele MC Dougall

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MINISTRY OF LAW AND HUMAN RIGHTS OF THE REPUBLIC OF INDONESIA

DIRECTORATE GENERAL OF IMMIGRATION

B211A
Jakarta, 30/06/2021

Dear,
ZOE ADELE MC DOUGALL
DENPASAR

We would like to inform you that your visa application has been approved, with the following data:
(This document contains the approval of your visa application, with the following data)
A. VISA DATA
ID/ Application Number : 170436176210427
Visa Type : VISIT
Visa Registration Number : 2A12IM27398JV
eVisa Number : EVV0081752LN
Visa must be used by : 30/09/2021
Length of Stay in Indonesia : 60 DAY

B. APPLICANT DATA
Gender : FEMALE
Place of Birth : CALIFORNIA
Date of Birth : 17/01/2000
Nationality : UNITED STATES OF AMERICA
Passport Type : PASPOR
Passport Number : 584186660
Place of Issue : UNITED STATES DEPARTMENT OF STATE
Passport Expiry Date : 28/01/2029
Address in Indonesia : DENPASAR

INFORMATION:
1. Foreign Nationals are required to present the same Travel Document used for the E-Visa application
Immigration Inspectors at Immigration Check Points / Inspections;
2. Foreign Nationals are subject to all Indonesian Laws and health protocols which is being enforced;
3. Stay Permit Extension may be done at a local Immigration Office, nearest to place of residence, when
applicable;
4. Foreign Nationals with Electronic Limited Stay Permit Visa are required to register at a local Immigration
Office, without leaving Indonesian territory, maximum 30 days after the e-visa is issued;
5. For more information, please visit www.imigrasi.go.id.

H.R. Rasuna Said Blok X 6 Kav. 8, Kuningan, South Jakarta . Call Centre 021-1500116

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