Ministry of Foreign Affairs of the Republic of Uzbekistan

Visa Application
Registration date: 2016.02.26

Surname

Expiration date: 2016.05.26

Previous Surname

DARMAWAN
First Name

Previous First Name

Joesef
Other Names

Previous Other Names

Date of Birth

Place of Birth

Country of Birth

Citizenship

01.09.1957

JAKARTA

Indonesia

Indonesia

Previous Citizenship

Passport Type

Passport Number

Date of Issue

Issue By

Expiration Date

Ordinary

A3890128

05.10.2012

IMIGRATION OFFICE SOU

05.10.2017

Sex

Marital Status

Spouse's Surname, First and Other Names

Planned Period of Visit (from-to)

Male

Married

DJAJA PUDJIATI FINNY

13.04.2016 - 18.04.2016

Number of Entries

Duration of Stay

Duration of Visa Procedure

Place of Visa Issuance

One

Usual

Jakarta

Route for transit through the territory of the Republic of Uzbekistan (cities):
TAS
Purpose of Visit
To Referee The 2016 Asian Judo Championship in Tashkent.
Inviting Party
Judo Union Of Asia
Occupation
Representatives of non-governmental and public organizations
Place of Work (Study) and Position
ALL INDONESIA JUDO FEDERATION AND POSITION AS JUDO REFEREE
Work (Study) Address and Phone
INDONESIA, JAKARTA, JALAN PINTU SATU SENAYAN, +622157940079, pbpjsi88@gmail.com
Home Address,Phone and E-mail
INDONESIA, BOGOR, PERUM BOGOR LESTARI NO 21, +628129119188, josefjudo@yahoo.co.id
Address in Uzbekistan
A. Kadiriy7A str., Shaykhontokhur dstr., Tashkent, Uzbekistan 100128, +998712326231.
Previous Visits to Uzbekistan
13 October 2014 - 19 October 2014, To Referee Judo Grand Prix Tashkent 2014, Judo Union of Asia
Accompanied Persons
Applicant's signature ______________

Date (dd.mm.yyyy): ______________

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