Willing Statement Letter

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WILLING STATEMENT LETTER

October 10, 2020

To : DIREKTORAT JENDERAL IMIGRASI


Subject : Willing Statement Letter Quarantine

I, the undersigned below :


Name : BELINGA PIERRE CHRISTIAN
Passport Number : 0591558
Nationality : Cameroon
Address : Makepe Happy Sport House Al-Shadai 1112, Street 01,
Cameroon.
To declare together with this statement that:
As a citizen of Cameroon who is about to enter the jurisdiction of Indonesia, I am willing
to enter quarantine and / or treatment at my own expense at a quarantine facility or health service
facility designated by the government if the PCR examination by the Indonesian health
authorities at the entrance of the country gives a positive result (+), or there are clinical
symptoms of COVID-19 in accordance with health protocols and statutory provisions;
This is a letter that states my willingness to complete the requirements for processing a
visa (permit to enter the territory) of the Republic of Indonesia.

Sincerely,

BELINGA PIERRE CHRISTIAN


WILLING STATEMENT LETTER
October 10, 2020

To : DIREKTORAT JENDERAL IMIGRASI


Subject : Willing Statement Letter For Monitoring

I, the undersigned below :


Name : BELINGA PIERRE CHRISTIAN
Passport Number : 0591558
Nationality : Cameroon
Address : Makepe Happy Sport House Al-Shadai 1112, Street 01,
Cameroon.
To declare together with this statement that:
As a citizen of Cameroon who is about to enter the jurisdiction of Indonesia, I am
willing conducted independent health monitoring during the quarantine or isolation period in
accordance with health protocols and statutory provisions;

This is a letter that states my willingness to complete the requirements for processing a
visa (permit to enter the territory) of the Republic of Indonesia.

Sincerely,

BELINGA PIERRE CHRISTIAN


WILLING STATEMENT LETTER
October 10, 2020

To : DIREKTORAT JENDERAL IMIGRASI


Subject : Willing Statement Letter Personal Health Funding Capabilities

I, the undersigned below :


Name : BELINGA PIERRE CHRISTIAN
Passport Number : 0591558
Nationality : Cameroon
Address : Makepe Happy Sport House Al-Shadai 1112, Street 01,
Cameroon.
To declare together with this statement that:
As a citizen of Cameroon who is about to enter the jurisdiction of Indonesia, I am
willing to do all payment independently for treatment and recovery at health service facilities -
owned by the private sector or the local government - according to Indonesian government
standards in the COVID-19 response protocol if affected by COVID-19 while in Indonesia.

This is a letter that states my willingness to complete the requirements for processing a
visa (permit to enter the territory) of the Republic of Indonesia.

Sincerely,

BELINGA PIERRE CHRISTIAN

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