KEMENTERIAN HUKUM DAN HAK ASASI MANUSIA

REPUBLIK INDONESIA
KANTOR WILAYAH DKI JAKARTA
KANIM KELAS I NON TPI JAKARTA PUSAT
JL. MERPATI BLOK B 12 / 3 KEMAYORAN

IZIN TINGGAL TERBATAS ELEKTRONIK

ELECTRONIC LIMITED STAY PERMIT

NIORA : ECU1QAR90652
Permit Number : 2C11JD0735-X
Stay/Multiple Entries Permit Expiry : 27-05-2024
Stay Permit Index : IB

Full Name : DOROTHEA MAGDALENA THIELKE

Place / Date of Birth : ZAFF / 08-06-1966
Passport Number : M00146771
Passport Expiry : 07-05-2025
Nationality : AFRIKA SELATAN
Gender : FEMALE
Address : MNC TOWER LT 18 JL KEBON SIRIH NO 17-19 JAKARTA
Occupation : HOUSEWIFE
Status : FAMILY UNION
Guarantor Name : PT MNC LAND LIDO

DISCLAIMER :
1. According to Article 71 Act Number 6 Year 2011 concerning Immigration, every changes of civil status, citizenship, occupation,
Guarantor, or change of address must be reported to Local Immigration Office in an immediate period of time.
2. This Limited Stay Permit (online) must be attach to the bearer’s Passport at all times
3. For further information please do not hesitate to contact Local Immigration Office or do visit our website www.imigrasi.go.id
4. This Electronic Limited Stay Permit is generated automatically by the Immigration Information Management System

Jakarta Pusat, 15-06-2023

Head of Kelas I Non TPI Jakarta Pusat Immigration Office.