VISA FORM 2

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FORM VISA AUSTRALIA

Full Name I PUTU GUNAWAN


: ............................................................................................................
Address Jl. Perum Griya Kencana Tosca
: ............................................................................................................
Serongga, Gianyar, Gianyar Bali
.............................................................................................................
Home Phone Number 087811582855
: ............................................................................................................
Home Phone Number 2 -
: ............................................................................................................
Email [email protected]
: ............................................................................................................

Job / School / College Data


Company / School Name : ............................................................................................................
PT. Bintang Bali Indah
Address Jl. Raya Sempidi No.2
: ............................................................................................................
Mengwi, Badung
.............................................................................................................
Phone Number 0361433436
: ............................................................................................................
Grade / Position Operative Area
: ............................................................................................................
January 2017
Working / Attending school since (year and month) : ............................................................

Travel Data
- Have you ever had an Australian visa before? (if yes, please attach the old visa)
- Have you ever traveled to Australia before?
- Planned departure and return dates from Australia:
- Purpose of trip to Australia:
- Have you ever been rejected when applying for a visa before? If yes, please state what visa)

Family Data in Indonesia


Is there any biological family (father, mother, brothers/sisters) who did not go to Australia?
Yes
If yes, please fill it in : ......................................................................................................................
Father's Full Name I Gusti Agung Hermawan
: ......................................................................................................................
29 March 1971
Father's Date of Birth : ......................................................................................................................

Mother's Full Name Ni Putri Rayani


: ......................................................................................................................
11 October 1973
Father's Date of Birth : ......................................................................................................................

Sister Full Name Ni Kadek Lucy


: ......................................................................................................................
Sister Date of Birth 04 July 1992
: ......................................................................................................................

Brother Full Name I Made Gusti


: ......................................................................................................................
08 May 1997
Brother Date of Birth : ......................................................................................................................

Relative Data in Australia


Do you have relatives living in Australia?
Do you have relatives living in Australia?
- Copy paspor
- Copy residence permit
- complete address, telephone number and email
- Proof of relationship with the participant (such as birth certificate, marriage certificate)
- Invitation Letter

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