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IM.12

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JABATAN IMIGRESEN MALAYSI
A
BORANG PERMOHONAN PAS LAWATAN
VISIT PASS APPLICATION FORM
PERATURAN-PERATURAN IMIGRESEN, 1963 [Peraturan 11(12) dan 11(15)]
*Jenis Pas
T
yp
s
*Jenis Permohonan
T
yp
e of A
pp
lication
Iktisas
Professiona
l
Sosial
Social
Berniaga
Business
Kerja Sementara
Temporary Employment
Baru
New
Lanjutan
Extension
A. MAKLUMAT PEMOHON
PARTICULARS OF APPLICANT
1.
Nama Penuh (Huruf Besar)
Full Name (Capital Letter)
Gambar Pemohon
Photograph Of
Applicant
(3.5 cm x 5.0 cm)
2. *Jantina
Gender
Lelaki
Male
Perempuan
Female
3. Tempat/Negara Lahir
Place/Countr
y
of Birth
4. **Tarikh Lahir
Date of Birth
hari bulan tahun
da
y
month
y
ear
5. Warganegara
Nationality
B. MAKLUMAT PASPORT PERJALANAN / DOKUMEN PERJALANAN
PARTICULARS OF PASSPORT / TRAVEL DOCUMENT
6. Jenis Dokumen Perjalanan
Type of Travel Document
7. Nombor
Number
8. Tempat / Negara Dikeluarkan
Place / Country of Issue
9. **Sah Sehingga
Valid Until
hari bulan tahun
month
C. MAKLUMAT PENGANJUR DI MALAYSI
A
PARTICULARS OF SPONSOR IN MALAYSIA
IM. 12 - Pin. 1/97
10. Nama Penuh (Huruf Besar)
Full Name (Capital Letter)
11. No. Kad Pengenalan
NRI
C
12. No. Telefon
Tele
p
hone No.
13. Alamat
Address
Negeri
State
D. KEPERLUAN VISA
VISA REQUIREMENT
14. *Adakah Visa Diperlukan
Visa Requirement
Tidak
No
15. *Jenis Visa
T
yp
e of Visa
Sekali Perjalanan
Sin
g
le Entr
y
Berulangkali Perjalanan
Multi
p
le Entr
y
Tarikh
Date
Tandatangan Pemohon / Penganjur
Si
g
nature of A
pp
licant / S
p
onsor
• Borang ini hendaklah ditaip. Tandakan (x) dalam petak yang berkenaan.
This form should be typed. Mark (x) in the appropriate box
.
** Format Tarikh 99/99/9999
Date Format DD/MM/YYYY
day month year
Yes
Ya
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IM.12

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Completed 17 June 2022

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