Fillable VISA APPLICATION FORM

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JABATAN IMIGRESEN MALAYSIA BORANG PERMOHONAN VISA APPLICATION FORM

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  • 14 check-boxes
  • 22 other fields

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JABATAN IMIGRESEN MALAYSI
A
BORANG PERMOHONAN VISA
VISA APPLICATION FORM
*Jenis Permohonan
T
yp
e of A
pp
lication
A. MAKLUMAT PEMOHON
PARTICULARS OF APPLICANT
1. Nama Penuh (Huruf Besar)
Full Name (Capital Letter)
Gambar
Pemohon
Photograph Of
Applicant
(3.5 cm 8 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
Nationalit
y
B. MAKLUMAT PASPORT PERJALANAN / DOKUMEN PERJALANAN
PARTICULARS OF PASSPORT / TRAVE
L DOCUMENT
IM. 47– Pin. 1/97
• 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
Dalam Malaysia
In Mala
sia
Seberang Laut
Oversea
7. Alamat
Address
6. Pekerjaan
Occupation
8. Taraf Perkahwinan
Marital Status
Belum Berkahwin
Single
Berkahwin
Married
9. Jenis Dokumen Perjalanan
T
yp
e Of Travel Documen
t
11. Tempat / Negara DiKeluarkan
Place/ Country Of Issue
10. Nombor
Number
12. **Sah Sehingga
Valid Unti
l
hari bulan tahun
da
y
month
y
ear
• 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
Tarikh
Date
Tandatangan Pemohon / Penganjur
Si
g
nature of A
pp
licant / S
p
onsor
C. BUTI
R
-BUTIR PENGANJUR DI MALAYSI
A
PARTICULARS OF SPONSOR IN M
ALAYSIA
13. Nama Penuh ( Huruf Besar)
Ful Name
(
Ca
p
ital Letter
)
14. No.Kad Pengenalan
NRI
C
16. Alamat
A
ddres
s
15. No Telefon
Tele
p
hone No.
Negeri
State
D. BUTI
R
-BUTIR PERMOHONAN
DETAIL OF APPLICATION
17. Tempoh Tinggal Yang Dicadangkan
Duration Of Pro
p
osed Sta
y
18. *Tujuan Perjalanan
Pur
p
osed Of Journe
y
Bercuti
Holida
y
Bekerja
Em
p
lo
y
men
t
Belajar
Stud
y
Transit
Transi
t
Lain-lain (Nyatakan)
Other S
p
ecif
y
Persidangan
Conference
Bulan
Month
Melawat Saudara Mara / Kawan
Visitin
g
Friends / Relative
s
Urusan Rasmi
Official Tri
p
Urusan Perniagaan
Busines
s
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JABATAN IMIGRESEN MALAYSIA BORANG PERMOHONAN VISA APPLICATION FORM

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Completed 2 March 2020

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