MINISTRY OF LAW AND HUMAN RIGHTS OF THE REPUBLIC OF INDONESIA
DIRECTORATE GENERAL OF IMMIGRATION
                                                                                                             B211A
Jakarta, 30/06/2021
Dear,
ZOE ADELE MC DOUGALL
DENPASAR
We would like to inform you that your visa application has been approved, with the following data:
(This document contains the approval of your visa application, with the following data)
A. VISA DATA
   ID/ Application Number                          :   170436176210427
   Visa Type                                       :   VISIT
   Visa Registration Number                        :   2A12IM27398JV
   eVisa Number                                    :   EVV0081752LN
   Visa must be used by                            :   30/09/2021
   Length of Stay in Indonesia                     :   60 DAY
B. APPLICANT DATA
   Gender                                          :   FEMALE
   Place of Birth                                  :   CALIFORNIA
   Date of Birth                                   :   17/01/2000
   Nationality                                     :   UNITED STATES OF AMERICA
   Passport Type                                   :   PASPOR
   Passport Number                                 :   584186660
   Place of Issue                                  :   UNITED STATES DEPARTMENT OF STATE
   Passport Expiry Date                            :   28/01/2029
   Address in Indonesia                            :   DENPASAR
INFORMATION:
1. Foreign Nationals are required to present the same Travel Document used for the E-Visa application
   Immigration Inspectors at Immigration Check Points / Inspections;
2. Foreign Nationals are subject to all Indonesian Laws and health protocols which is being enforced;
3. Stay Permit Extension may be done at a local Immigration Office, nearest to place of residence, when
   applicable;
4. Foreign Nationals with Electronic Limited Stay Permit Visa are required to register at a local Immigration
   Office, without leaving Indonesian territory, maximum 30 days after the e-visa is issued;
5. For more information, please visit www.imigrasi.go.id.
                       H.R. Rasuna Said Blok X 6 Kav. 8, Kuningan, South Jakarta . Call Centre 021-1500116