Application for BIPA Student

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Before filling this form, you must prepare all the required documents for registration, the list of all required documents can be found here

(Provide your name exactly as it appears on your passport)

(appears on passport)

Passport (Specify date and country issued)
Home Address
Address in Indonesia
Educational Background (List of your recent colleges or university)
Visa Information (Indicate which Indonesian Embassy or Consulate General you are going to apply your visa)

Health Insurance Information

Along with your completed application form, please enclose the following required documents

Allowed file type is pdf with max 3 mb file size

Allowed file type is pdf with max 3 mb file size

Allowed file type is pdf with max 3 mb file size

Allowed file type is pdf with max 3 mb file size

Allowed file types are jpg, jpeg, png with max 2 mb file size

Allowed file type is pdf with max 3 mb file size

Allowed file type is pdf with max 3 mb file size

Allowed file type is pdf with max 3 mb file size

Allowed file type is pdf with max 3 mb file size

Allowed file type is pdf with max 3 mb file size

Allowed file type is pdf with max 3 mb file size

Allowed file type is pdf with max 3 mb file size

If more than one, all family member’s passport merge in one pdf file with max 10 mb file size

If more than one, all children birth certificates merge in one pdf file with max 10 mb file size

If more than one, all Passport size photographs with white color of background upload here in jpg, jpeg, png with max 2 mb file size each.