KEMENTERIAN HUKUM DAN HAK ASASI MANUSIA

REPUBLIK INDONESIA
KANTOR WILAYAH SUMATERA UTARA
KANTOR IMIGRASI KLAS I POLONIA
Jl. MANGKUBUMI NO. 2

III B
IZIN TINGGAL TERBATAS ELEKTRONIK
ELECTRONIC LIMITED STAY PERMIT

NIORA : G1U1MBE88913

Permit Number : 2C21G10097-R

Stay/Multiple Entries Permit Expiry : 22-08-2018

Full Name : RAVIARASAN MAHGAIDREN

Place / Date of Birth : SELANGOR / 13-05-1995

Passport Number / Date of Expiry : A39983044 / 18-10-2022

Nationality : MALAYSIA

Sex : MALE

Address : JL. SEI PADANG NO. 36 B KEL. MERDEKA

Occupation : MAHASISWA

Notice:
1. According to Article 71 Act Number 6 Year 2011 concerning Immigration, every changes of civil status, citizenship,
occupation, Guarantor, or change of address must be reported to Local Immigration Office in an immediate period of
time.
2. This Limited Stay Permit (Electronic) must be attach to the bearers Passport at all times
3. For further information please do not hesitate to contact Local Immigration Office or do visit our website
www.imigrasi.go.id.

Polonia, 02-08-2017

Head of Klas I Polonia Immigration Office.