Jl. Gunung Sahari Raya No. 1
Komp. Ruko Mangga Dua Square Blok B No. 3 & 5, Jakarta Utara 14430, Indonesia Tel: (021) 6231 3500 Fax: (021) 6231 3056
Website: www.availelok.co.id
PT AVAIL ELOK INDONESIA
MEMORANDUM
INA/MM-MKT1601/011
Kepada
: Availian
Tanggal
: 20 Januari 2016
Perihal
: Insentif Wisata Zhangjiajie, China 2016
_________________________________________________________________________________________________________________
Salam Ceria Cemerlang,
Bersamaan dengan memo ini kami informasikan kepada Availian bahwa program “ Insentif
Member Get Member “ yang berlangsung mulai bulan bonus Januari – Desember 2015 telah
berakhir dan kami ucapkan selamat kepada Anda yang telah mampu mencapai apa yang
diinginkan.
Dengan berakhirnya masa program tersebut maka Wisata Zhangjiajie, China akan dilaksanakan
dengan detail sebagai berikut :
Tanggal Keberangkatan
: 24 April – 30 April 2016
Biaya
: Rp. 14.000.000,-
Harga termasuk : Visa, Hotel, Makan, Bus city tour
Tanggal Tutup Pendaftaran : 15 Maret 2016
Perlu diketahui, form pendaftaran Wisata Zhangjiajie, China bisa didapatkan di Center Avail
terdekat ataupun download di website resmi perusahaan www.availelok.co.id. Demikian
informasi ini kami sampaikan sebaik-baiknya. Jika ada pertanyaan lebih lanjut silahkan
menghubungi Marketing Support di No. HP 0855 702 9999 / 0855 703 9999, atas perhatian dan
kerjasamanya kami ucapkan terima kasih.
Jakarta, 20 Januari 2016
Hormat Kami,
第 第
第第1111页页页页 共共共共 4444 页页页页 / PagePage 1PagePage111 ofofofof 4444
Form Form Form Form V.201V.201V.201V.2013333
中 华 人 民 共 和 国 签 证 申 请 表
Visa
Visa
Visa
Visa Application
Application
Application
Application Form
Form
Form
Form of
of
of
of the
the
the
the People
People
People
People’’’’ssss Republic
Republic
Republic
Republic of
of
of
of China
China
China
China
(For(For(For(For thethethethe MainlandMainlandMainlandMainland ofofofof ChinaChinaChinaChina only)only)only)only) 申请人必须如实、
申请人必须如实、
申请人必须如实、申请人必须如实、完整、清楚地完整、清楚地完整、清楚地完整、清楚地填写本表格。请逐项在空白处用中文或英文大写字母打印填写，或在填写本表格。请逐项在空白处用中文或英文大写字母打印填写，或在填写本表格。请逐项在空白处用中文或英文大写字母打印填写，或在填写本表格。请逐项在空白处用中文或英文大写字母打印填写，或在□□□□内内内内打打打打
√
√
√
√
选择选择选择选择。如有关项目。如有关项目。如有关项目。如有关项目 不适用，请写不适用，请写
不适用，请写不适用，请写““““无无无无””””。。。。TheTheTheThe aaaapplicantpplicantpplicantpplicant shouldshouldshouldshould fillfillfillfill inininin thisthisthisthis formformformform trutrutrutruthfulthfulthfullythfullyly ，ly ，，，completelycompletelycompletelycompletely andand clearlyandandclearlyclearlyclearly.... PleasePleasePleasePlease typetypetypetype thethethethe answeransweransweranswer inin capitalinincapitalcapitalcapital EnglisEnglisEnglisEnglishhhh letters
letters
lettersletters inininin thethethethe spacespace providedspacespaceprovidedprovidedprovided orororor ticktickticktick ((((
√
√
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)))) thethethethe relevantrelevantrelevantrelevant boxbox toboxboxtototo select.select.select.select. IfIf someIfIfsomesomesome ofofofof thethethethe itemsitemsitemsitems dodododo notnotnotnot apply,apply, pleaseapply,apply,pleasepleaseplease typetypetypetype NNN/AN/A/A/A orororor None.None.None.None.一、个人信息 Part
Part
Part
Part 1
1
1
1:::: Personal
Personal
Personal
Personal IIIInformation
nformation
nformation
nformation
1.1 英文姓名 Full
Full Full
Full EnglishEnglishEnglishEnglish nnnnameameameame as
as as
as inininin passportpassportpassportpassport
姓 LastLastLastLast namenamenamename
粘贴一张近期正面免冠、浅色背 景的彩色护照照片。
照片/Photo
/Photo
/Photo
/Photo
A A A
Affixffixffixffix oneoneoneone recentrecentrecentrecent colorcolorcolorcolor passportpassportpassportpassport photo
photo photo
photo (full(full(full(full facefacefaceface,,,,frontfrontfrontfront viewviewviewview,,,,
bareheaded bareheaded bareheaded
bareheaded andandandand againstagainstagainstagainst aaaa plainplainplainplain light
light light
light coloredcoloredcoloredcolored background).background).background).background).
中间名 MiddleMiddleMiddleMiddle namenamenamename 名 FirstFirstFirstFirst namenamenamename 1. 1. 1. 1.2 中文姓名 N N N
Nameameameame inininin ChineseChineseChineseChinese
1.
1.1.1.3333 别名或曾用名 Other
OtherOtherOther nnnnameameameame((((ssss)))) 1.
1. 1.
1.4444 性别 SexSexSexSex □ 男 MMMM □ 女 FFFF 1.1.1.1.5555 出生日期 D
DDDOBOBOBOB((((yyyy-mm-ddyyyy-mm-ddyyyy-mm-ddyyyy-mm-dd)))) 1. 1. 1. 1.6666 现有国籍 Current Current Current
Current nnnnationalityationalityationalityationality(ies)(ies)(ies)(ies) 1.71.71.7 曾有国籍 Former1.7 FormerFormerFormer nnnnationalityationalityationalityationality(ies)(ies)(ies)(ies) 1. 1. 1. 1.8888 出生地点((((市、省////州、国)))) Place Place Place
Place ofofofof bbbbirth(irth(irth(irth(ccccityityityity,,,, provinceprovinceprovinceprovince/s/s/s/statetatetatetate,c,c,c,countryountryountryountry)))) 1. 1. 1. 1.9999 身份证////公民证号码 Local Local Local
Local IDIDIDID//// CitizenshipCitizenshipCitizenshipCitizenship numbernumbernumbernumber 1.
1. 1.
1.10101010 护 照 //// 旅 行 证 件 种 类 PassportPassportPassportPassport/Travel/Travel/Travel/Travel documentdocumentdocumentdocument ttttypeypeypeype
□ 外交 DiplomaticDiplomaticDiplomaticDiplomatic □ 公务、官员 ServiceServiceServiceService orororor OOOOfficialfficialfficialfficial
□ 普通 OrdinaryOrdinaryOrdinaryOrdinary □ 其他证件((((请说明)))) OtherOtherOtherOther (Please(Please(Please(Please specify)specify)specify)specify):::: 1.1 1.1 1.1 1.11111 护照号码 Passport Passport Passport Passport numbernumbernumbernumber
1.1 1.1 1.1 1.12222 签发日期 Date Date Date
Date ofofofof iiiissue(ssue(ssue(ssue(yyyy-mm-ddyyyy-mm-ddyyyy-mm-ddyyyy-mm-dd)))) 1.1 1.1 1.1 1.13333 签发地点 Place Place Place Place ofofofof iiiissuessuessuessue
1.1 1.1 1.1 1.14444 失效日期
D
D
D
Date
ate
ate
ate of
of
of
of eeeexpir
xpir
xpir
xpiry
y
y
y
((((yyyy-mm-ddyyyy-mm-ddyyyy-mm-ddyyyy-mm-dd))))1.1 1.1 1.1 1.15555 当前职业 （可选多项） Current Current Current Current o o o
occupation(s)ccupation(s)ccupation(s)ccupation(s)
□ 商人 BusinessBusinessBusinessBusinesspersonpersonpersonperson
□ 公司职员 CompanyCompanyCompanyCompany employeeemployeeemployeeemployee □ 演艺人员 EntertainerEntertainerEntertainerEntertainer
□ 工人////农民 Industrial/AgriculturalIndustrial/AgriculturalIndustrial/AgriculturalIndustrial/Agricultural workerworkerworkerworker □ 学生 StudentStudentStudentStudent
□ 乘务人员 CrewCrewCrewCrew membermembermembermember □ 自雇 Self-employedSelf-employedSelf-employedSelf-employed □ 无业 UnemployedUnemployedUnemployedUnemployed □ 退休 RetiredRetiredRetiredRetired
□ 前////现任议员 Former/incumbentFormer/incumbentFormer/incumbentFormer/incumbent mmmmemberemberemberember ofofofof parliamentparliamentparliamentparliament 职位 PositionPositionPositionPosition________________________________________________________________________________________________
□ 前////现任政府官员 Former/incumbentFormer/incumbentFormer/incumbentFormer/incumbent ggggovernmentovernmentovernmentovernment official
official official official
职位 Position________________________Position________________________Position________________________Position________________________ □军人 MMMMilitaryilitaryilitaryilitary personnelpersonnelpersonnelpersonnel
职位 Position________________________Position________________________Position________________________Position________________________ □ 非政府组织人员 NGONGONGONGO staffstaffstaffstaff
□ 宗教人士 ReligiousReligiousReligiousReligious personnelpersonnelpersonnelpersonnel □ 新闻从业人员 StaffStaffStaffStaff ofofofof mediamediamediamedia □ 其他((((请说明)))) OtherOtherOtherOther (Please(Please(Please(Please specify):specify):specify):specify):
1.16 1.16 1.16
1.16 受教育程度 Education EducationEducationEducation
□ 研究生 PostgraduatePostgraduatePostgraduatePostgraduate □ 大学 CollegeCollegeCollegeCollege □ 其他((((请说明)))) OtherOtherOtherOther (Please(Please(Please(Please specify):specify):specify):specify):
1.17 1.17 1.17 1.17 工作单位////学校 Employer/School Employer/School Employer/School Employer/School 名称 Name Name Name Name 联系电话 Phone Phone Phone Phone numbernumbernumbernumber
地址 AddressAddressAddressAddress 邮政编码 Zip Zip Zip Zip CodeCodeCodeCode
第 第
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二、旅行信息 Part
Part
Part
Part 2:
2:
2:
2: T
T
T
Travel
ravel
ravel
ravel IIIInformation
nformation
nformation
nformation
1.18 1.18 1.18 1.18 家庭住址 Home Home Home Home addressaddressaddressaddress
1.19 1.19 1.19 1.19 邮政编码 Zip Zip Zip Zip CodeCodeCodeCode 1.20 1.20 1.20 1.20 电话////手机 Home/mobile Home/mobile Home/mobile
Home/mobile phonephonephonephone numbernumbernumbernumber
1. 1. 1. 1.21212121 电子邮箱 E-mail E-mail E-mail E-mail addressaddressaddressaddress 1.
1. 1.
1.22222222 婚姻状况 MaritalMaritalMaritalMarital statusstatusstatusstatus □ 已婚 MarriedMarriedMarriedMarried □ 单身 SingleSingleSingleSingle □ 其他 Other(PleaseOther(PleaseOther(PleaseOther(Please specify):specify):specify):specify):
1.23 1.23 1.23 1.23 主要家庭成员 ((((配偶、子女、父母 等,,,,可另纸)))) Major Major Major Major familyfamilyfamilyfamily members members members
members（spouse,spouse,spouse,spouse, children,parents,et children,parents,et children,parents,et children,parents,et c.,may c.,may c.,may c.,may typetypetypetype onononon separate separate separate
separate paperpaperpaperpaper）
姓名 NameNameNameName 国籍 NationalityNationalityNationalityNationality 职业 OccupationOccupationOccupationOccupation 关系 RelationshipRelationshipRelationshipRelationship
1 1 1 1....24242424 紧急联络人信息 Emergency Emergency Emergency Emergency C C C Contactontactontactontact
姓名 Name Name Name Name 手机 Mobile Mobile Mobile
Mobile pppphonehonehonehone numbernumbernumbernumber 与申请人的关系
Relationship Relationship Relationship
Relationship withwithwithwith thethethethe applicantapplicantapplicantapplicant 1.25
1.25 1.25
1.25 申请人申请签证时所在的国家或地区 CountryCountryCountryCountry orororor territoryterritoryterritoryterritory wherewherewherewhere thethethethe applicant
applicant applicant
applicant isisisis locatedlocatedlocatedlocated whenwhenwhenwhen applyingapplyingapplyingapplying forforforfor thisthisthisthis visavisavisavisa
2 2 2 2.1.1.1.1 申请 入境事由 MajorMajorMajorMajor p
p p purposeurposeurposeurpose of of of
of yyyyourourourour vvvvisitisitisitisit
□ 官方访问 OOOOfficialfficialfficialfficial VVVVisitisitisitisit □ 常驻外交、领事、国际组织人员 As
As As
As rrrresidentesidentesidentesident ddddiplomatiplomatiplomatiplomat，cccconsulonsulonsulonsul orororor staffstaffstaffstaff ofofofof internationinternationinternationinternationalalalal organization
organization organization organization □ 旅游 TourismTourismTourismTourism
□ 交流、考察、访问 Non-businessNon-businessNon-businessNon-business visitvisitvisitvisit □ 永久居留 AsAsAs permanentAspermanentpermanentpermanent rerereressssidentidentidentident □ 商业贸易 BusinessBusinessBusinessBusiness &&&& TradeTradeTradeTrade □ 工作 WorkWorkWorkWork
□ 人才引进 AsAsAsAs introducedintroducedintroducedintroduced talenttalenttalenttalent □ 寄养 AsAsAs childAschildchildchild inininin fosterfosterfosterfoster carecarecarecare □ 执行乘务 AsAsAsAs crcrcrcrewewewew mmmmemberemberemberember
□ 过境 TransitTransitTransitTransit
□ 短期探望中国公民或者具有中国永久居留资格的 外 国 人 Short-termShort-termShort-termShort-term visitvisitvisitvisit tototo Chineseto ChineseChineseChinese citizencitizencitizencitizen orororor foreigner
foreigner
foreignerforeigner withwithwithwith ChineseChineseChineseChinese permanentpermanent residencepermanentpermanentresidenceresidenceresidence statusstatusstatusstatus
□ 与中国公民或者具有中国永久居留资格的外国人 家庭团聚居 留超 过 180180180180 日 FamilyFamilyFamilyFamily reunionreunionreunionreunion forforforfor overoveroverover 180
180 180
180 daysdaysdaysdays withwithwithwith ChineseChineseChineseChinese citizencitizencitizencitizen orororor foreignerforeignerforeignerforeigner withwithwithwith Chinese
Chinese Chinese
Chinese permanentpermanentpermanentpermanent residenceresidenceresidenceresidence statusstatusstatusstatus □ 短期探望因工作、学习等事由在中国停留居留的
外 国 人 Short-termShort-termShort-termShort-term visitvisitvisitvisit tototo foreignerto foreignerforeignerforeigner residingresidingresidingresiding inininin China
China
ChinaChina duedueduedue totototo work,work,work,work, studystudystudystudy orororor otherotherotherother reasonsreasonsreasonsreasons
□ 长期探望因工作、学习等事由在中国居留的外国人 As
As As
As accompanyingaccompanyingaccompanyingaccompanying familyfamilyfamilyfamily membermembermembermember ofofofof foreignerforeignerforeignerforeigner residing
residing residing
residing inininin ChinaChinaChinaChina duedueduedue totototo work,work, studywork,work,studystudystudy orororor otherotherotherother reasonsreasonsreasonsreasons □ 短期学习 Short-termShort-termShort-termShort-term studystudystudystudy forforforfor lesslesslessless thanthanthanthan 180180180180 daysdaysdaysdays □ 长期学习 Long-termLong-termLong-termLong-term studystudystudystudy forforfor overforoveroverover 180180180180 daysdaysdaysdays □ 短期采访报道 AsAsAsAs journalistjournalistjournalistjournalist forforforfor temporarytemporarytemporarytemporary newsnewsnewsnews
coverage coverage coveragecoverage
□外国常驻中国新闻机构记者 AsAsAsAs residentresidentresidentresident jjjjournalistournalistournalistournalist □ 其他((((请说明)Other)Other)Other)Other (Please(Please(Please(Please specify)specify)specify)specify)：
2 2 2 2.2.2.2.2 计划 入境次数 Intended Intended Intended Intended nnnnumberumberumberumber of
of of of eeeentriesntriesntriesntries
□ 一次((((自签发之日起 3333 个月有效)))) OneOneOneOne entryentryentryentry validvalid forvalidvalidforforfor 3333 monthsmonthsmonthsmonths fromfromfromfrom thethethethe datedatedatedate ofofofof issueissueissueissue □ 二次((((自签发之日起 3-3-3-3-6666 个月有效)))) TwoTwoTwoTwo entrentriesentrentriesiesies validvalidvalidvalid forforforfor 33 to33tototo 6666 monthsmonthsmonthsmonths fromfrom thefromfromthethethe datedatedatedate ofofofof issueissueissueissue □ 半年多次（自签发之日起 6666 个月有效)))) MultiMultiMultiMultipleplepleple entrentrentrentriesies validiesiesvalidvalidvalid forforforfor 66 months66monthsmonthsmonths fromfromfromfrom thethethe datethedatedatedate ofofofof issueissueissueissue □ 一年多次（自签发之日起 1111 年有效)))) MultiMultiMultiMultipleplepleple entrentrentrentriesiesiesies validvalidvalidvalid forforforfor 1111 yearyearyearyear fromfromfromfrom thethethethe datedatedatedate ofofofof issueissueissueissue □ 其他（请说明）OtherOtherOtherOther (Please(Please(Please(Please specify)specify)specify)specify)::::
2.3 2.3 2.3
2.3 是否申请加急服务 AreAreAreAre youyouyouyou applyingapplyingapplying forapplyingforforfor expressexpressexpressexpress service?service?service?service?
注：加急服务须经领事官员批准，将加收费用。Note:Note:Note: ExpressNote:ExpressExpressExpress serviceserviceserviceservice needsneeds approvalneedsneedsapprovalapprovalapproval ooooffff consular
consular consular
consular officials,officials,officials,officials, andandandand extraextra feesextraextrafeesfeesfees maymaymaymay apply.apply.apply.apply.
□ 是 YesYesYesYes □ 否 NoNoNoNo 2 2 2 2....4444 本次行程预计首次抵达中国的日期 Expected Expected Expected
第 第
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三、其他事项 Part
Part
Part
Part 3
3
3
3:::: Other
Other
Other
Other Information
Information
Information
Information
3.1 是否 曾 在 中 国 超 过 签 证 或 居 留 许 可 允 许 的 期 限 停 留 ？ HaveHaveHaveHave youyouyouyou everevereverever overstayedoverstayedoverstayedoverstayed youryouryouryour visavisavisavisa orororor residence
residence residence
residence permitpermitpermitpermit inininin China?China?China?China? □是 YesYesYesYes □否 NoNoNoNo 3.2 是否曾经被拒绝签发中国签证,或被拒绝进入中国？HaveHaveHaveHave youyouyouyou everevereverever beenbeenbeenbeen refusedrefused arefusedrefusedaaa visavisavisavisa forfor China,forforChina,China,China, oooorrrr
been been been
been refusedrefusedrefused entryrefusedentryentryentry intointointointo China?China?China?China? □是 YesYesYesYes □否 NoNoNoNo 3.3 是 否 在 中 国 或 其 他 国 家 有 犯 罪 记 录 ？ DoDoDoDo youyouyouyou havehavehavehave anyanyanyany criminalcriminalcriminalcriminal recordrecord inrecordrecordininin ChinaChinaChinaChina orororor anyanyanyany otherotherotherother
country? country? country?
country? □是 YesYesYesYes □否 NoNoNoNo
3.4 是否具有以下任一种情形 AreAreAreAre youyouyouyou experiencingexperiencingexperiencingexperiencing anyanyanyany ofof theofofthethethe followingfollowingfollowingfollowing conditionsconditionsconditionsconditions???? ①严重精神障碍 SeriousSeriousSeriousSerious mmmmentalentalental dentaldddisisisisorderorderorderorder
②传染性肺结核病 InfectiousInfectiousInfectiousInfectious pulmonarypulmonarypulmonarypulmonary ttttuberculosisuberculosisuberculosisuberculosis
③可能危害公共卫生的其他传染病 OtherOtherOtherOther infectiousinfectiousinfectiousinfectious diseasediseasediseasedisease ofof publicofofpublicpublicpublic healthhealthhealthhealth hazardshazardshazardshazards
□是 YesYesYesYes □否 NoNoNoNo 3.5 近 30 日内是否前往过流行性疾病传染的国家或地区？DidDidDidDid youyouyouyou visitvisitvisitvisit countriescountries orcountriescountriesororor territoriesterritoriesterritoriesterritories affectedaffectedaffectedaffected
by by by
by infectiousinfectiousinfectiousinfectious diseasesdiseasesdiseasesdiseases inininin thethethethe lastlastlastlast 30303030 days?days?days?days? □是 YesYesYesYes □否 NoNoNoNo 3.6 如果对 3.1 到 3.5 的任何一个问题选择“是”，请在下面详细说明。
If If If
If youyouyouyou selectselectselectselect YesYesYesYes totototo anyanyanyany questionsquestionsquestionsquestions fromfromfromfrom 3333....1111 totototo 3333....5555,,,, ppleaseppleaseleaselease givegivegivegive detaildetaildetaildetailssss belowbelowbelowbelow.... 2. 2. 2. 2.5555 预计行程中单次在华停留的最长天数 L L L
Longestongestongestongest iiiintendedntendedntendedntended sssstaytaytaytay inininin ChinaChina amongChinaChinaamongamongamong allallallall entriesentriesentriesentries DaysDaysDaysDays
2. 2. 2. 2.6666 在中国境内行 程（按时间顺序,,,, 可附另纸填写） Itinerary Itinerary Itinerary Itinerary inininin China China China China ((((inininin timtimtimtimeeee sequence sequence sequence sequence，maymaymaymay type
type type
type onononon separateseparateseparateseparate paper
paper paper paper))))
日期 DateDateDateDate 详细地址 DetailedDetailedDetailedDetailed addressaddressaddressaddress
2. 2. 2.
2.7777 谁 将 承 担 在 中 国 期 间 的 费 用 ？ WhoWhoWhoWho willwillwillwill paypay forpaypayforforfor youryouryouryour traveltraveltraveltravel andandandand expenses
expenses expenses
expenses duringduringduringduring youryouryouryour staystaystaystay inininin China?China?China?China?
2.8 2.8 2.8 2.8 中国境内邀请 单位或个人信息 Information Information Information Information ofofofof inviter inviter inviter
inviter inininin ChinaChinaChinaChina
姓名或名称 Name Name NameName 地址 Address Address AddressAddress 联系电话 Phone Phone PhonePhone numbernumbernumbernumber 与申请人关系 Relationship Relationship
RelationshipRelationship withwithwithwith thethethethe applicantapplicantapplicantapplicant
2.9 是否曾经获得过中国签证？如有，请说明最近一次获得中国签证的时 间和地点。HaveHaveHaveHave youyouyouyou everevereverever beenbeenbeenbeen grantedgrantedgrantedgranted aa ChineseaaChineseChineseChinese visa?visa?visa?visa? IfIf applicable,IfIfapplicable,applicable,applicable, pleapleapleapleasesesese specify
specify specify
specify thethethethe datedatedatedate andand placeandandplaceplaceplace ofofofof thethethethe lastlastlastlast timetimetimetime youyouyouyou werewerewere grantedweregrantedgrantedgranted thethethethe visa.visa.visa.visa.
2.10 过去 12 个月中访问的其他国家或地区 OOOOtherthertherther countriescountriescountriescountries orororor territoriesterritoriesterritoriesterritories you
you you
第 第
第第4444页页页页 共共共共 4444 页页页页 / PagePage 4PagePage444 ofofofof 4444
四、声明及签名 Part
Part
Part
Part 4:
4:
4:
4: Declaration
Declaration
Declaration
Declaration &
&
&
& Signature
Signature
Signature
Signature
五 、 他 人 代 填 申 请 表 时 填 写 以 下 内 容 Part
Part
Part
Part 5
5
5
5 ： If
If
If
If the
the
the
the application
application
application
application form
form
form
form is
is completed
is
is
completed
completed
completed by
by
by
by another
another person
another
another
person
person
person on
on
on
on the
the
the
the
applicant's
applicant's
applicant's
applicant's behalf,
behalf,
behalf,
behalf, please
please
please
please fill
fill out
fill
fill
out
out
out the
the
the
the information
information
information
information of
of
of
of the
the
the
the one
one
one
one who
who
who completes
who
completes
completes
completes the
the
the
the form
form
form
form
3.7 如果有本表未涉及而需专门陈述的其他与签证申请相关的事项，请在此或另纸说明。 If
If If
If youyouyouyou havehavehavehave moremoremore informationmoreinformationinformationinformation aboutaboutaboutabout youryour visayouryourvisavisavisa applicationapplicationapplicationapplication otherotherotherother thanthanthanthan thethe abovethetheaboveaboveabove totototo declare,pleasedeclare,pleasedeclare,pleasedeclare,please givegivegivegive detailsdetails belowdetailsdetailsbelowbelowbelow orororor typetype ontypetypeononon aaaa separate
separate separate separate paperpaperpaperpaper....
3.8 如申请人护照中的偕行人与申请人一同旅行，请将偕行人照片粘贴在下面并填写偕行人信息。IfIfIfIf someonesomeonesomeonesomeone elseelseelseelse travelstravelstravelstravels andandandand sharsharsharshareseseses the
the the
the samesamesamesame passportpassportpassportpassport withwithwithwith thethethethe applicantapplicantapplicantapplicant ,,,, pleasepleasepleaseplease affixaffixaffix theiraffixtheirtheirtheir photosphotosphotosphotos andandandand givegive theirgivegivetheirtheirtheir informationinformationinformationinformation below.below.below.below.
偕行人信息
Information
Information
Information
Information
偕行人 1 Person Person Person Person 1111 粘贴照片于此 Affix AffixAffixAffix PhotoPhotoPhotoPhoto
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偕行人 3 Person Person Person Person 3333 粘贴照片于此 Affix Affix Affix Affix PhotoPhotoPhotoPhoto
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姓名 Full Full Full Full namenamenamename
性别 Sex SexSexSex 生日 D
D D
DOBOBOBOB(yyyy-mm-dd)(yyyy-mm-dd)(yyyy-mm-dd)(yyyy-mm-dd)
4.1 我声明，我已阅读并理解此表所有内容要求，并愿就所填报信息和申请材料的真实性承担一切法律后果。
IIII herebyherebyherebyhereby declaredeclaredeclaredeclare thatthat IIII havethatthat havehavehave readreadreadread andandandand understoodunderstoodunderstoodunderstood allallallall thethe questionsthethequestionsquestionsquestions inininin thisthisthisthis applicationapplicationapplicationapplication andandandand shallshall beshallshallbebebearararar allallallall thethethethe legallegallegallegal consequencesconsequencesconsequencesconsequences forforforfor thethethethe authenticity
authenticity authenticity
authenticity ofofofof thethethethe informationinformationinformationinformation andandandand materialsmaterialsmaterialsmaterials IIII providedprovidedprovidedprovided....
4.2 我理解，能否获得签证、获得何种签证、入境次数以及有效期、停留期等将由领事官员决定，任何不实、误导或填写不完整均 可能导致签证申请被拒绝或被拒绝进入中国。
IIII understandunderstandunderstandunderstand thatthatthatthat whetherwhetherwhetherwhether totototo issueissueissueissue aaaa visa,visa,visa,visa, typetypetypetype ofof visa,ofofvisa,visa,visa, numbernumbernumbernumber ofof entries,ofofentries,entries,entries, validityvalidityvalidityvalidity andand durationandanddurationdurationduration ofofofof eacheach stayeacheachstaystaystay willwillwillwill bebebebe determineddetermineddetermineddetermined bybybyby consular
consular consular
consular official,official,official,official, andandandand thatthatthatthat anyanyanyany false,false,false,false, misleadingmisleading ormisleadingmisleadingororor incompleteincompleteincompleteincomplete statementstatementstatementstatement maymaymaymay resultresultresultresult inininin thethethethe refusalrefusalrefusalrefusal ofofofof aaaa visavisavisavisa forforfor orforororor denialdenialdenialdenial ofof entryofofentryentryentry intointointointo China.
China. China. China.
4.3 我理解，根据中国法律，申请人即使持有中国签证仍有可能被拒绝入境。
IIII understandunderstandunderstandunderstand that,that,that,that, accordingaccordingaccordingaccording totototo ChineseChinese law,ChineseChineselaw,law,law, applicantapplicantapplicantapplicant maymaymaymay bebebebe refusedrefused entryrefusedrefusedentryentryentry intointointointo ChinaChinaChinaChina eveneveneveneven ifif aififaaa visavisavisavisa isisisis granted.granted.granted.granted.
申请人签名 日期
Applicant Applicant Applicant
Applicant’’’’ssss ssssignature:ignature:ignature:ignature: DateDateDateDate ((((yyyy-mm-ddyyyy-mm-ddyyyy-mm-ddyyyy-mm-dd):):):):
注：未满 18 周岁的未成年人须由父母或监护人代签。Note:Note:Note:Note: TheTheTheThe pppparentarent orarentarentororor guardianguardianguardianguardian shallshallshallshall signsignsignsign ononon behalfonbehalfbehalfbehalf ofofofof aaaa minorminorminorminor underunder 18underunder181818 yearsyearsyearsyears ofofofof ageageageage....
5.1 姓名 NameNameNameName 5.2 与 申 请 人 关 系 RelationshipRelationshipRelationshipRelationship with
with with
with thethethethe applicantapplicantapplicantapplicant 5.3 地址 AddressAddressAddressAddress 5.4 电话 PhonePhonePhonePhone numbernumbernumbernumber 5.5 声明 DeclarationDeclarationDeclarationDeclaration
我声明本人是根据申请人要求而协助填表，证明申请人理解并确认表中所填写内容准确无误。
IIII declaredeclare thatdeclaredeclarethatthatthat IIII havehavehave assistedhaveassistedassistedassisted inininin thethe completionthethecompletioncompletioncompletion ofofofof thisthisthisthis formformformform atatat theatthethethe requestrequestrequestrequest ofof theofofthethethe applicantapplicantapplicantapplicant andand thatandandthatthatthat thethethethe applicantapplicantapplicantapplicant understandsunderstandsunderstandsunderstands andandandand agrees
agrees agrees
agrees thatthatthatthat thethethethe informationinformationinformationinformation providedprovided isprovidedprovidedisisis truetruetruetrue andandandand correct.correct.correct.correct.
Jl. Gunung Sahari Raya No. 1
Komp. Ruko Mangga Dua Square Blok B No. 3 & 5, Jakarta Utara 14430, Indonesia Tel: (021) 6231 3500 Fax: (021) 6231 3056
Website: www.availelok.co.id
PT AVAIL ELOK INDONESIA
Formulir Pendaftaran
Wisata Zhangjiajie - China (24 April – 30 April 2016)
Kota Keberangkatan & Kedatangan
: JAKARTA
Nama (sesuai passpor)
:
Jenis Kelamin
:
Usia :
No. Anggota
:
No. Passpor
:
Berlaku Sampai :
(Masa berlaku Passpor minimal sampai dengan 7 bulan sejak tanggal keberangkatan)
Alamat
:
:
No. Telp/Hp
:
Peringkat
:
Ukuran baju
: S / M / L / XL / XXL / XXXL (lingkari salah satu)
(Diisi apabila mengajak suami/istri/keluarga yang ingin sekamar)
Nama
:
Jenis Kelamin
:
Usia :
Hubungan
:
(Anggota keluarga yang tidak ikut wisata)
Nama
:
No.Hp/Tlp
:
Hubungan
:
Pendaftar,
(……….)
Tanggal :
NB : Formulir pendaftaran harap dikirim kembali ke PT. Avail Elok Indonesia dengan alamat yang tertera di atas,
paling lambat dokumen lengkap diterima pusat tanggal 15 Maret 2016.
Jl. Gunung Sahari Raya No. 1
Komp. Ruko Mangga Dua Square Blok B No. 3 & 5, Jakarta Utara 14430, Indonesia Tel: (021) 6231 3500 Fax: (021) 6231 3056
Website: www.availelok.co.id
PT AVAIL ELOK INDONESIA
SYARAT & KETENTUAN
1. Berlaku untuk Bonus Wisata 2013 – 2015 dan Insentif Member Get Member
2. Biaya wisata sebesar Rp 14.000.000,-
3. Mengisi Form pendaftaran
4. Pas Photo berwarna :
Ukuran 4x6 = 3 lembar
Latar belakang putih 80% tampak wajah
Tidak menggunakan pakaian dinas
Tidak terlihat gigi
Tidak menggunakan kacamata
5. Passpor asli masa berlaku minimal 7 bulan sebelum keberangkatan
6. Foto copy passpor halaman depan dan belakang, masing-masing 3 lembar
7. Dokumen lain :
a. Foto copy KTP / Kartu Pelajar
b. Foto copy Kartu Keluarga
8. Anak usia di bawah 13 tahun harus melampirkan surat pernyataan dari pihak orang tua, yang
menyatakan anak tersebut ikut pergi ke China
9. Menandatangani formulir aplikasi Visa China sesuai dengan contoh terlampir pada halaman
ke-4.
10. Apabila peserta wisata lahir di Tiongkok (RRC) HARUS melampirkan passpor lama dan VISA
RRC sebelumnya. Apabila tidak ada passpor lama atau visa RRC sebelumnya, maka HARUS
melampirkan Akte Lahir dan Surat Ganti Nama (jika ada) serta menuliskan nama
Mandarinnya di Formulir Aplikasi Visa (Poin 1.2 ‘Name In Chinese’) sesuai contoh terlampir
pada halaman ke-1.
11. Pembayaran dapat dilakukan melalui rekening BCA 701-5171-669 a/n Herny (bukti
transfer dilampirkan)
12. Pembatalan keberangkatan/pengunduran diri dengan alasan apapun dikenakan biaya
100%
Jl. Gunung Sahari Raya No. 1
Komp. Ruko Mangga Dua Square Blok B No. 3 & 5, Jakarta Utara 14430, Indonesia Tel: (021) 6231 3500 Fax: (021) 6231 3056
Website: www.availelok.co.id
PT AVAIL ELOK INDONESIA
Bahwa saya, ______________________________ NO KTP. ___________________ paham dan menyetujui
syarat-syarat diatas dan tidak akan mengambil tidakan, tuntutan, kompensasi, dan ganti rugi dalam bentuk
apa pun terhadap PT AVAIL ELOK INDONESIA atas kejadian-kejadian yang melibatkan diri atau harta
benda saya termasuk kerugian, cacat fisik atau kehilangan, keterlambatan, akibat bencana alam
seperti banjir, kebakaran, kerusuhan, peperangan, keributan, gempa bumi yang dialami pada saat
saya menjalankan wisata ke Zhangjiajie, China, termasuk dalam perjalanan pergi dan kembali. Saya
menyetujui untuk mengikuti segala aktivitas yang dijalankan serta mematuhi setiap peraturan yang
telah ditetapkan.
Materai 6000
_____________________________
Jl. Gunung Sahari Raya No. 1
Komp. Ruko Mangga Dua Square Blok B No. 3 & 5, Jakarta Utara 14430, Indonesia Tel: (021) 6231 3500 Fax: (021) 6231 3056
Website: www.availelok.co.id
PT AVAIL ELOK INDONESIA
WISATA ZHANGJIAJIE – CHINA
(24 – 30 April 2016)
GA 898G CGKCAN HK65 08.35-14.45
24 APR - HARI 01 : JAKARTA – GUANGZHOU - CHANGSHA (MM - BOX)
Hari ini Anda berkumpul di Bandara Soekarno-Hatta untuk bersama-sama memulai perjalanan
dengan penerbangan menuju GUANGZHOU. Setibanya Anda akan diantar ke train station untuk naik
CHINA HIGH SPEED TRAIN (Kereta tersepat di China dengan kecepatan 300/ jam). Setibanya di
CHANGSHA anda akan diantar menuju hotel untuk beristirahat.
Hotel : Sylvia hotel (4 star Hotel) / setaraf
25 APR - HARI 02 : CHANGSHA – FENGHUANG (MP,MS,MM)
Acara tour hari ini Anda akan mengunjungi FENGHUANG (Perjalanan 5 jam) kota bersejarah dan
budaya yang terkenal yaitu FENGHUANG ANCIENT TOWN yang pernah dipuji sebagai kota kecil
yang paling indah di Cina oleh seorang penulis terkenal di Selandia Baru. Kemudian kita akan menuju
ke SHENGCHENGWEN OLD HOUSE , WANMING PAGODA, sungai dan deretan rumah-rumah kayu
dibangun di atas panggung dan RAINBOW BRIDGE BUILDING ART yang memiliki sejarah lebih dari
600 tahun. Malam hari TOUR WITH TUO CRUISE untuk melihat keindahan lampu lampu kota
malam.
Jl. Gunung Sahari Raya No. 1
Komp. Ruko Mangga Dua Square Blok B No. 3 & 5, Jakarta Utara 14430, Indonesia Tel: (021) 6231 3500 Fax: (021) 6231 3056
Website: www.availelok.co.id
PT AVAIL ELOK INDONESIA
26 APR - HARI 03 : FENGHUANG - ZHANGJIAJIE (MP,MS, MM)
Hari ini perjalanan menuju ZHANGJIAJIE unuk mengunjungi TIANMEN MOUNTAIN (LONGEST
CABLE CAR) yang merupakan salah satu gunung paling indah di dunia, disini Anda dapat merasakan
pengalaman berjalan di atas GLASS SKY WALK. Kemudian mengunjungi 99 TURNS ROAD,
CELESTIAL ARCH (HOLE). Selanjutnya anda diajak menyaksikan FOX FAIRY SHOW yang
menampilkan cerita tradisional dipadu dengan musik, tarian, lagu dan efek cahaya.
Hotel : Satate Guest Hotel (4 star Hotel) / setaraf
27 APR - HARI 04 : ZHANGJIAJIE (MP,MS, MM)
Setelah makan pagi Anda diajak menyusuri BAOFENG LAKE Anda diajak berkeliling di tempat yang
indah ini dengan menggunakan perahu. Selanjutnya mengelilingi YELLOW DRAGON CAVE dimana
Anda dapat melihat stalaktit dan stalakmit yang menakjubkan dengan mengunakan perahu. Makan
Malam menu special KOREAN BARBECUE.
28 APR - HARI 05 : ZHANGJIAJIE (MP,MS, MM)
Usai makan pagi, Anda akan mengunjungi YUANJIAJIE disini anda dapat melihat pemandangan yang
menakjubkan seperti dalam film AVATAR dan anda juga berkesempatan untuk mencoba ELEVATOR
tertinggi di dunia dengan ketinggian 326 M dan melihat NATURAL BRIDGE. Selanjutnya
mengunjungi TIANZI SHAN (Cable Car down) yang terletak di bagian utara dari WULINGYUAN
SCENIC AREA yang termasuk dalam daftar warisan dunia UNESCO. Disini Anda akan menikmati
keindahan gunung batu dari sisi aras yang dihiasi tanaman secara alamiah dengan suasana alam
yang sangat menakjubkan.
29 APR - HARI 06 : ZHANGJIAJIE – CHANGSHA (MP,MS, MM)
Setelah makan pagi, Perjalanan dilanjut ke CHANGSHA ( perjalanan 4 - 5 jam). Setibanya anda
diajak sightseeing tour mengunjungi ORANGE LONG ISLAND, DUFU PAVILLION (Out side Look).
Setelah itu Anda akan diajak berbelanja di SOUTH HUANGXING ROAD PEDESTRIAN STREET.
Hotel : Sylvia hotel (4 star Hotel) / setaraf
GA 899G CANCGK HK65 15.45-19.55
30 APR - HARI 07 : CHANGSHA – JAKARTA (MP - BOX)
Hari ini Anda akan di antar ke Train station untuk naik CHINA HIGH SPEED TRAIN menuju
GUANGZHOU. Setibanya anda akan di antar ke airport untuk penerbangan kembali ke Tanah air.
Terimakasih atas ke ikutsertaan Anda bersama ROTAMA TOUR, sampai jumpa di acara tur kami
selanjutnya.
Jl. Gunung Sahari Raya No. 1
Komp. Ruko Mangga Dua Square Blok B No. 3 & 5, Jakarta Utara 14430, Indonesia Tel: (021) 6231 3500 Fax: (021) 6231 3056
Website: www.availelok.co.id
