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APPLICATION FOR PERMIT TO MAKE A FILM OR - Indonesia Film Services

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APPLICATION FOR PERMIT TO MAKE A FILM OR - Indonesia Film Services Powered By Docstoc
					APPLICATION FOR PERMIT TO MAKE A FILM OR VIDEO IN INDONESIA

The permit for a film / video shooting in Indonesia is granted by the Department of Foreign Affairs c.q. Directorate of Media and Information service in Jakarta, Indonesia. Application forms and statement can be requested and submitted through the Indonesian Embassy or Consulate located nearest your area. Requirements : 1. Fill out the application forms (6 copies) consisting the following information: 1. Curriculum Vitae of the applicant and crew members; 2. Purpose of production; 3. List of crew members; 4. Letter of solvency from bank guarantors in Indonesia and in country of origin; 5. List of equipment; 6. Shooting schedule; 7. Synopsis/scenario; 8. Photocopy of passports Complete visa application forms (the visa will be issued only after the approval for film shooting has been granted). Sign the statement and complete the application form regarding the compliance of regulations for film shooting in Indonesia.

2. 3.

KONSULAT JENDERAL REPUBLIK INDONESIA
CONSULATE GENERAL OF THE REPUBLIC OF INDONESIA

PERMOHONAN IZIN UNTUK SHOOTING FILM/VIDEO
Application For Film/Video Shooting Permit 1. 2. 3. 4. 5. 6. 7. 8. 9. Nama lengkap pemohon : Full name of applicant Tempat dan tanggal lahir : Place and date of birth Kebangsaan : Nationality Alamat pemohon/no. telpon : Address of applicant/phone no. Nama perusahaan : Name of company Alamat perusahaan/no. telpon : Address of company/phone no. Pekerjaan dan jabatan : Occupation and designation Tujuan produksi : Purpose of production Bank garansi di luar negeri : Bank guarantee abroad di Indonesia : in Indonesia 10. Pengalaman shooting film/video di Indonesia sebelumnya: Previous film/video shooting experiences in Indonesia 11. No. paspor/tempat/dan tanggal dikeluarkan paspor : Passport no./place and date of issue

Date : ………………………………………………………

(signature)

Rekomendasi KJRI :

c.c. :

1. Menteri Negara Kebudayaan dan Pariwisata u.p. Asisten Deputi Urusan Fasilitasi dan Pengembangan Perfilman 2. The Applicant

DAFTAR RIWAYAT HIDUP
PERSONAL HISTORY 1. Nama lengkap : Full name Alias : Other name Alamat : Address No. telpon : Phone no. Tempat dan tanggal lahir : Place and date of birth Kebangsaan : Nationality Pekerjaan dan jabatan : Occupation and designation Status perkawinan : Marital status Nama isteri/suami : Wife's/husband's name Pengalaman militer : Military record Pengalaman shooting film/video di Indonesia sebelumnya : Previous film/video shooting experience(s) in Indonesia Riwayat pendidikan : Educational record

2.

3. 4. 5. 6.

7. 8.

9.

10. Riwayat pekerjaan : Employment record

JADWAL SHOOTING
SHOOTING SCHEDULE No.: TANGGAL DATE LOKASI LOCATION SASARAN / KEGIATAN SUBJECT / ACTIVITY

Fill this form for all crew, talent, artist

KERABAT KERJA
CREW 1. Nama lengkap : Full name Pekerjaan dan jabatan : Occupation and designation No. Paspor : Passport no. Tempat dan tanggal dikeluarkan paspor : Place and date of issue of passport Nama lengkap : Full name Pekerjaan dan jabatan : Occupation and designation No. Paspor : Passport no. Tempat dan tanggal dikeluarkan paspor : Place and date of issue of passport Nama lengkap : Full name Pekerjaan dan jabatan : Occupation and designation No. Paspor : Passport no. Tempat dan tanggal dikeluarkan paspor : Place and date of issue of passport Nama lengkap : Full name Pekerjaan dan jabatan : Occupation and designation No. Paspor : Passport no. Tempat dan tanggal dikeluarkan paspor : Place and date of issue of passport Nama lengkap : Full name Pekerjaan dan jabatan : Occupation and designation No. Paspor : Passport no. Tempat dan tanggal dikeluarkan paspor : Place and date of issue of passport Nama lengkap : Full name Pekerjaan dan jabatan : Occupation and designation No. Paspor : Passport no. Tempat dan tanggal dikeluarkan paspor : Place and date of issue of passport etc.

2.

3.

4.

5.

6.

7.

SINOPSIS / SKENARIO
SYNOPSIS / SCENARIO

DAFTAR PERALATAN SHOOTING
LIST OF FILMING EQUIPMENT Item: Item Perincian peralatan Description of equipment Berat Weight Harga Value Negara asal Country of origin

KONSULAT JENDERAL REPUBLIK INDONESIA
CONSULATE GENERAL OF THE REPUBLIC OF INDONESIA Any where

STATEMENT
To complete our application for film / video shooting permit in Indonesia, We hereby declare that we shall :
1. 2. Comply with the laws and regulations of the Government of the Republic of Indonesia. Report our arrival to the Directorate of Media and Information service of the Department of Foreign Affairs in Jakarta in order to obtain press card(s) and general briefing regarding shooting procedure Report to the Information Service of the Provincial/Regional Government that will appoint a liaison officer, and bear expenses related to the services. Carry out the film shooting in accordance with the approved script / synopsis as submitted to the Government of the Republic of Indonesia Refrain from filming sacred rituals, objects or locations forbidden by local beliefs or practices and other restricted areas. Bear all expenses related to entering specific locations and shooting of objects if required. Re-export all shooting equipments at our expense upon completion of filming and bear all related-cost. Submit one released copy of the film/video to the Government of the Republic of Indonesia through the Embassy of the Republic of Indonesia which may be used at the discretion of the Government of the Republic of Indonesia for non-commercial use. Date : …………………………………………………………… Name : ……………………………………………………………

3. 4. 5. 6. 7. 8.

Signature : ……………………………………………………


				
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posted:1/31/2010
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