"*" indicates required fields

Step 1 of 4 - Passenger Details

BALI TAX ONLINE FORM

The Bali Tax is a mandatory requirement by the government. To save time, you can add up to 5 members of your travel group in the same application.

Passenger Details

Full Name*

Email*

Passport Number*

Arrival Date*

Partner Details

Are you traveling alone?*

Additional Visitor 1

Full Name according to the passport*

Passport Number*

Additional Visitor 2

Full Name according to the passport*

Passport Number*

Additional Visitor 3

Full Name according to the passport*

Passport Number*

Additional Visitor 4

Full Name according to the passport*

Passport Number*

Additional Visitor 5

Full Name according to the passport*

Passport Number*

Billing Details

Billing Full Name*

Billing Address*

Payement Page

Your Total

Credit Card*

American Express

Discover

MasterCard

Visa

Card Number

Expiration Date

Security Code Cardholder Name