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1. Declaration Header: Official title of the document, date, and reference number if applicable
2. Personal Information: Full legal name, place and date of birth, nationality, ID number (NIK for Indonesian citizens or passport number for foreigners)
3. Current Residence Details: Complete current address including RT/RW numbers, kelurahan, kecamatan, city/regency, and province
4. Period of Residence: Statement of how long the declarant has resided at the current address
5. Purpose of Declaration: Specific reason for making the declaration of residence
6. Declaration Statement: Formal statement declaring that the information provided is true and accurate
7. Legal Consequences: Statement acknowledging understanding of legal consequences for false declarations
8. Signature Block: Space for declarant's signature, date, and name
1. Previous Residence History: Details of previous addresses, used when required for specific administrative purposes
2. Family Members: Information about family members residing at the same address, included when relevant for family cards (Kartu Keluarga)
3. Immigration Status: For foreign nationals, details of current visa or stay permit
4. Landlord Verification: When the resident is a tenant, including landlord's confirmation of residence
5. Employment Information: Details of current employment, included when the declaration is for work-related purposes
6. Temporary Residence Details: For temporary residents, including expected duration of stay and reason for temporary residence
1. Identity Documents: Copies of KTP-el (ID card), passport, or other relevant identification documents
2. Proof of Residence: Utility bills, rental agreement, or property ownership documents
3. Supporting Letters: Letters from RT/RW (neighborhood officials) confirming residence
4. Immigration Documents: For foreigners, copies of relevant visas or stay permits
5. Previous Declarations: If applicable, copies of previous declarations of residence
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