Isi dengan Lengkap^*

Isi biodata dengan lengkap

ID Kurir^*

Nama Lengkap Sesuai KTP

Alamat Email^*

Phone Number^*

No NIK KTP^*

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Isi dengan lengkap^*

Isi Biodata

Nomor NPWP

Tempat Lahir^*

Alamat Sesuai KTP^*

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Penempatan

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Tanggal Lahir^*

Isi Tanggal Lahir dengan Format HH/BB/TTTT

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Alamat Tempat Tinggal Sekarang^*

kolom ini HARUS baik untuk alamat sama maupun berbeda dengan alamat KTP

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Status Menikah^*

Menikah

Belum Menikah

Janda/Duda

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Jumlah Tanggungan Anak^*

Jumlah anak yang ditanggung

Belum Punya

1

2

3

4

5

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Agama^*

ISLAM

KRISTEN PROTESTAN

KATOLIK

BUDHA

HINDU

KONGHUCHU

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Nama dari anggota keluarga yang tinggal di alamat yang sama^*

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Nomor Telp dari hubungan (suami/istri/anak/orang tua) dari anggota keluarga yang tinggal di alamat yang sama^*

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Nama kontak darurat dari anggota keluarga/kerabat yang tidak tinggal serumah^*

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Nomer Telfon kontak darurat dari anggota keluarga/kerabat yang tidak tinggal serumah^*

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Nama Ibu Kandung^*

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Nama Bank^*

Rekening harus punya pribadi, jika tidak maka tidak akan di proses

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Nomer Rekening^*

Mohon di isi dengan teliti & benar, di cek kembali apakah nomer rekening sudah benar

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Nama Pada Rekening^*

Harus nama pribadi

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Nomor SIM^*

Harus nama pribadi

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Jenis-tipe SIM

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Upload SURAT KETERANGAN DOMISILI RT SETEMPAT

You can drag & drop or paste as well

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Upload Buku Rekening^*

You can drag & drop or paste as well

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Upload Foto KK^*

You can drag & drop or paste as well

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Upload Foto NPWP

You can drag & drop or paste as well

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Upload Foto KTP^*

You can drag & drop or paste as well

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Upload SIM^*

You can drag & drop or paste as well

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Upload FOTO DIRI^*

Pakai Pakaian Yang Rapih

You can drag & drop or paste as well

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