FORMULIR BIODATA PESERTA UJIAN KEAHLIAN PELAUT
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PERIODE / BULAN
Masukan Periode Pengambilan Pasca, Contoh : JUNI 2016
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TINGKAT IJAZAH
Masukan Ijazah Profesi, Contoh : ANT III atau ATT III
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ASAL DIKLAT
Asal Diklat diisi AKPELNI
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Seafarer Code *
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Nama Peserta *
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Nomor ID (KTP) *
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Tempat / Tgl Lahir *) *
Contoh Penulisan : TULUNGAGUNG, 23 MARET 1996
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Jenis Kelamin *
Nama Ibu Kandung *
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Kewarganegaraan *
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Alamat *
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Propinsi *
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Kabupaten / kota *
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Kecamatan *
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Kelurahan / Desa *
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RT. *
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RW. *
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Kode Pos *
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No. HP *
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Email *
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