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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