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Nama
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NIM/NIP/NIK
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Program Studi
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Tempat Lahir
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Tanggal Lahir
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DD
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Jenis Kelamin
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Laki-laki
Perempuan
Golongan Darah
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Alamat Sekarang
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No.Hp.
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Alamat Rumah
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Nomor Telepon
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