Pendaftaran Calon Anggota KPPS Desa Pegiringan
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Nomor KTP/NIK *
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Nama Lengkap *
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Tempat Lahir *
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Tanggal Lahir *
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Usia Sekarang *
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Alamat Rumah *
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No. HP *
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Pekerjaan *
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Ijazah Terakhir *
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Riwayat Kepemiluan *
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