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DINAS KOPERASI, USAHA MIKRO DAN PERDAGANGAN KABUPATEN BANYUWANGI
Pengajuan BPUM 2021
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NIK (Nomor Induk Kependudukan)
*
Your answer
Nomor KK (Kartu Keluarga)
*
Your answer
Nama Lengkap (sesuai KTP)
*
Your answer
Tanggal Lahir
*
MM
/
DD
/
YYYY
Jenis Kelamin
*
Laki-laki
Perempuan
Provinsi
*
Jawa Timur
Kabupaten/Kota
*
Banyuwangi
Kecamatan
*
Choose
BANYUWANGI
GIRI
GLAGAH
WONGSOREJO
KALIPURO
LICIN
KABAT
ROGOJAMPI
SONGGON
SINGOJURUH
BLIMBINGSARI
SEMPU
GENTENG
GLENMORE
KALIBARU
SRONO
CLURING
MUNCAR
TEGALDLIMO
PURWOHARJO
TEGALSARI
BANGOREJO
SILIRAGUNG
PESANGGARAN
GAMBIRAN
Alamat (sesuai KTP)
*
contoh : Dsn. Cangkring RT/RW 02/03 Ds. Pengatigan
Your answer
Alamat Usaha
*
isikan alamat tempat usaha, contoh : Dsn. Krajan RT/RW 01/01 Ds. Mangir Kec. Rogojampi
Your answer
Bidang Usaha
*
Your answer
NIB (Nomor Induk Berusaha) / SKU (Surat Keterangan Usaha)
*
contoh : NIB (1267000xxxxxx)
Your answer
No. Telp Aktif
*
Your answer
No. Rekening (Jika Ada)
Your answer
Nama Rekening (Jika Memiliki Rekening)
contoh : Siti Fatimah
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Bank (Jika Memiliki Rekening)
BRI
BNI
Other:
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