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FORMULIR PMB ONLINE 2022 STIE PUTRA TIMOR
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Nama Lengkap
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N I K
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Jenis Kelamin
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Laki - Laki
Perempuan
Tempat Lahir
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Tanggal Lahir
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MM
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DD
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YYYY
Agama
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Choose
Katholik
Kristen
Islam
Hindu
Budha
Konghucu
Alamat
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Desa/Kelurahan
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Kecamatan
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Kabupaten
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Propinsi
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email
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Pastikan email yang didaftarkan aktif dan bisa dibuka, karena BUKTI PENDAFTARAN akan dikirim lewat email ini
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No. HP
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Nama Ayah
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Pekerjaan Ayah
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Nama Ibu
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Pekerjaan Ibu
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