PT. Inti Ganda Perdana
BKK SMK NEGERI 3 KOTA BEKASI
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Nama Lengkap *
No. KTP *
Jenis Kelamin *
Tinggi Badan *
Berat Badan *
Tempat, Tanggal Lahir *
Contoh : Jakarta, 27 Oktober 2002
No. Handphone *
No. Whatsapp *
Jurusan *
Asal Sekolah *
No. NPWP *
Nilai US MTK (Ijazah) *
Posisi yang Dipilih *
Tanggal Vaksin 1 *
MM
/
DD
/
YYYY
Tanggal Vaksin 2 *
MM
/
DD
/
YYYY
Tanggal Vaksin 3 (Booster) *
MM
/
DD
/
YYYY
Kode Token *
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