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Formulir KOTA AYAT
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Nama Lengkap
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Alamat Lengkap
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Telp/ HP
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Yang nyaman bagi anda untuk di Hubungi
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Email/ Facebook
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Jenis santunan
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Orang tua asuh
Sumbangan rutin bulanan
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Jenis Sumbangan
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pilih salah satunya
Tunai/ chase
Cek/ Giro
Transfer via Bank
Pesan atau saran
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