CERTIFICATE OF PRATIQUE
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Tanggal Keberangkatan / Date of Departure *
MM
/
DD
/
YYYY
Tanggal Kedatangan / Date of Arrival *
MM
/
DD
/
YYYY
Jam Kedatangan / Time of Arrival *
Time
:
Nama Maskapai/Name of Airline *
Nomor Registrasi Pesawat/Airplane Registration Number *
Tipe Pesawat/Airplane Type *
Kebangsaan Maskapai/Flag of Airline *
Bandara Keberangkatan/Airport of Departure *
Hasil Penilaian / Assessment Result *
Nama Petugas KKP / Port Health Officer *
NIP Petugas KKP
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