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FORM PANGKALAN DATA DPKP
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* Indicates required question
NIT
*
Wajib diisi, perhatikan penulisannya
Your answer
Nama Lengkap
*
Isikan nama dengan menggunakan huruf kapital
Your answer
Tempat Lahir
*
Isikan tempat atau kota lahir
Your answer
Tanggal Lahir
*
Sesuikan dengan di KTP
MM
/
DD
/
YYYY
Seafarer Id
*
wajib diisi, sejumlah 10 digit (lihat BST)
Your answer
NIK
*
Isikan No. KTP sejumlah 16 digit
Your answer
Kewarganegaraan
*
Choose
Indonesia
Asing
Pasport
Isikan No Pasport kalo sudah ada
Your answer
Jenis Kelamin
*
Choose
Laki-Laki
Perempuan
Submit
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