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Formulir Permohonan Surat Keterangan Mahasiswa Aktif
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NIM
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Nama Lengkap
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Alamat
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Tempat dan Tanggal Lahir
*
contoh: Tangerang 1 Januari 2000
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Keperluan Surat
*
contoh: Untuk pengurusan kartu BPJS Kesehatan.
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Alamat Email
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Surat akan dikirimkan melalui email.
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