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Formulir tanpa judul
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Email
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Your email
TANGGAL BERKAS MASUK
*
MM
/
DD
/
YYYY
NAMA PELAKU USAHA
*
Your answer
NOMOR INDUK KEPENDUDUKAN
*
Your answer
NOMOR KARTU KELUARGA
Your answer
TEMPAT LAHIR
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Your answer
TANGGAL LAHIR
*
MM
/
DD
/
YYYY
ALAMAT
Your answer
NAMA USAHA
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Your answer
ALAMAT USAHA
*
Your answer
MODAL USAHA
*
Your answer
SARANA USAHA YANG DIGUNAKAN
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Your answer
JENIS IZIN
ORANG PERSEORANGAN
BADAN USAHA
Clear selection
NOMOR IZIN YANG DI TERBITKAN
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Your answer
TANGGAL IZIN KELUAR
MM
/
DD
/
YYYY
NOMOR PESERTA WAJIB PAJAK
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Your answer
JUMLAH TENAGA KERJA
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Your answer
NOMOR TELEPON
Your answer
PERKIRAAN PENDAPATAN PERTAHUN
*
Rp
Kursi
Liter
Ton
Other:
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PETUGAS DPMPTSP YANG MENERIMA BERKAS
*
ARNET SASELA, SE
NENY SARUNDAITAN, S.Kom
ROOS MERI RIUNG, SH
JITRO TAWATUAN, A.Md. Ts
TETI DEICE LADI, A.Md. Ak
MARSONI SARANAUNG
HENDRI TAARAUNGAN, S,Pd
SEBLUM SAHABIR
YEHEZKIEL BANUA, S.Pd
DANIEL LOSOH, S.Kom
Required
APAKAH IZIN SUDAH DI PROSES
SUDAH DI PROSES
BELUM DI PROSES
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