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Formulir Permintaan Pembuatan Akun Rumah Dataku
hanya untuk kader dan PLKB/PKB
* Indicates required question
Nama Lengkap
*
Your answer
Jabatan
*
Your answer
NIK
*
Your answer
Nomor HP
Your answer
Alamat
(Kecamatan dan Kelurahan wajib dicantumkan)
Your answer
Permintaan dokumen pendukung
Dokumen Permohonan
Dokumen BAST
Alamat email
(digunakan sebagai username)
Your answer
Submit
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