Professional Documents
Culture Documents
Dfwade
Dfwade
Dfwade
DATA MEMBER
Nama yg Dipilih : ……………………………………………………………………………………………………………
Nama Lengkap : ……………………………………………………………………………………………………………
No. KTP : ……………………………………………………………………………………………………………
Tgl. Lahir : ……………………………………………………………………………………………………………
Alamat : ……………………………………………………………………………………………………………
Kota : ……………………………………………………………………………………………………………
Provinsi : ……………………………………………………………………………………………………………
Negara : ……………………………………………………………………………………………………………
No. HP : ……………………………………………………………………………………………………………
Nama Ibu Kandung : ……………………………………………………………………………………………………………
Ahli Waris : ……………………………………………………………………………………………………………
Email : ……………………………………………………………………………………………………………
NPWP : ……………………………………………………………………………………………………………
DATA BANK
Bank : ……………………………………………………………………………………………………………
Cabang : ……………………………………………………………………………………………………………
No. Rek : ……………………………………………………………………………………………………………
Atas Nama : ……………………………………………………………………………………………………………
Administrasi : Rp. 100.000,- (Tas, flipchart, browsur dan web pribadi)
MEMBANGUN EKONOMI RAKYAT CINTA INDONESIA
Hari___________ Tgl. ____ / ___ / _______
Leader merci hormat kami
Member baru