Taekwondo

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심 사 신 청 서

Aplication for Promotion Test


1 ID-size photo
국 적 Tel
주 소 attach with paste
Nationality INDONESIA Address
(Citizen) e-mail

First Year Current Grade


Date
성명 Dan/Poom
Middle of Moon Dan Sertification No.
Name applied for
Birth
Last Day Date of Issue Sex

I submitt this application to the Promotion Board of KUKKIWON for a promotion test.

Date of application : 6 Februari 2024 Applicant : M. Julian Saputra

I Honestly recommended the above person as a well-qualified applicant for the promotion test of Dan/Poom grades.
Name of INDONESIA TAEKWONDO
country INDONESIA Recommended
Association/Dojang ASSOCIATION RICHARD T. H. TAMPUBOLON
by (LIEUTNAN GENERAL RET.)
Address of STC SENAYAN 3 rd. Fl. No. 173 B. JL. ASIA AFRIKA
Association/Dojang SENAYAN JAKARTA 10270. INDONESIA. Recommender’s
PRESIDENT of INDONESIA
Dan Certificate No
Tel/ Fax/ e-mail +62.21.2940.7769 / /info@pbti.or.id or Date of Birth TAEKWONDO ASSOCIATION

To: President
KUKKIWON (World Taekwondo Headquarters)

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