PERSONAL DATA UPDATE

Name Employee No.*

Place of Birth BPJS TK No.
Date of Birth BPJS Kes No.
NIK / ID No. NPWP No.
Current Address Join Date
Department
Position
City-Province Religion
Postal Code Email Address
Phone No. Blood Type
Emergency Contact BCA Acc. No.
Person
Emergency Contact Gender
Number
Last Education

Tax Status S0 S1 MO M1 M2 M3
List of Family - Wife / Husband :
- Children : 1. Date of Birth :
2. Date of Birth :
3. Date of Birth :

List of Certification (if any):

1.________________________________________________ Issued by :________________
2.________________________________________________ Issued by :________________
3.________________________________________________ Issued by :________________

Outstanding balance : 31 Dec 2019 Note : Signature:

Jika ada perubahan data dari
Annual Leave : __________
tahun sebelumnya, misalnya
Public Holiday : __________ dari single menjadi menikah
atau jika ada penambahan
Complimentary Off : __________
anak mohon dilampiri
Total : __________ dengan dokumen Stated by:
penunjang. Date :

* Diisi oleh HRD