FORMULIR PENDAFTARAN

PENDIDIKAN KHUSUS PROFESI ADVOKAT

2012 2013

Angkatan

: ( ____ ) XVI

( ____ ) XVII

( ____ ) XVIII

Kelas

: ( ____ ) Weekdays A / B / C

Nama Lengkap

: _______________________________________________________________

Tempat Tgl Lahir

: _______________________________________________________________

Alamat Lengkap

: _______________________________________________________________

( ____ ) Weekend A / B

( ____ ) XIX

( ____ ) Kelas Sore A / B

_______________________________________________________________
Telp Rumah

: _______________________________________________________________

HP

: GSM _________________________ CDMA ________________________

E-Mail

: _______________________________________________________________

Nama Kantor

: _______________________________________________________________

Jabatan

: _______________________________________________________________

Alamat Kantor

: _______________________________________________________________

Telp Kantor

: _______________________________________________________________

Asal Universitas

: _______________________________________________________________

No. Ijazah

: _______________________________________________________________
Jakarta,

20_____

Peserta PKPA

Foto Berwarna
4x6
(_____________________________________)

Nb : Berkas yang harus dikumpulkan pada hari pertama PKPA : Slip Transfer Asli, Formulir
Pendaftaran 2 lembar, Foto Copy Ijazah S1 Hukum Legalisir Asli 2 lembar, Foto Copy KTP 2 lembar,
Foto Berwarna 3x4 & 4x6 @3 lembar. Semua berkas tersebut dilampirkan dalam MAP MERAH.

Office :

th

Menara Karya, 28 Floor

Jl. H.R Rasuna Said Blok X-5, Kav 1-2
Jakarta 12950, Indonesia
Tel : (62-21) 5794 4372 / (021) 5789 5943
Fax : (62-21) 5794 4369 / (021) 5789 5888
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www.fhp-edulaw.com