Anda di halaman 1dari 1

BIODATA PESERTA MAGANG BUMN

(diisi dengan huruf cetak)

1. Nama : .............................................................................
2. NIM : .............................................................................
3. Tempat, tanggal lahir : .............................................................................
4. Agama : .............................................................................
5. Jenis Kelamin : .............................................................................
6. Prodi : .............................................................................
7. Alamat Rumah
a. Di Bandung (lengkap) : .............................................................................
.............................................................................
8. Alamat Rumah
a. Orang Tua : .............................................................................
.............................................................................
9. Nomor KTP : .............................................................................
10. Alamat e-mail : .............................................................................
11. No. Hp : .............................................................................
12. No. Telp Orang Tua : .............................................................................
13. IPK : .............................................................................

Mengetahui, Bandung,
Prodi Tanda Tangan

....................................... ..................................................

Anda mungkin juga menyukai