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FORMULIR MEMBER
 DATA PRIBADI

Nama Lengkap : .........................................................................................................


No. KTP : .........................................................................................................
Alamat sesuai KTP : .........................................................................................................
Alamat Domisili : .........................................................................................................
(kosongkan jika sama dengan KTP)
Status Pernikahan : .........................................................................................................
(Lajang/Menikah)
No. HP/WA : .........................................................................................................
Email : .........................................................................................................
Sosial Media (FB/IG) : .........................................................................................................

 DATA PEKERJAAN
Pekerjaan : .........................................................................................................
Jabatan/Posisi : .........................................................................................................
Alamat Kantor : .........................................................................................................
No. Tlp Kantor/Rekan

 DATA PERBANKAN
Nomer Rekening : .........................................................................................................
BANK : .........................................................................................................
Atas Nama : .........................................................................................................

 KERABAT KANDUNG

Nama Saudara/Kerabat : .........................................................................................................


Hubungan : .........................................................................................................
Pekerjaan : .........................................................................................................
No. HP aktif : .........................................................................................................
NB : Wajib mencantumkan Nama Suami/Istri apabila sudah menikah

 BERKAS PENDUKUNG
- Foto KTP : terlampir
- Foto Kartu Keluarga (KK) : terlampir
- Foto BPJS/NPWP : terlampir
- Foto Buku Tabungan : terlampir
*Wajib melampirkan berkas-berkas di atas.

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