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KOPERASI PRODUSEN PORANG INDONESIA JAYA

Dukuh Kepandean RT 01 RW 02 Desa Bekare Kecamatan Bungkal


Telp. 082231454002 Email kpporangindonesiajaya@gmail.com
Kode pos 63462 Kabupaten Ponorogo

FORMULIR PENDAFTARAN CALON ANGGOTA


KOPERASI PRODUSEN PORANG INDONESIA JAYA

Nama : .....................................................................................................................

NIK : .....................................................................................................................

Jenis Kelamin : .....................................................................................................................

Tempat Tanggal : .....................................................................................................................


Lahir

Status Perkawinan : .....................................................................................................................

Pekerjaan : .....................................................................................................................

Agama : .....................................................................................................................

Alamat : .....................................................................................................................

No. HP : .....................................................................................................................

Tanggal Registrasi : .....................................................................................................................

Luas Lahan :

Kewajiban Anggota :

1. Simpanan Pokok Rp. 300.000,00


2. Simpanan Wajib Rp. 10.000,00
3. Kaos Rp. 70.000,00

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