No
Nomor JKN Jenis mutasi No Kartu Keluarga NIK
Urut
1 2 3 4 5
CONTOH PENGISIAN
1 - 3514143005120013 3514145105890002
2 - 3514143005120013 3514142407880003
3 - 3514143005120013 3514140603120001
4 - 3514143005120013 3514145110160001
NIPlama NIPbaru Nama Lengkap Jenis Kelamin Status Kawin
6 7 8 9 10
- - II c -
- - - - -
- - - - -
- - - - -
Tambahan
Tunjangan Jabatan/ Tunjangan Tunjangan
TMT Pegawai Gaji Pokok Penghasilan Lain Iuran
Keluarga Tunjangan Profesi Kinerja
26 27 28 29 30 31 Bagi PNS
32Daerah 33
- - puskesmas kedopok
- - puskesmas kedopok
- - puskesmas kedopok
- - puskesmas kedopok
Kode Faskes Gigi Nama Faskes Gigi Nomor Telepon No NPWP
37 38 39 40
- - 082234412451 41.055.056.0-624000
- - 089531005600 96.213.538.0-624.000
- - - -
- - - -
NIPBARU NIP_BARU
NULL 196405031987032021
NULL 195206171978071001
NULL 195304241978071001
NULL 195109191978032003
NULL 195309211977032001
NULL 195507231978031004
NULL 195802061978032008
NULL 195212151979071001
NULL 195211211979072001
NULL 195211261978032003
NULL 195704211978032015
NULL 195205181977032001
NULL 195107141977032001
NULL 195312311977031018
NULL 198004142010012004
NULL 195106211979121002
NULL 195112171976011002
NULL 195105161978071001
NULL 195612311975121061
NULL 196708102008012022
NULL 197401272010012002
NULL 197311212010012001
NULL 195412041979072001
NULL 195207251979072001
NULL 195402011979032003
NULL 195308111979031013
NULL 195507061979071001
NULL 195910021979072001
NULL 195402021979121004
NULL 197308242010012003
NULL 198412122010011036
NULL 198411092011011004
NULL 195810271979071005
NULL 195309281979121003
NULL 195210031979031008
NULL 195106271979032002
NULL 195207151979032005
NULL 196505022010011002
NULL 197804112010012003
NULL 195310151978032006
NULL 195108281978032002
NULL 195902121979071005
NULL 195802111979071003
NULL 195205121976011007
NULL 195201061976011002
NULL 195108151977032002
NULL 198712252014101007
NULL 195306291979121001
NULL 195709291976011002
NULL 195512291976012005
NULL 195404161975122011
NULL 195112171976012002
NULL 195203081979032001
NULL 195311051977031002
NULL 195908251977031001
NULL 195108251978071001
NULL 195408121978071002
NULL 195707201978072001
NULL 195402011978071004
NULL 196208192008012003