PEMERINTAH KABUPATEN LANGKAT

KECAMATAN BESITANG
KANTOR KEPALA DESA SUKA JAYA
KODE POS : 20859

Suka Jaya, 7 April 2022

Kepada Yth :
Bapak Kepala Puskesmas
Kec Besitang
Di,-
Tempat

SURAT PENGANTAR
Nomor :140- /SP-SJ/IV/2022

Dengan Hormat,

Bersama ini kami sampaikan kepada Bapak kepala Puskesmas Kecamatan Besitang untuk
memberikan Rekomendasi usulan mengurus BPJS ke kantor BPJS STABAT, selanjutnya
diterangkan nama tersebut berikut (data Terlampir ) belum memiliki kartu BPJS :
Jumlah KK : KK
Jumlah Usulan : orang

Demikianlah Surat pengantar ini kami sampaikan, atas perhatian Bapak kami ucapkan
terima kasih.

PLT. Kepala Desa suka Jaya

Kecamatan Besitang

SURUNG GULTOM S.Pd

NIP. 196304111993061001
NO Nama Nik NO KK Alamat Tmpt/Tgl Lahir
1 Zainal Abidin 1205162705780001 1205161009070163 Suka Tani Sukatani/27-05-1
2 Muliyani 1205164606840003 1205161009070163 Jamur Labu/ 06-0
3 Annisa Aulia Azahra 1205165304100001 1205161009070163 Langkat/13-04-20
4 Suparno B 1205160603670001 1205161009070259 Suka Tani/06-03-
5 Jumilah 1205165706690001 1205161009070259 Deli Tua 17-06-1
6 Ependi 1205165706690001 1205161009070259 Sukatani
7 Hendrik 1205160507910003 1205162912140004 Suka Tani/05-07-
8 Rini 1205164111940002 1205162912140004 Suka Tani/01-11-
9 Yasmin Khairunnisa 1205167103150001 1205162912140004 Langkat/31-03-20
10 Ega Khalista 1205166706180002 1205162912140004 Langkat/27-06-20
11 Muhammad Ridho 1205160103150002 1205160701110029 Langkat/01-03-20
12 Muhammad Rizky 1205160103150001 1205160701110029 Langkat/01-03-20
13 Suginok 1174020610890005 1174050810150002 Langsa/06-10-198
14 Susilawati 1205165305920001 1174050810150002 Suka Tani/13-05-
15 Bagas Aldiansyah 1174053001150003 1174050810150002 Suka Tani/30-01-
16 Dika Mirza Hakin 1174053001170002 1174050810150002 Langsa/31-01-201
17 Suganda 1205161002500002 1205160909700247 Sarang Jaya/10-02
18 Manisem 1205167012540001 1205160909700247 Sarang Jaya/30-12
19 Supardi 1205161212920005 1205160909700247 Suka Tani/12-12-
20 Heriadi 1471060702690002 1205161912170003 Galang/07-02-196
22 Yusliarni 1471065111690001 1205161912170003 Sei Liput/11-11-1
23 Suhardi 1407132108890001 1205160802190003 Kisaran/21-08-19
24 Nova Liana 1205164303980005 1205160802190003 Suka Tani/03-03-
25 Shela Ramadhani 1205164905190001 1205160802190003 Langkat/09-05-20
26 Karmin 1205162506680001 1205160909070155 S tani/25-06-1968
27 Boinem 1205166111680001 1205160909070155 S Tani/21-11-196
28 Pendi 1205161102920001 1205160909070155 S Tani/11-02-199
29 Wanto 1205160508940001 1205160909070155 S Tani/05-08-199
30 Azehar 1205160204000001 1205160909070155 S Tani/02-04-200
31 Monica Angela Rouse 1205164610070001 1205160909070155 Suka Jaya/06-10-
32 Yohan Syahputra 1205162307090006 1205160909070155 Suka Jaya/23-07-
33 Suradi 1205160911810008 1205161910100001 Suka tani/19-11-1
34 Sri Mariati 1205165011840011 1205161910100001 Suka Tani/10-11-
35 Wini Syahputri 1205166509060002 1205161910100001 Harum Sari/25-09
36 M. Alvin Aditya 1205161908140001 1205161910100001 Langkat/19-08-20
37 Sawal 1205162109630002 1205160112080001 T Tinggi/21-09-2
38 Misgiatik 1205165504760005 1205160112080001 Suka tani/15-04-1
39 Dedi Irawan 1205161705060007 1205160112080001 Suka tani/17-05-2
40 Revalno 1205161711800002 1205160601160001 Medan/17-11-198
41 Musini 1205166511900003 1205160601160001 Suka tani/25-11-1
42 Inshan Pranata 1205162701160003 1205160601160001 Langkat/27-01-20
43 Sudariyanto 1205160101820004 1205160605080014 Sukatani/01-01-1
44 Fitriani 1205155803920001 1205160605080014 B karang/18-03-1
45 Indah Permata Sari 1205164903070003 1205160605080014 Sarang Jaya/09-03
46 Siti Aisyah 1205166210110003 1205160605080014 Langkat/22-10-20
47 Dwi Gustina 1205166008150003 1205160605080014 Langkat/20-08-20
48 Adelia Novitasari 1205164601140001 1205160909070108 Langkat/06-11-20
49 Azka Jagat Satria 1205162309170001 1205160909070108 Langkat/23-09-20
50 Wahyu Ramadani 1205161701990003 1205160311200008 Suka Mulia/17-01
51 Zea Zafina Shatara 1205164606210003 1205160311200008 Langkat/06-06-20
52 Sogimin 1205161510730001 1205160909070320 Tebing Tinggi/15
53 Cici Parwati 1205165405010001 1205160909070320 Suka Mulia/14-05
54 Reza Hendriyansah 1205162808070001 1205160909070320 Suka Mulia/28-08
55 Anggi Kurniawan 1205161212020006 1205162910210004 Suka Muliya/12-1
56 Paini 1205165510570001 1205163103210001 Dolok Ilir/15-10-1
57 Sugiono 1205161706860004 1205161006150007 Suka Muliya/17-0
58 Novita Sari 1116085011871001 1205161006150007 Rantau/10-11019
59 Hanza Khumaira 1205165407150001 1205161006150007 Langkat/14-07-20
60 Sarju 1205161106650002 1205160909070159 T. Tinggi/11-06-1
61 Paini 1205165302750001 1205160909070159 Lubuk Pakam/13-
62 Samidi 1205161207590001 1205160909070170 T. Tinggi/12-07-1
63 Paini 1205164412630001 1205160909070170 Tebing Tinggi/04
64 Misno 1205161909680001 1205160909070145 Dolok Hirir/19-09
65 Musinem 1205166510750001 1205160909070145 Suka Tani/25-10-
66 Aldi 1205160104070001 1205160909070145 Suka Mulia/01-04
67 Agus Muliono 1205160105870002 1205160412200002 Besitang/01-05-1
68 Ermi 1205165506000002 1205160412200002 Suka Tani/15-06-
69 Putri Muliani 1205165005160002 1205160412200002 Langkat/10-05-20
70 Hasanuddin 1205160909640001 1205160909070143 Sp. Kanan/ 09-09
71 Kartik 1205165104700001 1205160909070143 Suka Tani/11-04-
72 Darna Eka Syahputra 1205161604900002 1205160909070143 Suka Tani/17-04-
73 Dedi Swardana Syahputra 1205161408920001 1205160909070143 Suka Tani/14-08-
74 Ernilawati Syahputri 1205165111000002 1205160909070143 Suka Tani/11-11-
75 Ferdi Prabowo 1205160601050004 1205160909070143 Suka Tani/06-01-
76 Anita Rahma Sari 1205166310150002 1205161803110001 Langkat/23-10-20
77 Kiki Ardiansyah 1205160812200003 1205161803110001 Langkat/08-12-20
78 Tukiran 1205160710660001 1205160909070060 Simpang Kanan/0
79 Katini 1205165006680001 1205160909070060 Perbaungan/10-06
80 Yunika 1205166308020001 1205160909070060 Suka tani/23-08-2
81 Arsyila Syahputri 1205164408210001 1205160601150001 Langkat/04-08-20
82 Nursian 1205161101830002 1205160305100011 Sidodadi/11-01-1
83 Nurliyah 1205166711840003 1205160305100011 Sukatani/27-11-1
84 Dela Safria Ningsih 1205164203070001 1205160305100011 Harum Sari/02-12
85 Harifin 1205160110110004 1205160305100011 Langkat/01-10-20
86 Davit Syahputra 1205162012190001 1205160305100011 Langkat/20-12-20
87 Giok 1205160809730003 1205160701110027 Langkat/08-09-19
88 Suti 1205164607810003 1205160701110027 Binjai/06-07-1981
89 Nurhassana 1205165204020004 1205160701110027 Rih Sogong/12-04
90 Siti Juleha 1205166606060004 1205160701110027 Harum sari/26-06
91 Arjuna Akbar 1205160710120002 1205160701110027 Langkat/07-1110-
92 Yetno 1205160202740002 1205161907100005 Suka Tani/02-02-
93 Suwardiah 1205164304770004 1205161907100005 Besitang/03-04-1
94 Irfan Syah 1205160809040002 1205161907100005 Suka Jaya/08-09-
95 Dani Sanjaya 1205163103120001 1205161907100005 Langkat/31-03-20
96 Rajali S 12051601055630001 1205161009070039 Sumut/01-07-195
97 Hamidah 1205166412640001 1205161009070039 Tualang Cut/24-1
98 Hendra 1205162104980001 1205161009070039 Suka tani/21-04-1
99 Suhendro 1205160707720005 1205160701110025 Stabat/07-07-197
100 Fitria 1271206608800007 1205160701110025 Medan/26-08-198
101 Ghaali Pratama 1205160908140002 1205160701110025 Langkat/09-08-20
102 Jaris Wiguna 1205162011150001 1205160701110025 Langkat/20-11-20
103 Deddy Purnama 1205160112080002 1205160112080002 Sukatani/10-07-1
104 Tukiran MD 1205161210670001 1205160909070056 Sidodadi/12-10-1
105 Katinem 1205164702710003 1205160909070056 Suka Sari/07-02-1