BIODATA CREW

NAMA SESUAI KTP : ____________________________________________________________________________________

TEMPAT / TGL LAHIR : ____________________________________________________________________________________
ALAMAT SEKARANG : ____________________________________________________________________________________
ALAMAT EMAIL :
NAMA KAPAL : ____________________________________________________________________________________
JABATAN DAN KELAS : ____________________________________________________________________________________
NO HP PRIBADI : Gol Darah :__________________________________
TGL NIKAH :
EMERGENCY CALL : Nama :
Hubungan :
No Telp :
Nama :
Hubungan :
No telp :
NAMA IBU KANDUNG : ____________________________________________________________________________________
NO NPWP : ____________________________________________________________________________________
NO BPJS KETENAGAKERJAAN : ______________________________________________________________________________:
No BPJS KESEHATAN :_____________________________________________________________________________________
NO REK MANDIRI : ____________________________________________________________________________________
CAB REK MANDIRI : ____________________________________________________________________________________
STATUS (Nama Istri) : ____________________________________________________________________________________
JUMLAH ANAK : ____________________________________________________________________________________
1. LAKI-LAKI : ____________________________________________________________________________________
2. PEREMPUAN : ____________________________________________________________________________________

WAJIB MENGISI SEMUA DATA

EMERGENCY CALL HARUS 2 ORANG
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Crew Usda seroja Jaya

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