SURAT IZIN KELUAR

Yang bertanda tangan/Cap Jempol di bawah ini :

1. Nama

: SUANDI

2. Umur

: 50 Tahun

3. Alamat

: Barelantan Desa Gapura Kecamatan Pujut

Kabupaten Lombok Tengah

Selaku Orang Tua dari :

1. Nama

: MANDRI AMBARA DESA

2. Jenis Kelamin

: Laki-Laki

3. Tempat Tanggal Lahir

: Barelantan, 30 Desember 1989

4. Status

: Belum Kawin

5. Alamat

: Barelantan Desa Gapura Kecamatan Pujut

Kabupaten Lombok Tengah

Dengan ini menyatakan bahwa saya tidak keberatan dan secara sadar
serta ikhlas memberikan ijin kepada ANAK Untuk bekerja di Korea
Demikian Surat Pernyataan ini saya buat dengan penuh tanggung jawab
dan benar serta berani angkat sumpah bila diperlukan.

Barelantan, 31 Maret 2012

Mengetahui

Yang Membuat Pernyataan

Kepala Desa Gapura

MAKTAL

LSC, 29 Maret 2012

SUANDI

NO
1
2
3
4
5
6
7
8
9
10
11
12
13
14
15
16
17
18
19
20
21
22
23
24
25
26
27
28
29
30
31
32
33
34
35
36
37
38
39
40
41
42
43
44
45
46
47
48
49
50
51
52
53
54
55
56
57
58
59
60
61
62
63

ID
ID02012003103
ID02012003351
ID02012003735
ID02012003188
ID02012003140
ID02012002932
ID02012002705
ID02012002389
ID02012002624
ID02012002826
ID02012002518
ID02012004032
ID02012002841
ID02012002481
ID02012003230
ID02012002863
ID02012002979
ID02012003039
ID02012001515
ID02012003558
ID02012003335
ID02012002821
ID02012002925
ID02012002717
ID02012004127
ID02012001260
ID02012002729
ID02012002533
ID02012002123
ID02012001715
ID02012002930
ID02012003869
ID02012001917
ID02012003585
ID02012001273
ID02012003040
ID02012002489
ID02012003259
ID02012003851
ID02012001906
ID02012003092
ID02012003283
ID02012002487
ID02012002984
ID02012002756
ID02011005124
ID02012003167
ID02012003579
ID02012004080
ID02012001240
ID02012003494
ID02011004399
ID02012003589
ID02012000680
ID02012003158
ID02012002867
ID02012003016
ID02012003271
ID02012003668
ID02012003925
ID02012002710
ID02011008998
ID02012002894

NAMA
A MUHAMMAD KRISJAYADI
AAN ROMADHON
ADI BAGUS SETIAWAN
ADNAN JULIYANTO
AGUNG PURNOMO
AGUS ATTAMIMI
AGUS PRAMONO
AGUS PRASETYO
AGUS PURWANTO
AGUS RAHMAT
AGUS SETIAWAN
AGUS SOLEMAN
AGUS WIDAYANTO
AGUS ZAENAL ARIFIN
AGUSSALIM SIDDIQ
AHMAD MUDHIR
AHMAD NURSALIM
AHMAD TAUFIK
AHMAD YASIN BN BASARI
AMIN ARI RISTANTO
AMIN FAUZI
AMIR MAHMUD SUBANDI
ANDI PRISTIONO
ANDIK SATRIYA
ANTON WAHIDIN
ARIFIN YUDI PRASETIYO
ARYA WARDANA
ASEP KAMALUDIN
ASEP SUPRIATNA
ASMAN HASSE
AWANPANJAITAN
BIMO PRABOWO
BUDI ISWANTO
BUDI SUHARIYANTO
BUKHORI
BUSTORUL ARIFIN
CAHYO WIBOWO
CARYADI
CASKIM
CASMIN
CHOLIN CAHYONO
CITO SUGIANTORO
CITRA KUSUMA YUNIANTO
DANI ISMAIL
DARYATNO
DASUNI
DENA HERYANA
DENI NURYANTO
DEPI WANTRI
DEVIK OKTAVIA
DHYAN PURNAMA
DIAN INDAH PERTIWI
DIDIK SUSANTA
DWI ADMOKO
EDDY HARTONO
EDI PRAYITNO
EDI SURYONO
EDY WARSITO
EKA HUDIANA
EKO FITRADIN WALUYO
EKO SANJAYA
EKO SULISTIYONO
EKO SUSILO

TGL LAHIR
19900520
19900401
19890412
19880718
19780414
19830823
19800508
19880326
19841109
19770718
19850807
19840815
19810813
19891123
19790622
19801122
19811029
19800420
19860920
19890722
19840518
19870710
19841004
19840719
19830420
19911204
19890624
19910303
19830528
19920302
19820317
19870803
19760815
19770918
19740505
19870124
19920128
19860718
19871020
19830312
19890212
19890806
19820629
19780803
19850607
19870612
19841007
19891203
19851130
19880511
19900107
19870304
19841017
19850405
19911010
19800215
19770105
19770510
19841013
19850616
19881226
19900731
19881018

GENDER
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Female
Male
Male
Male
Female
Male
Female
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male

SEKTOR
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing

64
65
66
67
68
69
70
71
72
73
74
75
76
77
78
79
80
81
82
83
84
85
86
87
88
89
90
91
92
93
94
95
96
97
98
99
100
101
102
103
104
105
106
107
108
109
110
111
112
113
114
115
116
117
118
119
120
121
122
123
124
125
126
127

ID02012004094
ID02012003225
ID02011003644
ID02012003034
ID02012004500
ID02011004387
ID02012003597
ID02012002486
ID02012003768
ID02011009035
ID02012002282
ID02012003740
ID02012002217
ID02012002637
ID02012003804
ID02012003002
ID02012002287
ID02012002628
ID02012004078
ID02012001074
ID02012001287
ID02011009555
ID02012002772
ID02012002800
ID02012002851
ID02011003998
ID02012003981
ID02012002910
ID02012002555
ID02012002165
ID02012002811
ID02012003328
ID02012001357
ID02012003246
ID02012001916
ID02012003511
ID02012002685
ID02012002177
ID02012003567
ID02012004105
ID02012003263
ID02012002937
ID02012002948
ID02012003374
ID02011008951
ID02012002928
ID02012002657
ID02012002550
ID02012003272
ID02012001256
ID02012002653
ID02012002379
ID02012003286
ID02012003468
ID02012001440
ID02012001485
ID02012003693
ID02012003487
ID02012003443
ID02012003215
ID02012000443
ID02012003004
ID02012001364
ID02012001871

ENDANG MULYADI
ENDI WINARKO
ENUNG HASANAH
ERWANTO
FAHRIZAL EFFENDY
FEBRIANI
FERRI JATMIKO
FERRY VERLIAN APRNILIANDO
GANJAR GERHANA
GAYUH SLAMET RIYADI
GIRI
GUGUN HERMAWAN
GUNAWAN BIN SUTARJI
GUPRON
HADI PURWANTO
HADI SUMARNO
HADI SUTRISNO
HARI KRISWANTO
HENDRA JAYA
HENRI EKO PRAMUDIANTO
HERI SUSANTO
IHWANDANU
IIS RISWANTO
IMAM MAKRUF
IMAM SUWARNO
INDRIANI
IVAM ANDRIANNA
IWAN
JAINUL SAIVUDIN
JALALUDIN GAHRAP
JAMZANI
JASWADI
JEMMY BELLY CHRISTIAN
JOKO PRASETYO ASTRESIA
JOKO TRIMANTO
JULIANTO
JUMADI
JUNARDI
JUPRIYADI
JUSMAN EKI
KAKAP ARJANI
KUSNADI
KUSNI
LESMANA SETIAJI
MAHROJI
MANDRI AMBARA DESA
MIFTAHUL HUMAM
MIFTAKUL HUDA
MUDZAKIR
MUFID
MUH IWAN
MUHAMAD NUR MUHAIMIN
MUHAMAD SAPARI
MUHAMAD ZAENAL ABIDIN
MUHAMMAD ANTON
MUHAMMAD IRFAN IMADUDDIN
MUHAMMAD KHOYYUM MUSHTHOFA
MUHAMMAD RIZAL AMIRULLOH
MUHAMMAD ZAENAL ARIFIN
MUHTADIN
MUKHAMAD YUNUS
MULYANTO
MUNAWIR
MUNTOLIB

19830920
19790206
19870926
19850518
19820711
19920214
19820611
19910427
19790907
19930312
19791022
19911020
19901211
19910203
19900125
19890424
19900308
19860112
19900503
19860813
19910204
19920819
19840430
19770725
19840228
19830810
19881123
19881008
19840810
19760216
19750624
19770209
19781221
19860107
19751212
19860707
19870612
19800317
19880810
19900601
19821209
19901101
19750801
19800917
19770724
19891230
19840307
19880828
19850321
19730415
19771008
19741017
19880405
19790712
19820408
19800124
19870427
19850903
19790924
19820215
19920905
19850129
19820110
19740803

Male
Male
Female
Male
Male
Female
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Female
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male

Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Fishing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing

128
129
130
131
132
133
134
135
136
137
138
139
140
141
142
143
144
145
146
147
148
149
150
151
152
153
154
155
156
157
158
159
160
161
162
163
164
165
166
167
168
169
170
171
172
173
174
175
176
177
178
179
180
181
182
183
184
185
186
187
188
189
190
191

ID02012003479
ID02012002871
ID02012002563
ID02012003209
ID02012001745
ID02012002160
ID02011003429
ID02012002944
ID02011003705
ID02011004000
ID02011006757
ID02012002519
ID02012003652
ID02012003172
ID02012002743
ID02011009421
ID02012001809
ID02012003046
ID02012003347
ID02012004055
ID02012004081
ID02012002968
ID02012002394
ID02012004060
ID02012003400
ID02012003066
ID02012000769
ID02012003220
ID02011004113
ID02012002784
ID02012001802
ID02012004483
ID02012003457
ID02012003905
ID02012003765
ID02011004563
ID02012003256
ID02012001171
ID02012000486
ID02012003691
ID02012002986
ID02012003062
ID02011000109
ID02012001236
ID02011008836
ID02012002993
ID02012003436
ID02011008678
ID02012001517
ID02012003214
ID02011009434
ID02012003590
ID02012001433
ID02012000474
ID02012003844
ID02012000313
ID02011009219
ID02012003041
ID02012002667
ID02012003064
ID02012002629
ID02012001385
ID02012000387
ID02012000336

MUSTOFA
NANA SUPRIATNA
NANANG KUSWOYO
NANANG SAEPUN
NOFIANTO
NOKHIN
NOPI
NUR CHAMID
NUR JAENAH
NUR NASIBAH ASYAHIDAH
NURUL SAFITRI
NURYAMAN
OJI AHMAD FAUJI
PANDE MADE MANDIASA
PARJOKO
PESTIPAL LIMBONG
PRIYAN APRIYAN
PUAD PALAHUDIN
PURWANTO
RABYAN
RASUDI
RIAN IRAWAN
RIANTO
RIKI SUSANTO
RINTO
RISTIYONO WIDODO
RIZKI HIDAYAT
ROBIIN
ROVIATIN
RUDY BUSRAH
RUPAAT
SADIRAN
SAIFULLAH NADZIRIN
SAMSUDIN
SANDI NURPALAH
SARYANTI
SENTANU
SETIAWAN
SHOLIYAMI WAGINI
SISWANTO
SISWANTO
SISWANTORO
SITI HARDIYANTI
SLAMET ABDULLAH
SOBIRIN
SUDARSONO
SUDI ASIHONO
SUDIARTO
SUGENG
SUGIHARTO
SUGIYANTO
SUGIYANTO
SUGIYANTO
SUPRIYATIN
SUGIYATNO
SUGIYONO
SUHARTOYO
SUKIRNO
SUKO RUMANDONO
SULAEMAN
SUMARNO
SUNARDI KARTOTARUNO
SUNARSO
SUPARMO

19910711
19890718
19870905
19880531
19841121
19731218
19900528
19770824
19910613
19901227
19920323
19820531
19791021
19810911
19831129
19711128
19920323
19830415
19820720
19810307
19861016
19900711
19830409
19900512
19820606
19800229
19830902
19910725
19880121
19860822
19751213
19820318
19900404
19740103
19890425
19850730
19881109
19811222
19740420
19760917
19830830
19840502
19910110
19841028
19750730
19840703
19900916
19751021
19830429
19910601
19730710
19870830
19861220
19850913
19830213
19771012
19921023
19841125
19800719
19890608
19910917
19811223
19751228
19720710

Male
Male
Male
Male
Male
Male
Female
Male
Female
Female
Female
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Female
Male
Male
Male
Male
Male
Male
Female
Male
Male
Female
Male
Male
Male
Female
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male

Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing

192 ID02012003966
193 ID02012002712
194 ID02012002296
195 ID02012003845
196 ID02012001560
197 ID02012001797
198 ID02012001035
199 ID02012002806
200 ID02012002805
201 ID02012003287
202 ID02012003865
203 ID02012002926
204 ID02012003237
205 ID02012002036
206 ID02012003284
207 ID02012000202
208 ID02012003169
209 ID02012001037
210 ID02011004429
211 ID02012002205
212 ID02012002515
213 ID02012001292
214 ID02012001618
215 ID02012002804
216 ID02012002668
217 ID02012002903
218 ID02012002812
219 ID02012003412
220 ID02011004342
221 ID02012001525
222 ID02012002666
223 ID02012003097
224 ID02011009150
225 ID02011009923
226 ID02011005357
227 ID02012002860
228 ID02012002701
Tags:

maret 2012
slc

SUPRAPTO
SUPRIYANTO
SURATMAN
SURONO
SUSANTO
SUTIKNA
SUTIKNO MISIRAN
SUTRISNO
SUWARDO
SYAMSUL HADI
TAHIMAN
TAMBAH WIDODO SLAMET
TATUK JIMMY MARHAENTO
TEKI PRIYANTO
TORIKHIN
TOWIL SUPRIYO
TRI PUJIYANTO
TRI SUSANTO
TURINIH CIPTAWATI
UNTUNG CONDRO PURNUMO
UNTUNG SETIONO
UNTUNG SUJARWO
WAHYUDI
WANDA
WIJIANTO
WINA AUSTRIA WIJAYA
WITONO
WIWIK RUDIANTO
YANUAR KRISTIANTI
YAZID BUSTHONI
YOGI AHMAD SEPTIAN
YOSEP SAPUTRA
YOYOK SUBAGYO
YULIANTO
YUNIATUN
ZAMHARI
ZULKIFAR ACHMAD

19780618
19780409
19910119
19890401
19750512
19760418
19790615
19850204
19800526
19841231
19900223
19780623
19850125
19750827
19780128
19851113
19850803
19800627
19870521
19900724
19760729
19760603
19750405
19760912
19900615
19860218
19790418
19771111
19910125
19800420
19880811
19890101
19750503
19840718
19890623
19800417
19760304

Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Male
Female
Male
Male
Male
Male
Male
Male
Male
Male
Male
Female
Male
Male
Male
Male
Male
Female
Male
Male

Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing
Manufacturing