Format Integrasi Jamkesda

FORM MIGRASI PESERTA
JENIS PESERTA
INSTANSI/BADAN/PERUSAHAAN
KODE VIRTUAL ACCOUNT
K TEMPAT PEMBAYARAN IURAN
TANGGAl REGISTRASI
NOMOR PKS
KODE PKS
MASA BERLAKU
KODE TANGGUNGAN
KODE KC
KODE DATI2
No No KK NIK/KITAS/KITAP Nama Lengkap
1 2 3 4
1 7406070504110058 7406070110850001 ARFAN YUNUS
7406070504110058 7406076102840002 AMINAH
7406070504110058 7406071011090001 ALYATUL MUTMAINNAH ARFAN
2 7406071006150001 7406011102720001 BAGUS WIJAYA KUSUMA

7406071006150001 7406014107640003 NISWATI
3 7406071503080013 740607016710009 AMBO TUO

7406071503080013 7406074107740011 MASWATI
7406071503080013 7406072512930001 FAISAL PRATAMA
7406071503080013 7406074803940001 AYU FRADILLA
7406071503080013 7406076801060001 IRSYA DIATUL PASYA
4 7406071403080065 7406070107430015 BASO

7406071403080065 7406074107520023 BUNGALA
7406071403080065 7406076210010002 NIKEN AYU SAPUTRI
7406071403080065 7406076111030001 SUCI RAHMADHANI
7406071403080065 HADAMU
5 7406071603080016 7406074107610029 SALMA

7406071603080016 7406071904880001 SUKARMAN
6 7406071503080027 7406071403800001 MASMUR

7406071503080027 7406074109840001 HARLINA
7406071503080027 7406070208070001 ANGLIN MAS AJIB
7406071503080027 740605808120001 ASILATU RAHMI
7 7406072711140015 7406071408720001 AHMAD YUNUS

7406072711140015 7406074703850001 SARWATI SAFITRIANI.SH
7406072711140015 7406072012070004 MUHAMMAD NANDAN NIZAR PRATAMA
7406072711140015 740607407630010 SABNARIA
8 74060728004080039 7406074107710037 JABERIA

74060728004080039 7406074504910001 IRMAYANTI,S.KOM
9 7406071603080151 7406070107640009 SAPARENG

7406071603080151 7406074107650015 HJ.KAMARIA
7406071603080151 7406072210030001 SAHRUL
10 7406072509140001 7406075710940001 NISMAWATI

7406072509140001 7406070807140001 ANDI MUH. MA'RIFATULLAH
11 7406071503080012 7406070705690001 SUKRI

7406071503080012 7406074707710001 NURHAEDA
7406071503080012 7406072503940001 ASKAR
7406071503080012 7406072606960001 ARSIL SUKRI
7406071503080012 7406072805040001 ASLIM
12 74060715003080208 7406071305160002 MUH. FADLIKAL
7407070811070144 7407071709700612 MARSUKI

7407070811070144 7407075108730613 RAJEMING
7407070811070144 7407071003890614 YUSRAN
7407070811070144 7407074803980615 ITRA WATI KALBI
13 7406071603080121 7406070310680001 SAKIBE

7406071603080121 7406074506690001 BECCE TANG
7406071603080121 747103100490001 SUPARDI
14 7406071511170002 7406071304910001 RISMAL, S.Pd

7406071511170002 7406075603920001 IRMAWATI, S.Sos
15 7406071701110001 7406073112630001 RUSLAN

7406071701110001 7406075205770001 DARNI
7406071701110001 7406076707950001 RIDA WULANDARI
7406071701110001 7406076511050001 SOFIA NOVITA
7406071701110001 7406074811130001 SYIFA SAHRA
16 7406071503080094 7406070109790001 BASRI

7406071503080094 740607640780001 HAJEMING
7406071503080094 7406070405040001 ARJUN
7406071503080094 7406072204140001 ARFAN
17 7406071503080139 7406070701800001 BISMAN

7406071503080139 7406076111820002 KAMSINAR
7406071503080139 7406076106050001 MILDA BISMAN
7406071503080139 7406071010090001 PUTRA DWI PERMANA BISMAN
18 7406071008160001 7406206411940001 RISNAWATI

7406071008160001 7406075504150001 ALFINA SYAKIRA
19 7406070804130001 7406072807850003 ANDI MUSRIADI

7406070804130001 7406075503950003 YULIANA
7406070804130001 7406072306140001 ANDI RIFQIE EL-FATH
20 7406070406120004 7406073112770010 KAHARUDDIN

7406070406120004 7406075405810002 RUSNAH.K
7406070406120004 7406076601110001 ZALZA SYAM FADILLAH
21 7406071503080009 7406071002770001 HASANUDDIN

7406071503080009 7406074107770068 SINARTI
7406071503080009 7406070202950001 RIZAL ASRIL
7406071503080009 7406070305000001 EMIL
7406071503080009 7406071806010001 ASRUL
7406071503080009 7406074107570040 NADIRA
21 7406071403080057 7406070107580056 KADIR

7406071403080057 7406074107600077 MANYA
7406071403080057 7406074408960001 LIS DAHLIA
7406071403080057 7406071303920003 IRMAL DARWIS
22 7406071503080129 7406070805720001 AMIR ARMIN

7406071503080129 7406075209780001 SUNIARTI
7406071503080129 7406071906960002 AHMAD AMIRUDDIN
7406071503080129 7406072508030004 MUH. FAUZAN AMSAR
7406071503080129 7406075704100001 NAILA AMNASTIA
23 7406071503080126 7406070107520035 YUSRAN BANDU

7406071503080126 7406074107570035 AYANA
7406071503080126 7406070704800001 YANSAR, SE
24 7406071503080010 7406070106690002 DARWIS

7406071503080010 7406075208770001 BANATI
7406071503080010 7406074202950002 DARLIANA DARWIS
7406071503080010 740607490800001 DARLIANTI DARWIS
7406071503080010 7406070612100001 DARLIANCHA DARWIS
25 7406071603080057 7406073112790004 YEMMANG

7406071603080057 7406076510800001 SAMSIANI
7406071603080057 7406072501120001 PARIL
26 7460714003080059 7406072502650001 DAMIRE

7460714003080059 7406076004670001 NURJANNAH
7460714003080059 7406075101930001 EKA DARMA
7460714003080059 7406076403990001 KASMIR
27 7406071603080065 7406072110750001 SUDIRMAN

7406071603080065 7406075102820002 SALMAWATI
7406071603080065 7406072810980001 RIZAL FAUZAN
7406071603080065 7406071401020001 RISDAL
7406071603080065 7406076808050002 RISKAWATI
28 7406071603080043 7406075509940001 NINDA LESTARINDA

7406071603080043 7406071308970001 NELWAN
29 7406070610120001 7406071506900002 PANDI

7406070610120001 7406075311900003 SARDIANA
7406070610120001 7406076012120001 NURIN AQILAH SAFIRA
7406070610120001 7406076201150001 NUR ERINA QAIRINA
30 7406071603080147 7406071211550001 ABD. ASIS

7406071603080147 7406074307730001 NUR LAELA
7406071603080147 7406076504910001 SARNILA
7406071603080147 7406075309930002 SARMILA ASIS
7406071603080147 7406074703030001 MIRDA
7406071603080147 7406074812050002 AYU NISA
31 7406073112120077 7406071506840002 ANDI KAMALUDDIN
7406073112120077 7406077112850002 ERMAWATI
7406073112120077 7406074706100002 ANDI WINDI ANGINI SAFITRI
32 74060716003080075 7406070107770063 DANIARTA

74060716003080075 7406074503790002 RAMINA
74060716003080075 7406073107040005 HASNANDAR
33 74060715003080092 7406070107550006 CAING

74060715003080092 7406074107580003 HALE
74060715003080092 7406070908880001 JUSRI
34 7406070504110002 7406073112870004 SARJUN

7406070504110002 7406074709920001 NURHAENI
7406070504110002 7406077012090001 AIRIN DWI SAPUTRI
35 7406072607160004 7406071708850002 LUKMAN HAKIM

7406072607160004 7406074608900002 ROSDIANA
36 7406070305170001 7406011808870002 SYAMSUDDIN

7406070305170001 7406075710950001 NILEM CAHYA
7406070305170001 7406072210160001 AHLAN ABRIZAM
37 7406070410120005 7406070107740057 SAHRUDDIN

7406070410120005 7406074107780067 NURHAYA
38 7406070504110037 7406070309740001 YANAS

7406070504110037 7406074710770001 SUMARNI
7406070504110037 7406075211020002 INTAN ILMI RAMADHANI
7406070504110037 7406072701090001 MUH IKHRAM FAHREZI
39 7406070410120008 7406076802470002 TIA

7406070410120008 7406076911750001 SALIM SURIADI
7406070410120008 7406072506820002 AMIRUDDIN.P
7406070410120008 7471102109900001 SAMIRUDDIN EFENDI, S.Sos
40 7406071301160002 7406074507680002 HURIA

7406071301160002 7406074101950004 MEGAWATI
7406071301160002 7406070101010002 DARNO
41 7406071503080183 7406072002710001 SUMARDI

7406071503080183 7406074107700018 HASNA
7406071503080183 74060729119120001 SURATMAN
42 7406071503080179 7406071603560001 ANDI SADEYN.R

7406071503080179 7406076506590001 SANATANG
43 7406071503080170 7406070601630001 ISKANDAR

7406071503080170 7406075811650001 ERNI
7406071503080170 7406074608900003 KUSMAWATI,A.Md.Keb
44 7406072405130001 7406070107760069 ICHSAN

7406072405130001 7406074707810001 ANDI ROSDIANTI,S.I.P
7406072405130001 7406072309010003 ISRAWAN ICHSAN
7406072405130001 7406070504130002 AHMAD RIZA ICHSAN
45 7406071008160002 7406073005870001 RIDWAN

7406071008160002 7406075901000002 DIANI PUTRI HANDAYANI
7406071008160002 AMEL SAPUTRI
46 7406071203080012 7406073112710007 ADUMA

7406071203080012 7406077112740005 NURLIA
7406071203080012 7406076207950001 NUSRIANTI
7406071203080012 7406075110980001 ASRIANI
7406071203080012 7406071311020001 ALAMSYAH
7406071203080012 7406074505060001 AYU
47 7406072808160001 7401080101930005 SAMSUL RIJAL

7406072808160001 7406076205950001 NUSRIANTI
7406072808160001 7406074811130002 EISYAH SALSABILA
48 7406070504110040 7406070403880001 ARHAM

7406070504110040 7406076407920001 EKA SARINA
7406070504110040 7406074306150001 NUR ASIZA
49 7406070504110067 7406070107700078 DANIL

7406070504110067 7406074808840001 NURMING
7406070504110067 7406075202080002 SELFI
7406070504110067 7406075210110001 SAHRINI
7406070504110067 7406076910150001 AYU LESTARI
50 7406071603080167 7406070506750001 SAMSUDDIN

7406071603080167 7406074809830001 JUNARIA
7406071603080167 7406072709990001 ASRUN EFRIANSA
7406071603080167 7406074903090002 ASNA ERLINA
51 7406071603080082 7406070107630009 ALWI

7406071603080082 7406076703660001 HINIS
7406071603080082 7406071109880001 HAERUL HIDAYAT
7406071603080082 7406070503040001 WIRANTO
52 7406072804080007 7406071004700001 YARIS

7406072804080007 7406075005710001 BUNGATANG
7406072804080007 7406075208930001 INDAH SAFITRIANI
7406072804080007 7406071507000002 ADI PUTRA
7406072804080007 7406075407070001 ARDINA RASTI
53 7406070504110127 7406077112760002 SANARIA

7406070504110127 7406075808990001 SURYA WAHYUNI
54 7406070504110073 7406071108820002 TASMIN

7406070504110073 7406074911860001 NISFIANTI
7406070504110073 7406071308070002 DIRGA AGUS SAPUTRA
7406070504110073 7406072604120001 TEGAR SIREGA
7406070504110073 7406074904140001 SUCI ASY SYURAH APRILIA
55 7406071108160004 7401070604870001 MARWAN

7406071108160004 7406075303880001 ERNI AYU SARTIKA
7406071108160004 7406070607140002 MUH.AWAL RAMADHAN.MD
56 7406070410120001 7406070107760065 LIAS

7406070410120001 7406074504780003 CAHAYA
7406070410120001 7406075303940001 UMMI KALSUM
7406070410120001 7406075707990001 RESKY YULIANTI
57 7406070504110136 7406070107580045 ARIFING
7406070504110136 7406074107630051 JULLE
7406070504110136 7406070107880038 ASRI
7406070504110136 7406070306020001 DANDI
58 7406071503080204 7406071406710001 SALAMA

7406071503080204 7406074312730001 HAMDANA
7406071503080204 7406075212980001 SALMAWATI
7406071503080204 7406071009020002 HAMZA HAS
59 7406070504110104 7406070108720005 MUSTANG

7406070504110104 7406074107750051 DAIMANG
7406070504110104 7406071101960002 RIZAL
7406070504110104 7406071802970001 BINTANG
7406070504110104 7406077012980002 MUSDALIFA
60 7406070202130001 7406070508860002 SUPARMAN

7406070202130001 7406077112860004 NUR ASRY
7406070202130001 7406074802100001 PUPUT FEBRINA
61 7406072704080070 7406071005770001 YARISE

7406072704080070 7406076908790001 SAMSINAR
7406072704080070 7406076602000001 DEA ANANDA
7406072704080070 7406072909050002 ALFIANSAH
62 7406071603080018 7406071708830002 MANSUR

7406071603080018 7406074803860001 SURNIATI
7406071603080018 7406074602060002 CLAUDIA SINTIA BELLA
7406071603080018 7406074401110001 ADELIA DWI ANANDA
63 7406071603080035 7406072306740001 NAWIR

7406071603080035 7406074708800001 SUMARNI
7406071603080035 7406072904950001 FERDI ALFENDI
7406071603080035 7406076206970001 NOVITA SARI
64 7406070608000305 7406070711730001 JAMALUDDIN

7406070608000305 7406074502750001 NURSIAH
7406070608000305 7406075111950001 DARNIATI
7406070608000305 7406076506970001 YULIANA
7406070608000305 7406075606990001 YUNI ADRIANI
7406070608000305 7406071012010001 YUSRI ASWANDI
7406070608000305 7406072611060001 YUSHAR
7406070608000305 7406070806080001 ARHAM
65 7406071403080043 7406073001780001 JAMALUDDIN

7406071403080043 7406076512800001 NURTATI
7406071403080043 7406075812990001 NURUL AKRAMILA
7406071403080043 7406072511130001 ALBI FAYZA ZIKRI
66 7406070441110001 7406071510880002 MUSTAMIN MUSTAFA

7406070441110001 7406075805950001 DARNIATI
7406070441110001 7406074908110001 NABILA
67 7406071503080119 7406073112760002 ABDULLAH

7406071503080119 7406077112760003 HARIANTI
7406071503080119 7406075610000002 HILDA AYU SASMITA
7406071503080119 7406072408040002 MUH. AFDAL
7406071503080119 7406070606070002 AHMAD ADRIAN
68 74060731121120019 7406075607800001 NURLIANTI

74060731121120019 7406076707990005 FIFIN ALFIANTI
74060731121120019 740607210020002 ERIKA ALFIADI
74060731121120019 7406071501130002 MUHAMMAD RIZQI
69 7406073110160006 7406076210150001 ANINDITA KEYSAH ZAHRA
70 7406071503080068 7406071210060001 NELLYA AULIA RAHMADAN

7406074510140001 MELDA ADHA
71 7406071503080066 7406075111140001 KAYLA
72 7406071503080070 740607670190003 DEDE
73 7406071503080166 7406070310140001 AKMAL FAJAR
74 7406071503080178 7406070708920001 ANDI MISRAN
75 7406070500040016 7406076806770001 RATNAWATI

7406070500040016 7406074509030003 AULIA SELVI
7406070500040016 7406071205100001 AIRIL JAINUL
7406070500040016 - WALANG
1 7406071010120024 74060769058100001 MARLIANI

7406071010120024 74060707128700001 ASWAR
7406071010120024 74060728120500001 MUH. AULAN
2 74060705041100075 74060701007660026 MAMMA

74060705041100075 7406074107760040 NURNIA
74060705041100075 7406074107940018 KIKI PUSPITA SARI
74060705041100075 7406075610970001 SARYANI
74060705041100075 74060701079990020 SUSANDI
74060705041100075 74060761090000001 NIRA HANDAYANI
74060705041100075 7406072004100001 REZA
Jenis Status
HUBKEL Tgl Lahir
Ke1amin 2awin
1=P 1=BK, 2=K,

1=LAKI-
2=S 3=CH,
LAKI
3=I Tempat Lahir dd/mm/yyyy 4=CM
2=PERE
4=A 5 = TDK
MPUAN
5=T TAU
5 6 7 8 9
2 UJUNG PANDANG 01/10/1985 1 2
3 SOPA 21/02/1984 2 2
4 RAKADUA 10/11/2009 2 1
2 SURABAYA 02/11/1972 1 2
3 PUNRANGA 07/01/1964 2 2
2 RAKADUA 07/01/1971 1 2
3 RAKADUA 04/01/1974 2 2
4 EWOLANGKA 25/12/1993 1 1
4 EWOLANGKA 03/08/1994 2 1
4 RAKADUA 28/01/2006 2 1
2 GAMBERE 07/01/1943 1 2
3 GAMBERE 07/01/1952 2 2
4 GAMBERE 22-10-2002 2 1
4 GAMBERE 21-11-2005 2 1
5 GAMBERE 58 TH 2 4
3 RAKADUA 07/01/1961 1 4
4 LAROLEA 19/04/1988 2 1
2 RAKADUA 14/03/1980 1 2
3 RAKADUA 09/01/1984 2 2
4 RAKADUA 08/02/2007 1 1
4 RAKADUA 18/08/2012 2 1
2 BOEPINANG 14/08/1972 1 2
3 RAKADUA 03/07/1985 2 2
4 JEMBER 20/12/2007 1 1
5 EWOLANGKA 03/07/1954 2 4
3 RAKADUA 01/07/11971 1 2
4 EWOLANGKA 04/05/1991 2 1
2 KESSIE 03/07/1960 1 2
3 RAKADUA 01/07/1965 2 2
4 GAMBERE 22/10/2003 1 1
3 GAMBERE 17/10/1994 2 2
4 KOLAKA 08/07/2014 1 1
2 RANOKOMEA 07/05/1969 1 2
3 RAKADUA 07/07/1971 2 2
4 UTTANGNGE 25/03/1994 1 1
4 RANOKOMEA 26/06/1996 1 1
4 EWOLANGKA 28/05/2004 1 1
4 RAKADUA 13/05/2016 1 1
2 EWOLANGKA 17/09/1970 1 2
3 RAKADUA 11/08/1973 2 2
4 EWOLANGKA 10/03/1989 1 1
4 EWOLANGKA 08/03/1998 2 1
2 RAKADUA 03/10/1968 1 2
3 RAKADUA 05/06/1969 2 2
4 EW0LANGKA 10/04/1989 1 1
2 PABBIRING 13/04/1991 1 2
3 POKURUMBA 15/03/1993 2 2
2 RAKADUA 31/12/1963 1 2
3 RAKADUA 12/05/1977 2 2
4 RAKADUA 27/07/1995 2 1
4 RAKADUA 25/11/2005 2 1
4 RAKADUA 08/11/2013 2 1
2 GAMBERE 01/06/1983 1 2
3 GAMBERE 12/12/1983 2 2
4 GAMBERE 11/06/2004 1 1
4 GAMBERE 22/04/2014 1 1
2 RAKADUA 07-01-1980 1 2
3 RAKADUA 21/11/1982 2 2
4 RAKADUA 24/07/2005 2 1
4 RAKADUA 10/10/2009 1 1
3 TONGKO SENG 24/11/1994 2 2

4 GAMBERE 15/04/2015 2 1
2 EWOLANGKA 28/07/1985 1 2
3 BONE 15/03/1995 2 2
4 EWOLANGKA 23/06/2014 1 1
2 RAKADUA 31/12/1977 1 2
3 EWOLANGKA 14/05/1981 2 2
4 GAMBERE 26/01/2011 2 1
2 BOEPINANG 10/02/1977 1 2
3 RAKADUA 01/07/1977 2 2
4 RAKADUA 02/02/1995 1 1
4 BOEPINANG 03/05/2000 1 1
4 RAKADUA 18/06/2001 1 1
5 RAKADUA 01/07/1957 2 2
2 RAKADUA 01/07/1958 1 2
3 RAKADUA 01/07/1960 2 2
4 EWOLANGKA 04/08/1996 2 1
EWOLANGKA 10/07/1992 1 1
2 TANRU TEDONG 09/05/1972 1 2

3 GAMBERE 12/09/1978 2 2
4 UTTANGNGE 19/06/1996 1 1
4 UTTANGNGE 25/08/2003 1 1
4 RAKADUA 17/04/2010 2 1
2 EW0LANGKA 01/07/1952 1 2
3 EW0LANGKA 01/07/1957 2 2
4 GAMBERE 07/04/1980 1 1
2 RAKADUA 01/06/1969 1 2
3 UTTANGNGE 12/08/1977 2 2
4 UTTANGNGE 02/02/1995 2 1
4 RAKADUA 09/08/2000 2 1
4 RAKADUA 06/12/2010 1 1
2 TAMBERA 31/12/1979 1 2
3 UTTANGNGE 15/10/1980 2 2
4 GAMBERE 25/01/2012 1 1
2 RAKADUA 25/02/1965 1 2
3 RAKADUA 20/04/1967 2 2
4 EWOLANGKA 11/01/1993 2 1
4 EWOLANGKA 03/03/1999 1 1
2 GAMBERE 21/10/1975 1 2
3 BULUMANAI 11/02/1982 2 2
4 BULUMANAI 28/10/1998 1 1
4 BULUMANAI 14/01/2002 1 1
4 GAMBERE 28/08/2005 2 1
4 GAMBERE 15/09/1994 2 1
4 GAMBERE 13-0801997 1 2
2 LAGOGA 15/06/1990 1 2
3 RANOKOMEA 13/11/1990 2 2
4 RAKADUA 20/12/2012 2 1
4 BOMBANA 22/01/2015 2 1
2 RAKADUA 12/11/1955 1 2
3 RAKADUA 03/07/1973 2 2
4 GAMBERE 25/04/1991 2 1
4 GAMBERE 13/09/1993 2 1
4 GAMBERE 07/03/2003 2 1
4 GAMBERE 08/12/2005 2 1
2 KALIMANTAN TIMUR 16/06/1984 1 2
3 GAMBERE 31/12/1985 2 2
4 GAMBERE 07/06/2010 2 1
2 TONGKOSENG 01/07/1977 1 2
3 GAMBERE 05/03/1979 2 2
4 GAMBERE 31/07/2004 1 1
2 GAMBERE 01/07/1955 1 2
3 UTTANGNGE 01/07/1958 2 2
4 GAMBERE 09/08/1988 1 1
2 GAMBERE 31/12/1987 1 2
3 RAKADUA 07/09/1992 2 2
4 RAKADUA 30/12/2009 2 2
2 TOARI 17/08/1985 1 2
3 GAMBERE 06/08/1990 2 2
2 KASABOLO 18/08/1987 1 2
3 GAMBERE 17/10/1995 2 2
4 GAMBERE 22/10/2016 1 1
2 GAMBERE 01/07/1974 1 2
3 GAMBERE 01/07/1978 2 2
2 GAMBERE 03/09/1974 1 2
3 RAKADUA 07/10/1977 2 2
4 RAKADUA 12/11/2002 2 1
4 RAKADUA 27/01/2009 1 1
2 GAMBERE 28/02/1947 1 2
3 GAMBERE 29/11/1975 2 2
4 GAMBERE 25/06/1982 1 1
4 GAMBERE 21/09/1990 1 1
3 RAKADUA 05/071968 2 3
4 RAKADUA 01/01/1995 2 1
4 RAKADUA 01/01/2001 1 1
2 RAKADUA 20/02/1971 1 2
3 KOLAKA 01/07/1970 2 2
4 RAKADUA 29/11/1992 1 1
2 TOARI 16/03/1956 1 2
3 RAKADUA 25/06/1959 2 2
2 RAKADUA 06/01/1963 1 2
3 RAKADUA 18/11/1965 2 2
4 EWOLANGKA 06/08/1990 2 1
2 BOEARA 01/07/1976 1 2
3 EWOLANGKA 07/07/1981 2 2
4 RAKADUA 23/09/2001 2 1
4 RAKADUA 05/04/2013 1 1
2 RAKADUA 15/08/1996 1 2
3 MATABUNDU 19/01/1999 2 2
4 RAKADUA 03/09/2017 2 1
2 RAKADUA 31/12/1971 1 2
3 RAKADUA 31/12/1974 2 2
4 RAKADUA 22/07/1995 2 1
4 RAKADUA 11/10/1998 2 1
4 RAKADUA 13/11/2002 1 1
4 RAKADUA 05/05/2006 2 1
2 LAMUNDE 01/01/1993 1 2
3 PUSUUTE 22/04/1995 2 2
4 BOMBANA 08/11/2013 2 1
2 GAMBERE 04/03/1988 1 2
3 GAMBERE 24/07/1992 2 2
4 GAMBERE 03/06/2015 2 1
2 RAKADUA 01/07/1970 1 2
3 RAKADUA 08/08/1984 2 2
4 RAKADUA 12/02/2008 2 1
4 RAKADUA 12/10/2011 2 1
4 RAKADUA 29/10/2015 2 1
2 GAMBERE 05/06/1975 1 2
3 GAMBERE 08/09/1983 2 2
4 GAMBERE 27/09/1999 1 1
4 GAMBERE 09/03/2009 2 1
2 PALLIMAE 08/06/1972 1 2
3 BONTO SUNGGU 27/03/1965 2 2
4 JOMPIE 18/03/1998 1 1
4 RAKADUA 05/05/2004 1 1
2 BONE 10/04/1970 1 2
3 BOEPINANG 10/05/1971 2 2
4 TAMBERA 12/08/1993 2 1
4 TOLEWOLA 15/07/2000 1 1
4 RAKADUA 14/07/2007 1 1
3 RAKADUA 31/12/1976 2 3
4 RAKADUA 18/08/1999 2 1
2 GAMBERE 11-06`1982 1 2
3 BAU-BAU 09/11/1986 2 2
4 BAU-BAU 13/08/2007 1 1
4 BOMBANA 26/04/2012 1 1
4 RAKADUA 09/04/2014 1 1
2 POMALAA 06/04/1987 1 2
3 SINJAI 13/03/1988 2 2
4 RAKADUA 06/07/2014 1 1
2 TIRONG 01/07/1976 1 2
3 BOEPINANG 05/04/1978 2 2
4 POKURUMBA 13/03/1994 2 1
4 RAKADUA 27/07/1999 2 1
2 SINJAI 01/07/1958 1 2
3 SINJAI 01/07/1963 2 2
4 SINJAI 01/07/1998 1 1
4 TOLEWOLA 03/06/2002 1 1
2 BONE 14/06/1971 1 2
3 SINJAI 03/12/1998 2 2
4 GAMBERE 12/12/1998 2 1
4 GAMBERE 10/09/2012 1 1
2 KASTARIB 01/08/1972 1 2
3 TOARI KOLAKA 01/07/1975 2 2
4 GAMBERE 02/03/1996 1 1
4 JOMPIE 01/01/1997 2 1
4 JOMPIE 30/12/1998 2 1
2 WOIMENDA 05/08/1986 1 2
3 WAWOUSO 31/12/1986 2 2
4 WAWOUSO 08/02/2010 2 1
2 LAPRI 10/05/1977 1 2
3 BOEPINANG 29/08/1979 2 2
4 BOEPINANG 26/02/2000 2 1
4 RAKADUA 29/09/2005 1 1
2 KESSIE 17/08/1983 1 2
3 RAKADUA 08/03/1986 2 2
4 RAKADUA 06/02/2006 2 1
4 BOMBANA 04/01/2011 2 1
2 RAKADUA 23/06/1974 1 2
3 RAKADUA 07/08/1980 2 2
4 PUSUETE 17/06/1999 1 1
4 RAKADUA 26/11/2006 2 1
2 RAKADUA 17/11/1973 1 2
3 RAKADUA 05/02/1975 2 2
4 RAKADUA 11/11/1995 2 1
4 RAKADUA 25/06/1997 2 1
4 RAKADUA 16/06/1999 2 1
4 RAKADUA 10/12/2001 1 1
4 RAKADUA 26/11/2006 1 1
4 RAKADUA 08/06/2008 1 1
2 KESSIE 30/01/1978 1 2
3 RANOKOMEA 25/12/1979 2 2
4 RANOKOMEA 18/12/1999 2 1
4 RAKADUA 25/11/2013 1 1
2 GAMBERE 15/10/1998 1 2
3 GAMBERE 18/05/1995 2 2
4 GAMBERE 09/08/2011 2 1
2 RAKADUA 31/12/1976 1 2
3 RAKADUA 31/12/1976 2 2
4 RAKADUA 16/10/2000 2 1
4 RAKADUA 24/08/2004 1 1
4 RAKADUA 06/06/2007 1 1
2 KOLAKA 16/07/1980 1 2
3 KOLAKA 27/07/1999 2 2
4 KOLAKA 12/10/20002 2 1
4 RAKADUA 15/01/2013 1 1
4 RAKADUA 22/10/2015 2 1
4 RAKADUA 11/10/2006 2 1
4 TANDEBURA 05/10/2014 2 1
4 RAKADUA 11/11/2014 2 1
3 PUSUUTE 17/01/1979 2 2
4 RAKADUA 03/10/2014 1 1
4 UTTANGNGE 07/08/1992 1 1
3 RAKADUA 28/06/1977 2 2
4 RAKADUA 05/09/2003 2 1
4 RAKADUA 12/05/2010 1 1
5 RAKADUA 12/04/1950 2 3
3 APALA 29-05-1981 2 2
4 APALA 17/07/1987 1 1
4 RAKADUA 28-12-2005 1 1
2 BONE 07/01/1966 2 1
3 RAKADUA 07/01/1976 2 2
4 RAKADUA 07/01/1994 1 2
4 RAKADUA 11/10/1997 1 2
4 RAKADUA 17-06-1999 1 1
4 RAKADUA 09/02/2000 1 2
4 BOMBANA 20-04-2010 1 1
Kode
Kecamatan
Alamat Tempat Tinggal RT RW Kode Pos Nama Kecamatan
(diisi
petugas)
10 11 12 13 14 15
DESA RAKADUA POLEANG BARAT







POLEANG BARAT














POLEANG BARAT












DESA RAKADUA















DESA RAKADUA POLEANG B ARAT















POLEANG B ARAT
POLEANG B ARAT
POLEANG B ARAT
POLEANG B ARAT
DESA RAKADUA



DESA RAKADUA
Kode
Kode Desa Kode Faskes Tk.I
Nama Desa Nama Faskes Tk.I Faskes
(diisi petugas) (diisi petugas) Dokter Gigi
16 17 18 19 20
DESA RAKADUA PUSKESMAS POLEANG BARAT

DESA RAKADUA


DESA RAKADUA

































PUSKESMAS POLEANG BARAT




























Kelas
Status Rawat
Nama Nomor 1=Tetap, TMT Kerja (Kary.

Faskes Telepon Email NPP Jabatan 2=Kontrak, 1=Kelas I, Aktif)
Dokter Gigi Peserta 3=Paruh 2=Kelas II,
waktu
4=Penerim 3=Kelas III
a Pensiun
21 22 23 24 25 26 27 28
Kewarga
Negaraan Asuransi Lainnya
Gaji Pokok
+ Tunj. No
Tetap No. NPWP Passport
(Kary. 1=WNI, Nama
Aktif) 2=WNA No. Polis Asuransi
29 30 31 32 33 34

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FORM MIGRASI PESERTA

No No KK NIK/KITAS/KITAP Nama Lengkap

2 7406071006150001 7406011102720001 BAGUS WIJAYA KUSUMA

3 7406071503080013 740607016710009 AMBO TUO

4 7406071403080065 7406070107430015 BASO

5 7406071603080016 7406074107610029 SALMA

6 7406071503080027 7406071403800001 MASMUR

7 7406072711140015 7406071408720001 AHMAD YUNUS

8 74060728004080039 7406074107710037 JABERIA

9 7406071603080151 7406070107640009 SAPARENG

10 7406072509140001 7406075710940001 NISMAWATI

11 7406071503080012 7406070705690001 SUKRI

12 74060715003080208 7406071305160002 MUH. FADLIKAL

7407070811070144 7407071709700612 MARSUKI

13 7406071603080121 7406070310680001 SAKIBE

14 7406071511170002 7406071304910001 RISMAL, S.Pd

15 7406071701110001 7406073112630001 RUSLAN

16 7406071503080094 7406070109790001 BASRI

17 7406071503080139 7406070701800001 BISMAN

18 7406071008160001 7406206411940001 RISNAWATI

19 7406070804130001 7406072807850003 ANDI MUSRIADI

20 7406070406120004 7406073112770010 KAHARUDDIN

21 7406071503080009 7406071002770001 HASANUDDIN

21 7406071403080057 7406070107580056 KADIR

22 7406071503080129 7406070805720001 AMIR ARMIN

23 7406071503080126 7406070107520035 YUSRAN BANDU

24 7406071503080010 7406070106690002 DARWIS

25 7406071603080057 7406073112790004 YEMMANG

26 7460714003080059 7406072502650001 DAMIRE

27 7406071603080065 7406072110750001 SUDIRMAN

28 7406071603080043 7406075509940001 NINDA LESTARINDA

29 7406070610120001 7406071506900002 PANDI

30 7406071603080147 7406071211550001 ABD. ASIS

32 74060716003080075 7406070107770063 DANIARTA

33 74060715003080092 7406070107550006 CAING

34 7406070504110002 7406073112870004 SARJUN

35 7406072607160004 7406071708850002 LUKMAN HAKIM

36 7406070305170001 7406011808870002 SYAMSUDDIN

37 7406070410120005 7406070107740057 SAHRUDDIN

38 7406070504110037 7406070309740001 YANAS

39 7406070410120008 7406076802470002 TIA

40 7406071301160002 7406074507680002 HURIA

41 7406071503080183 7406072002710001 SUMARDI

42 7406071503080179 7406071603560001 ANDI SADEYN.R

43 7406071503080170 7406070601630001 ISKANDAR

44 7406072405130001 7406070107760069 ICHSAN

45 7406071008160002 7406073005870001 RIDWAN

46 7406071203080012 7406073112710007 ADUMA

47 7406072808160001 7401080101930005 SAMSUL RIJAL

48 7406070504110040 7406070403880001 ARHAM

49 7406070504110067 7406070107700078 DANIL

50 7406071603080167 7406070506750001 SAMSUDDIN

51 7406071603080082 7406070107630009 ALWI

52 7406072804080007 7406071004700001 YARIS

53 7406070504110127 7406077112760002 SANARIA

54 7406070504110073 7406071108820002 TASMIN

55 7406071108160004 7401070604870001 MARWAN

56 7406070410120001 7406070107760065 LIAS

58 7406071503080204 7406071406710001 SALAMA

59 7406070504110104 7406070108720005 MUSTANG

60 7406070202130001 7406070508860002 SUPARMAN

61 7406072704080070 7406071005770001 YARISE

62 7406071603080018 7406071708830002 MANSUR

63 7406071603080035 7406072306740001 NAWIR