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  • Kode Formulir E-Ktp

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    KhusnantoWidianto
    34 views3 pages
    This document contains an online registration form for an electronic ID card (e-KTP). The form requests the registrant to provide personal details such as name, date of birth, address, religion, gender, and registration date. It includes fields for the registrant to input or select details with options like text boxes, drop-down menus, radio buttons and text areas. Submit buttons allow submitting or cancelling the registration.

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    Original Title

    Kode Formulir E-ktp

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    This document contains an online registration form for an electronic ID card (e-KTP). The form requests the registrant to provide personal details such as name, date of birth, address, religion, gender, and registration date. It includes fields for the registrant to input or select details with options like text boxes, drop-down menus, radio buttons and text areas. Submit buttons allow submitting or cancelling the registration.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    34 views3 pages

    Kode Formulir E-Ktp

    Uploaded by

    KhusnantoWidianto
    This document contains an online registration form for an electronic ID card (e-KTP). The form requests the registrant to provide personal details such as name, date of birth, address, religion, gender, and registration date. It includes fields for the registrant to input or select details with options like text boxes, drop-down menus, radio buttons and text areas. Submit buttons allow submitting or cancelling the registration.

    Copyright:

    © All Rights Reserved
    Download as DOC, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 3

    <html>

    <head>
    <title>FORMULIR PENDAFTARAN E-KTP</title>
    <h1><center>FORM PENDAFTARAN E-KTP</cemter></h1>
    </head>
    <body>
    <form action=" formulir.html" method="get">
    <table>
    <tr>
    <td>No. Pendaftaran</td><td>:</td>
    <td><INPUT TYPE="Text" NAME="varNodaftar" SIZE="30"></td>
    </tr>
    <tr>
    <td>Nama</td><td>:</td>
    <td><INPUT TYPE="Text" NAME="varNama" SIZE="30"></td>
    </tr>
    <tr>
    <td>Tempat, Tanggal lahir</td><td>:</td>
    <ul>
    <td>Tempat<INPUT TYPE="Text" NAME="varTempat" SIZE="10"></td>
    <td>Tanggal<INPUT TYPE="Text" NAME="varTanggal" SIZE="10"></td>
    <td>Bulan<INPUT TYPE="Text" NAME="varBulan" SIZE="10"></td>
    <td>Tahun</td>
    <td><SELECT NAME="tahun" SIZE="1">
    <option>2014</option>
    <option>2013</option>
    <option>2012</option>
    <option>2011</option>
    <option>2010</option>
    <option>2009</option>
    <option>2008</option>
    <option>2007</option>
    <option>2006</option>
    <option>2005</option>
    <option>2004</option>
    <option>2003</option>
    <option>2002</option>
    <option>2001</option>
    <option>2000</option>
    <option>1999</option>
    <option>1998</option>
    <option>1997</option>
    <option>1996</option>
    <option>1995</option>
    <option>1994</option>
    <option>1993</option>
    <option>1992</option>
    <option>1991</option>
    <option>1990</option>
    </ul>
    </select> </td>
    </tr>
    <tr>
    <td>Pekerjaan</td><td>:</td>
    <td><INPUT TYPE="Text" NAME="varPekerjaan" SIZE="30"></td>
    </tr>
    <tr>
    <td>Status Pernikahan</td><td>:</td>
    <td>
    <INPUT TYPE="Checkbox" NAME="Status" VALUE="Menikah">Menikah
    <INPUT TYPE="Checkbox" NAME="Hobi" VALUE="BelumMenikah">Belum Menikah
    <INPUT TYPE="Checkbox" NAME="Status" VALUE="Janda">Janda
    <INPUT TYPE="Checkbox" NAME="Status" VALUE="Duda">Duda
    </td>
    </tr>
    <tr>
    <td>Alamat</td><td>:</td>
    <td><textarea Cols="30" Rows="5" Name="Alamat"></textarea></td>
    </tr>
    <tr>
    <td>Agama</td><td>:</td>
    <td><SELECT NAME="agama" SIZE="1">
    <option>Islam</option>
    <option>Kristen</option>
    <option>katolik</option>
    <option>Budha</option>
    <option>Hindu</option>
    </select> </td>
    </tr>
    <tr>
    <td>Rt / Rw</td><td>:</td>
    <td>Rt<INPUT TYPE="Text" NAME="varRT" SIZE="10"></td>
    <td>Rw<INPUT TYPE="Text" NAME="varRW" SIZE="10"></td>
    </tr>
    <tr>
    <td>Kelurahan</td><td>:</td>
    <td><INPUT TYPE="Text" NAME="varKelurahan" SIZE="30"></td>
    </tr>
    <tr>
    <td>Kecamatan</td><td>:</td>
    <td><INPUT TYPE="Text" NAME="varKecamatan" SIZE="30"></td>
    </tr>
    <tr>
    <td>Kabupaten</td><td>:</td>
    <td><INPUT TYPE="Text" NAME="varKabupaten" SIZE="30"></td>
    </tr>
    <tr>
    <td>Provinsi</td><td>:</td>
    <td><INPUT TYPE="Text" NAME="varProvinsi" SIZE="30"></td>
    </tr>
    <tr>
    <td>Jenis kelamin</td><td>:</td>
    <td><INPUT TYPE="Radio" NAME="Kelamin" VALUE="Pria">Pria</td>
    <td><INPUT TYPE="Radio" NAME="Kelamin" VALUE="Wanita">Wanita</td>
    </tr>
    <tr>
    <td>Tanggal Pendaftaran</td><td>:</td>
    <ul>
    <td>Tanggal<INPUT TYPE="Text" NAME="varTanggal" SIZE="10"></td>
    <td>Bulan<INPUT TYPE="Text" NAME="varBulan" SIZE="10"></td>
    </ul>
    </tr>
    </table>
    <br>
    <br>
    <br>
    <form method="get" action="POST"title="Daftar"target="_blank"><input name="Button"
    type="submit" value="Daftar" /><form method="get"
    action="POST"title="Cancel"target="_blank"><input name="Button" type="submit"
    value="Cancel" /></form>

    </FORM>
    </body>
    </html>

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