No. Doc : F-PTES-MSO-03.

01
PT. ELABRAM SYSTEMS No. Rev : 01
Date : 1-Oct-2017
Page : 1
UPDATING PERSONAL DETAILS
1 Full Name (based on ID) NAMA LENGKAP SESUAI KTP
2 Job Title nama jabatan
3 Home Base area penempatan
4 Gender Male Female
5 Place of Birth tempat lahir
6 Date of Birth (dd/mm/yyyy) Date
Date Month
Month Year
Year
7 Marital Status for PTKP purpose
8 Religion
9 Permanent Address permanent address

10 Correspondence Address correspondence address

11 Mobile Number 1 mobile no1

12 Mobile Number 2 mobile no2
13 Home Phone Number home no
14 Email 1 email1
15 Email 2 email2
16 ID Number (KTP/SIM/Passport) * nomor KTP/SIM/Passport (wajib diisi)
17 BPJS Tenaga Kerja No. * nomor BPJS Tenaga Kerja (wajib diisi)
18 BPJS Kesehatan number (virtual account) * nomor BPJS Kesehatan (wajib diisi)
19 Mother's Maiden Name nama ibu kandung
20 NPWP Number * nomor NPWP (wajib diisi)
21 NPWP registered date (dd/mm/yyyy) Date
Date Month
Month Year
Year
NPWP registered address alamat register NPWP
22

23 Bank Name * (Bank Mandiri preferred) nama Bank

24 Bank Branch wilayah kantor cabang
25 Account Bank Name (Recipient's on a accoun nama pemilik rekening
26 Account Bank Number * nomor rekening bank
27 Emergency Contact Emergency Contact #1 Emergency Contact #2
28 Name name1 nam2
29 Mobile Number mobile1 mobile2
30 Address address1 address2
31 Relationship with employees relation1 relation2
32 Spouse Info
33 Name nama pasangan (suami/istri)
34 Birth Date 30-Nov-1999
35 Gender Male Female
36 Children Info Children info #1 Children info #2 Children info #3
37 Name anak1 anak2 anak3
38 Birth Date Date
Date Month
Month Year
Year Date
Date Month
Month Year
Year Date
Date Month
Month Year
Year
39 Gender Male Female Male Female Male Female
40 Character Referees Referee #1 Referee #2 Referee #3
41 Name name1 name2 name3
42 Position pos1 pos2 pos3
43 Company Name company1 company2 company3
44 Contact No.(s) contact1 contact2 contact3
45 Family Background (parents, brothers and sisters)
46 Name Phone/Mobile Relationship Current Address
(1) xxx xxx xxx xxx
(2) xxx xxx xxx xxx
(3) xxx xxx xxx xxx
(4) xxx xxx xxx xxx
(5) xxx xxx xxx xxx

I, hereby confirm that the above information given is correct to the best of my knowledge, and shall hold myself liable for disciplinary action, including
immediate dismissal, should the above information be found to be false.

*) Please provide scan copy documents