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LEMBAR ISIAN KARTU MAHASISWA

NAMA : …………………………………………………………………………….
Pas Foto
NIM : …………………………………………………………………………….
3 x 4 cm
PROGRAM STUDI : …………………………………………………………………………….
Warna, Latar
TEMPAT TANGGAL LAHIR : ……………………………………………………………………………. Merah
ALAMAT : …………………………………………………………………………….

: …………………………………………………………………………….

GOLONGAN DARAH : …………………………………………………………………………….


III-005/STIKES-NH/FRM/BAA

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