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  • Form Biodata Lapor Diri PDPT PD Dikti

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    Ahmad Shabirin
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    FORM-BIODATA-LAPOR-DIRI-PDPT-PD-DIKTI

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    © All Rights Reserved
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    5 views2 pages

    Form Biodata Lapor Diri PDPT PD Dikti

    Uploaded by

    Ahmad Shabirin
    .

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 2

    BIODATA MAHASISWA

    PANGKALANDATA PERGURUANTINGGI(PD-DIKTI)

    Nama* :
    ………………………………………………………………………………………
    TempatLahir* :
    ………………………………………………………………………………………
    JenisKelamin : Laki-laki/ Perempuan

    NamaIbu* :
    ………………………………………………………………………………………
    Tanggallahir* :
    ………………………………………………………………………………………
    Agama* :
    ………………………………………………………………………………………
    Kewarganegaraan* :
    ………………………………………………………………………………………
    NIK* :
    ………………………………………………………………………………………
    NISN :
    ………………………………………………………………………………………
    NPWP :
    ………………………………………………………………………………………

    Alamat

    Jalan :
    ………………………………………………………………………………………
    Dusun :………………………………………………………RT:……..RW:……..

    Kelurahan* :………………………………………………………KodePos:……………

    Kecamatan* :
    ………………………………………………………………………………………
    JenisTinggal :
    ………………………………………………………………………………………
    AlatTransportasi :
    ………………………………………………………………………………………

    Telepon :
    ………………………………………………………………………………………
    HP :
    ………………………………………………………………………………………
    PenerimaKPS* : Ya/ Tidak

    No.KPS :
    ………………………………………………………………………………………
    OrangTua

    Ayah

    NIK :
    ………………………………………………………………………………………
    Nama :
    ………………………………………………………………………………………
    TanggalLahir :
    ………………………………………………………………………………………
    Pendidikan :
    ………………………………………………………………………………………
    Pekerjaan :
    ………………………………………………………………………………………
    Penghasilan :
    ………………………………………………………………………………………
    Ibu

    NIK :
    ………………………………………………………………………………………
    Nama :
    ………………………………………………………………………………………
    TanggalLahir :
    ………………………………………………………………………………………
    Pendidikan :
    ………………………………………………………………………………………
    Pekerjaan :
    ………………………………………………………………………………………
    Penghasilan :
    ………………………………………………………………………………………

    *)WAJIBDIISI

    SOURCE:FEEDERPDDIKTI

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