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SURAT KETERANGAN MENINGGAL DUNIA
Isikan sesuai pertanyaan, khusus untuk bulan ditulis lengkap tidak disingkat memakai angka kecuali pertanyaan Bulan Romawi
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Bulan Romawi
*
Choose
I
II
III
IV
V
VI
VII
VIII
IX
X
XI
XII
Email Pribadi
Isikan denga email pribadi yang dipunyai
Your answer
Nama Sesuai KK
*
Your answer
Jenis Kelamin
*
Choose
Laki - laki
Perempuan
Tempat /Tanggal Lahir
*
Contoh: Fakfak, 17 Agustus 2022
Your answer
No. KK/KTP/Kartu Pelajar
*
Your answer
Pekerjaan/Sekolah
*
Choose
Pelajar
Swasta
Wiraswasta
Pedagang
Guru
Tenaga Kesehatan
PNS
TNI / POLRI
IRT
Lainnya
Agama
*
Choose
Islam
Katholik
Kristen
Hindu
Budha
Khonghuchu
Blok dan Nomor Rumah
*
Choose
B3/15
B3/16
B3/17
B3/18
B3/19
B3/20
B3/21 -22
B3/23
B3/24
B3/25-26
B3/27
B3/28
B4/01-02
B4/03
B4/04 - 05A
B4/05B
B4/06
B6/05
B4/07
B8/04
B4/09
B4/10
B4/11
B5/01
B5/02
B5/03
B5/04
B5/05
B5/06
B5/07
B5/08
B5/09
B5/10
B5/11
B5/12
B5/13
B5/14
B5/15
B5A/01
B5A/02
B5A/03
B5A/04
B5A/05
B5A/06
B5A/07
B5A/12
B5A/12A
B5A/13
B5A/14
B5A/15
B5A/16
B5A/17
B5A/18
B6A/01
B6A/02
B6A/03
B6A/04-05
B6A/06
B6A/07-08
B6A/09-10
B6A/11
B6A/12
B7/24
B7/25-26
B7/28
B7/29
B7/30
B7 / 31
B7 / 32
B7 / 33
B8/01
B8/02
B8/03
B8/04
B8/05,B8/11
B8/06
B8/08
B8/09A
B8/09B
B8/10
B8/12
B8/13
B8/14
B8/15
Jam Meninggal
*
Time
:
AM
PM
Hari/Tanggal Meninggal
*
Contoh: Jumat, 17 Agustus 2022
Your answer
Tanggal Permohonan
*
Contoh: 17 Agustus 2022
Your answer
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