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Transcript of 9.-FORMULIR-PENDAFTARAN-ISTRI-2-Suami-Anak-2.pdf
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KEPEGAWAIAN NEGARA DAN DIREKTURJENDERAL ANGGARANNOMOR : 19 / SE / 1993NOMOR : SE - 51 / A / 1989TANGGAL : 14 APRIL 1989
Yang bertanda tangan dibawah I I :1. Nama : ........................................2. Nama Kecil : ........................................3. Tempat / Tgl. Lahir : ........................................ ........................................4. Tgl/No. Surat : ........................................ Keputusan pensiun : ........................................5. Pokok pensiun : Rp. .................................6. Pensiun terhitung mulai : ........................................7. A l a m a t : ........................................ : ........................................9. Tanda tangan : ........................................ Disahkan tanggal : ........................................ Nomor : ........................................
A.N. KEPALABADAN ADMINISTRASI KEPEGAWAIAN NEGARA
DEPUTI MUTASI KEPEGAWAIANU.b.
____________________ NIP.
FORMULIR PENDAFTARAN ISTRI (2) / Suami / Anak (2)(Untuk penerima pensiun pegawai)
Nama Anak (2) KandungKeterangan tentang IBU / AYAH Keterangan tentang Penerima Pensiun
PegawaiN a m a CeraitanggalMeninggalTanggal
Lk.Pr.
Tanggallahir
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Isteri (2) Suami Isteri Kedua Isteri Ketiga Isteri EmpatIsteri Pertama Suami
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N a m a
Nama Kecil
Tempat / Tgl. Lahir
Tanggal Nikah
Tanggal Pendaftaran
Tanggal Cerai
Tanggal wafat
A l a m a t
Tanda tangan/cap jempol kiri
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Rp_11: Text17:
FP_NMANK1: FP_NMANK2: FP_NMANK3: FP_NMANK4: FP_NMANK5: FP_NMANK6: FP_NMANK7: FP_NMANK8: FP_NMANK9: FP_NMANK10: FP_JK1: FP_JK3: FP_JK4: FP_JK5: FP_JK6: FP_JK7: FP_JK8: FP_JK9: FP_JK10: FP_NM1: FP_NM2: FP_NM3: FP_NM4: FP_NM5: FP_NM6: FP_NM7: FP_NM8: FP_NM9: FP_NM10: FP_CERAI1: FP_CERAI2: FP_CERAI3: FP_CERAI4: FP_CERAI5: FP_CERAI6: FP_CERAI7: FP_CERAI8: FP_CERAI9: FP_CERAI10: FP_MD1: FP_MD2: FP_MD3: FP_MD4: FP_MD5: FP_MD6: FP_MD7: FP_MD8: FP_MD9: FP_MD10: FP_NMIS/SM1: FP_NMIS/SM2: FP_NMIS/SM3: FP_NMIS/SM4: FP_NMKC1: FP_NMKC2: FP_NMKC3: FP_NMKC4: FP_TTL1: FP_TTL2: FP_TTL3: FP_TTL4: FP_TGLNKH1: FP_TGLNKH2: FP_TGLNKH3: FP_TGLNKH4: FP_TGLDFTR1: FP_TGLDFTR2: FP_TGLDFTR3: FP_TGLDFTR4: FP_TGLCRI1: FP_TGLCRI2: FP_TGLCRI3: FP_TGLCRI4: FP_TGLWFT1: FP_TGLWFT2: FP_TGLWFT3: FP_TGLWFT4: FP_ALMT1: FP_ALMT2: FP_ALMT3: FP_ALMT4: FP_TTD1: FP_TTD2: FP_TTD3: FP_TTD4: FP_ii_NAMA: FP_ii_NAMAKECIL: FP_ii_TEMPATLAHIR: FP_ii_TGLLAHIR: FP_ii_t: n: sURAT:
FP_ii_KEP_PENSIUN: FP_ii_PENSIUN_TERHITUNG: FP_ii_ALAMAT: FP_ii_KOTA: FP_ii_TTD: FP_ii_TGL_DISAHKAN: FP_ii_NOMOR_DISAHKAN: FP_ii_TGL_LAHIR_1: FP_ii_TGL_LAHIR_2: FP_JK2: FP_ii_TGL_LAHIR_3: FP_ii_TGL_LAHIR_4: FP_ii_TGL_LAHIR_5: FP_ii_TGL_LAHIR_6: FP_ii_TGL_LAHIR_7: FP_ii_TGL_LAHIR_8: FP_ii_TGL_LAHIR_9: FP_ii_TGL_LAHIR_10: FP_NIP_0: FP_NIP_1:
