Lampiran : Keputusan Kepala Badan Pengawas Perdagangan Berjangka Komoditi Nomor : 60/BAPPEBTI/Per/3/2007 Tanggal : 30 Maret 2007

BADAN PENGAWAS PERDAGANGAN BERJANGKA KOMODITI KEMENTERIAN PERDAGANGANFORMULIR PENDAFTARAN UJIAN PROFESI CALON WAKIL PIALANG BERJANGKA Nomor Ujian *) Tanggal Ujian : .................................... : ....................................Pasphoto (3 x 4)

Nama Lengkap Tempat Nomor KTP Nama Perusahaan Alamat Kantor

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Alamat Rumah

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Pendidikan Formal Terakhir Cara memperoleh pengetahuan Perdagangan Berjangka **) Pengalaman di Bidang Perdagangan Berjangka

: : :

.................................................................................................... .................................................................................................... .................................................................................................... .................................................................................................... .................................................................................................... .................................................................................................... Telp : .............................. Fax : ................................................ .................................................................................................... .................................................................................................... Telp/Fax : ....................... HP : ................................................. .................................................................................................... .................................................................................................... .................................................................................................... .................................................................................................... .................................................................................................... Jakarta, .........................................

Petugas Pendaftaran

Pendaftar,

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