Formulir ISEI

FORMTJT-IP. PENDAFTARAI{ KEAI{G G OTAAN IKATAN SARJANA EKoNorvlr ii.ino-Ni-sil frsnii ^^ ' Sekretariat pp_ISEI jalan Daksa IV No.9, Kebayoran Biru, Jakarta l2l l0 'f et. 62 -021 -7 2081 30, 7 2224 $ ; p .,x ei_6zi' _7 20 t 81 2 Alamat Rrrnralr ii Lc ls'ilt/\1't()N lr()tttvl/ it)- I /5/().1 l'crsyaratalr Adnri nistrasi 1 P"" (]] brr.rlr pr;1sf616 Lrerwai.na be,rukuran 3x4crn L I.)tl,l (2) lru.th pasftrto l.crn'arrr;t bcrrrktrrlrr 2x3crrr '. /'/r,'.,'1 1r|17 lj,rz,tlr S,rr.j,rrr.t v,rrr'l rji lt,u.tlisir .1. I ).r. t,rr liirv,rr.ri I I itl ir n v,irrr:'lt.r.,,lki,. :. lti,rr',r J)crrtla.t.r.rrarr Rli. i0 O'Ott,-.(59pLltr6 Ilibtr ltgpiah) (r' t-'rrrg ltrr'ttr liP 15 0d0'- (l-irln uelis niu" rti,piin) pcibulan - cli bavarkan 1 (::i,,r) ta6un cli muka, 'l;rtt 'ii trattsftir k* rck. ulls.ntra Artc'i-Mas'jp.;;.i.'';i;;ilh,;:i.l: y:ij:,'J. !st,i rrcug.rrr no. r.t,k.: 2.245.0()55.00 7. ir.rrrrrrir'icngkapr cran lrukti trnnsre..iitirin-'tnn t","tiotilio'ipp-rsEf"' DATA PRIBADT UNTUK DILENCKAPI ISEI Tangr.rl 'f.. ngga l I Taneil.rr t I I t N;rnra lengkalr sesriai KTp il,rls baw;thi ,uin *"tunrgr1 Tenrp;rt/Tangeal Lahir Nanta yan!l rii kehendaki pacia kartu N., KTP/Paspor Kode Pos (wajib diisi) Nunr;r f'urLrsahaan / lnst;r:rsi ]l,"k"r,am Lain ny.r D Doser-r ' fl Ka0yawan D Wiraswasra i\l,rrnat Pertrsalraan / lrrstansi Kode Pos (waiib diisi E-m.ril : PENDIDIKAN % - nsl os2-En Frkult,rs Fr kultas Jtrrtrr,trt I u rrrs;tn Ll r-riversit.r s Kota / Neg:ir a lJi,r'ri.lt;t .rlelr I ffi

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Transcript of Formulir ISEI

FORMTJT-IP.PENDAFTARAI{ KEAI{G G OTAANIKATAN SARJANA EKoNorvlr ii.ino-Ni-sil frsnii

^^ '

Sekretariat pp_ISEIjalan Daksa IV No.9, Kebayoran Biru, Jakarta l2l l0'f et. 62 -021 -7 2081 30, 7 2224 $ ; p .,x ei_6zi' _7 20 t 81 2

Alamat Rrrnralr

ii Lc ls'ilt/\1't()N lr()tttvl/ it)- I /5/().1l'crsyaratalr Adnri nistrasi1 P"" (]] brr.rlr pr;1sf616 Lrerwai.na be,rukuran 3x4crnL I.)tl,l (2) lru.th pasftrto l.crn'arrr;t bcrrrktrrlrr 2x3crrr'. /'/r,'.,'1 1r|17 lj,rz,tlr S,rr.j,rrr.t v,rrr'l rji lt,u.tlisir

.1. I ).r. t,rr liirv,rr.ri I I itl ir n v,irrr:'lt.r.,,lki,.:. lti,rr',r J)crrtla.t.r.rrarr Rli. i0 O'Ott,-.(59pLltr6 Ilibtr ltgpiah)(r' t-'rrrg ltrr'ttr liP 15 0d0'- (l-irln uelis niu" rti,piin) pcibulan - cli bavarkan 1 (::i,,r) ta6un cli muka,

'l;rtt 'ii trattsftir k* rck. ulls.ntra Artc'i-Mas'jp.;;.i.'';i;;ilh,;:i.l: y:ij:,'J. !st,i rrcug.rrr no. r.t,k.: 2.245.0()55.007. ir.rrrrrrir'icngkapr cran lrukti trnnsre..iitirin-'tnn t","tiotilio'ipp-rsEf"'

DATA PRIBADT

UNTUK DILENCKAPI ISEI

Tangr.rl

'f.. ngga l

I Taneil.rr

N;rnra lengkalr sesriai KTp il,rls baw;thi ,uin *"tunrgr1 Tenrp;rt/Tangeal Lahir

Nanta yan!l rii kehendaki pacia kartu N., KTP/Paspor

Kode Pos (wajib diisi)

Nunr;r f'urLrsahaan / lnst;r:rsi ]l,"k"r,am

Lain ny.rD Doser-r ' fl Ka0yawan D Wiraswasra

i\l,rrnat Pertrsalraan / lrrstansi

Kode Pos (waiib diisi E-m.ril :