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DATA PRIBADI
Nama Sesuai KTP
Tempat, Tanggal Lahir
Agama
Jenis Kelamin
No. KTP
Nama Ibu Kandung
Kewarganegaraan
Jumlah Tanggungan
Alamat
Kelurahan :
Kecamatan :
Kota :
Status Rumah
No. Telepon
Alamat Email (Jika Ada)
No. NPWP
DATA PEKERJAAN
Nama Perusahaan
Departemen / Bagian
Alamat Kantor
Kota :
No. Telp Kantor
Pekerjaan
Jabatan
Bidang Usaha
Status Karyawan
Penghasilan Kotor Per Tahun Rp
Data Keluarga Yang Tidak Serumah
Nama
Hubungan Orang Tua
Alamat
No. Telepon
Pria Wanita
BULAN TAHUN
ISLAM KRISTEN KATOLIK BUDHA HINDU
Status Perkawinan :
Status Pendidikan :
Lajang MenikahWNI WNA
Lama Menempati :
Kode Pos :
Cerai
SMA Diploma Universitas
RWRT
Sewa/Kontrak/Kos
No. Ponsel
Kode Pos :
No. Extention :
Milik Sendiri Milik Keluarga Milik Perusahaan
Lama Bekerja :
Kode Area No. Telp
Karyawan Profesional Wiraswasta
Pemilik Direktur Manager Supervisor
Sebutkan
Kode Pos:
No. Ponsel
FORM PENGAJUAN KARTU KREDIT BUKOPIN
TANGGAL
Saudara Kandung Sepupu Lainnya :
Tahun Bulan
Jumlah Pegawai :
Staff
Tetap Kontrak Part Time Lain-lain

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DATA PRIBADI DAN PEKERJAAN

  • 1. DATA PRIBADI Nama Sesuai KTP Tempat, Tanggal Lahir Agama Jenis Kelamin No. KTP Nama Ibu Kandung Kewarganegaraan Jumlah Tanggungan Alamat Kelurahan : Kecamatan : Kota : Status Rumah No. Telepon Alamat Email (Jika Ada) No. NPWP DATA PEKERJAAN Nama Perusahaan Departemen / Bagian Alamat Kantor Kota : No. Telp Kantor Pekerjaan Jabatan Bidang Usaha Status Karyawan Penghasilan Kotor Per Tahun Rp Data Keluarga Yang Tidak Serumah Nama Hubungan Orang Tua Alamat No. Telepon Pria Wanita BULAN TAHUN ISLAM KRISTEN KATOLIK BUDHA HINDU Status Perkawinan : Status Pendidikan : Lajang MenikahWNI WNA Lama Menempati : Kode Pos : Cerai SMA Diploma Universitas RWRT Sewa/Kontrak/Kos No. Ponsel Kode Pos : No. Extention : Milik Sendiri Milik Keluarga Milik Perusahaan Lama Bekerja : Kode Area No. Telp Karyawan Profesional Wiraswasta Pemilik Direktur Manager Supervisor Sebutkan Kode Pos: No. Ponsel FORM PENGAJUAN KARTU KREDIT BUKOPIN TANGGAL Saudara Kandung Sepupu Lainnya : Tahun Bulan Jumlah Pegawai : Staff Tetap Kontrak Part Time Lain-lain