03.Rekap Lap Permintaan Cetak Kartu

FORM CETAK KARTU E-ID PESERTA JENIS PESERTA PESERTA NAMA INSTANSI/PUSKESMAS NAMA PIC NOMOR TELEPON PIC EMAIL PIC TANGGAL PENGAJUAN Kode H!Ke"

No

No Ka,. PJS Ke0e1a.an 2KJS3

# $ +* Jana, $+#( 0001206818346 0001641796762 0001641796773 0001641796784 0001641796795 0001154781371 0001623976064 0001623976108 0001370293661 0001370293672 0001370293683 0001370293694 0001370293705 0001209027396 0001208600447 0001208600458 0001207929194

Jen0 M.a0

Tg" Ak.4 e,"ak M.a0

No KK

NIK/KITAS/KITAP

Nama Lengkap

%

&

'

(

)

3171032507700003 3171031801098407 3171031801098407 3171031801098407 3171031801098407 3171031801098407 3171031401095982 3171032604111019 3171032604111019 3171031101091510 3171031101091510 3171031101091510 3171031101091510 3171031101091510 3171031701097760 3171032501121028

3171031101098933 edy suryana 31 3171036011780011 RINI 3171035410970002 NUR OKTAVIANI 3171031811030004 RAMDHAN MAUANA 3171036312101002 !HA"RANI NA NA#IAH 3171036602141005 $I%& MAHARANI 3171036310950001 I'MA ARUM (U$(A 3171036106700004 MA&A 3171031001980004 "KO (RA$T&O 3171030603650007 H #AHARUDIN 3171036511680001 HA$NAH MA))A 3171034510940001 MU%ARRIDAH 3171031211950002 AHMAD !HAIDIR 3171030609010001 AHMAD AKRAM 31 3 171035112500001 KAR$ITI 31 3171035410830003 AR&ANI 3171032410091003 MUHAMMAD NA#I)H MANNAN 3171035804121001 MUMTA*AH NADHRA NA#IAH

# 5 Pe0e,.a $ 5 Sam % 5 I0., & 5 Anak ' 5 Tam!a1an *

1 1 4 4 4 4 4 1 4 1 3 4 4 4 1 3 4 4

0001224824049 0001229222272 0001205539108 0001369430278 0001369430289 0001369430291 0001208600199 0001208600201 0001208600212 0001207697793 0001641797223 0001372111547 0001308087753 0001641796852 0001281566889 0001281567418 0001281567903 0001281568768 0001281569231 0001208783395 0001621636975 0001621636986 0001621636997 0001621637008 0001621637021 0001651181433 0001651181444 0001226047959 0001226048038

3172022301096317 3171031501099948 3171032001092899 3171031101096675 3171031101096675 3171031101096675 3171031503110037

3171032101094291 3171031201096319 3172022201099802 3171031301093376 3171031312100238 3171031801092460 3171031801092460 3171031801092460 3171031801092460 3171031801092460 3171031101097494 3171031901097112 3171031901097112 3171031901097112 3171031901097112 3171031901097112 3171030806111018 3171030806111018 3172020510120011 3172020510120011

3172020612740011 HOTMA (ARINDUN)AN N 3171032909010003 NUR !HOI$ 31 3 171036509620007 T+A$KINI 31 3 171030505490001 HARU$ A$ 3171035403740007 VIVIAN RU#IANTI 3171030608141006 KA KA KAUT$AR $A(UTRA 3171036107951001 #"A &UIANTI 3171032202981001 RO##& AKTAVIA$&AH 3171032804051001 ADO A%RIAN$&AH 3171036104730006 $ITI HAR&ANTI 3171034101730007 (RIHARTINI NUR$ANTI 3172022203980008 I,-a. %/ransya 3171033003131005 RA%%I A*HARI #A!HRI 3171034212121009 VIVI &UNITA 3171030711790014 N"NDA 3171035506810006 IIN KARINAH 3171034507000008 I!A ANDRI&ANI 3171036110060002 INDA RAHMAATI 3171035803131002 NA NADIRA AUIA A**AHRA 3171036705910003 TIA AH&UNI 3171030101700003 H"RU I&ONO 3171034706720001 $RI MUR&ATI 3171036412000002 $I $IAM DI NUR HAIMAH 3171032808030003 )AUH NUR ROHMAH 3171031012070002 %A!HRI NUR ROHIM 3171031905121002 M"IRO TAM(U#OON 3171036203141004 RA!H" DR DRUNOVTI TA TAM(U#OON 3172020601540001 $"T&A #O"DH& 3172024306600011 U!IANA

1 4 5 1 3 4 4 4 4 3 4 4 4 1 1 3 4 4 4 4 1 3 4 4 4 1 4 1 3

Jen0 Ke"amn

Tg" La1,

S.a.0 Ka9n "ama. Tempa. Tngg +5TD #5; $5K; %5C

Tempa empa.. La1 La1, ,

dd/m dd/mm/ m/777 7777 7

#5L $5P

8

#+

##

#$

1 2 2 1 2 2 2 2 1 1 2 1 1 1 1 2 1 2

2 1 2 2 2 2 1 3 1 2 2 1 1 1 2 2 1 1

+AKART +AKARTA +AKART +AKARTA +AKART +AKARTA +AKART +AKARTA #"KA$I #"KA$I +AKART +AKARTA ("KAON)AN +AKART +AKARTA #ON" $IN)K"( +AKART +AKARTA +AKART +AKARTA +AKART +AKARTA KUNIN)AN +AKART +AKARTA +AKART +AKARTA +AKART +AKARTA

2571970 2571970 20111978 20111978 14101997 14101997 18112003 18112003 23122010 26022014 23101995 23101995 2161970 1011998 1011998 631965 25111968 12111995 12111995 12111995 12111995 692001 692001 11121950 14101983 14101983 24102009 24102009 1642012 1642012

#%

 ana da.a $UKA$ARI $UKA$ARI $UKA$ARI $UKA$ARI $UKA$ARI $UKA$ARI $UKA$ARI $UKA$ARI RU$UN DAK DAKOT OTA A #"NDUN)AN +A)O #"NDUN)AN #"NDUN)AN +A)O )) $(OOR IV DAAM )) $(OOR IV DAAM )) $(OOR IV DAAM )) $(OOR IV DAAM )) $(OOR IV DAAM !"M(AKA AN)I )) $(OOR IV DAAM )) $(OOR IV DAAM )) $(OOR IV DAAM

6 005 005 005 005 005 15 10 10 8 8 8 8 8 4 7 7 7

RT

R6

#&

#'

5 004 004 004 004 004 11 1 1 4 4 4 4 4 9 5 5 5

Kode Kode Po0 Ke:ama.an

#(

10610 10640 1182 10640 1182 10640 1182 10640 1182 10640 1182 10630 10650 10650 10610 10610 10610 10610 10610 10640 10610 10610 10610

#)

Nama Ke:ama.an

Kode De0a

Nama De0a

#*

#8

$+

K"MA&OR K"MA&ORAN AN K"MA&OR K"MA&ORAN AN K"MA&OR K"MA&ORAN AN K"MA&ORAN K"MA&ORAN K"MA&OR K"MA&ORAN AN K"MA&ORAN K"MA&OR K"MA&ORAN AN K"MA&ORAN K"MA&ORAN K"MA&OR K"MA&ORAN AN K"MA&OR K"MA&ORAN AN K"MA&OR K"MA&ORAN AN K"MA&ORAN K"MA&OR K"MA&ORAN AN K"MA&OR K"MA&ORAN AN K"MA&OR K"MA&ORAN AN

33780 33780 33780 33780 33780

HARA( HARA(AN MU&A HARA( HARA(AN MU&A HARA( HARA(AN MU&A HARA(AN MU&A HARA(AN MU&A K"#ON KO$ON) KO$ON) $"RDAN) $"RDAN) )UNUN) $AHARI )UNUN) $AHARI )UNUN) $AHARI )UNUN) $AHARI )UNUN) $AHARI HARA(AN MU&A )UNUN) $AHARI )UNUN) $AHARI )UNUN) $AHARI

+AKARTA +AKARTA +AKARTA M"DAN #ANDUN) +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA Kun/nan +AKARTA +AKARTA KUNIN)AN KUNIN)AN KUNIN)AN +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA #ITAR $URA#A&A

5121974 2992001 2591962 551949 1431974 682014 2171995 2221998 2842005 2141973 01011973 3221998 3032013 02122012 7111979 1561981 572000 21102006 1832013 2751991 111970 761972 24122000 2882003 10122007 19052012 22032014 161954 631960

1 1 2 1 2 1 2 1 1 2 2 1 1 2 1 2 2 2 2 2 1 2 2 1 1 1 2 1 2

2 1 3 2 2 1 1 1 1 1 2 2 1 2 2 2 2 2 2 2 2 2 2 1 1 1 2 2 2

MAAR $UNT"R +A&A 12 $"RDAN) #ARU 17 UTAN (AN+AN) 5 A$RAMA (ORI K"MA&O 5 A$RAMA (ORI K"MA&O 5 A$RAMA (ORI K"MA&O5  ana da.a 2  ana da.a 2  ana da.a 2 !"M(AKA #ARU 5 K"MA&ORAN #ARAT 007 K #erd/ar/ 13 K"(U DAAM 8 UTAN (AN+AN) II 009 !"M(AKA AN)I 7 !"M(AKA AN)I 7 !"M(AKA AN)I 7 !"M(AKA AN)I 7 !"M(AKA AN)I 7 )ARUDA 7 UTAN (AN+AN) III 5 UTAN (AN+AN) III 5 UTAN (AN+AN) III 5 UTAN (AN+AN) III 5 UTAN (AN+AN) III 5 $UMUR #ATU 004 $UMUR #ATU 004 $UNT"R #"NT"N)AN 9 $UNT"R #"NT"N)AN 9

7 5 6 9 9 9 5 5 5 8 005 7 2 010 9 9 9 9 9 4 6 6 6 6 6 006 006 5 5

10650 10650 10610 10610 10610 10610 10610 10610 10640 10630 1182 10620 10650 1182 10640 10640 10640 10640 10640 10610 10650 10650 10650 10650 10650 10640 1182 10640 1182

TAN+UN) (IOK K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN TAN+UN) (IOK K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN TAN+UN) (IOK TAN+UN) (IOK

33771

33792

33790 33790

$UNT"R +A&A $"RDAN) UTAN (AN+AN) )UNUN) $AHARI )UNUN) $AHARI )UNUN) $AHARI )UNUN) $AHARI )UNUN) $AHARI )UNUN) $AHARI !"M(AKA #ARU K"MA&ORAN $UNT"R +A&A K"MA&ORAN UTAN (A+AN) HARA(AN MU&A HARA(AN MU&A HARA(AN MU&A HARA(AN MU&A HARA(AN MU&A )UNUN) $AHARI UTAN (AN+AN) UTAN (AN+AN) UTAN (AN+AN) UTAN (AN+AN) UTAN (AN+AN) $UMUR #ATU $UMUR #ATU $UNT"R +A&A $UNT"R +A&A

Kode Fa0ke0 Tk
Nama Fa0ke0 Tk
$#

$$

K"! K"MAK"! K"MA K"! K"MAK"! K"MA K"! K"MAK"! K"MA K"! K"MAK"! K"MA K"! K"MAK"! K"MA K"! K"MA K"! K"MA K"! K"MA $"ATAN K"! K"MA $"ATAN K"! K"MA $"ATAN K"! K"MA $"ATAN K"! K"MA $"ATAN K"! K"MA

$"ATAN $"ATAN $"ATAN

Ke"a0 Kewarga Negaraan Ra9a. Kode #5Ke"a0 Nama Nomo, Fa0ke0 I; Fa0ke0 Te"epon Dok.e, Dok.e, Gg Pe0e,.a $5Ke"a0 1=WNI, 2=WNA Gg II; %5Ke"a0 III $% $& $' $( $)

$"ATAN $"ATAN $"ATAN $"ATAN $"ATAN $"ATAN K"! K"MA K"! K"MA K"! K"MA&ORAN K"! K"MA

$"ATAN

09010300K"! K"MA&ORAN 09010300K"! K"MA&ORAN K"! K"MA K"! K"MA

FORM CETAK KARTU E-ID PESERTA JENIS PESERTA NAMA INSTANSI/PUSKESMAS NAMA PIC NOMOR TELEPON PIC EMAIL PIC TANGGAL PENGAJUAN Kode H!Ke"

No


# $ +# DESEMER $+#' 1 0001209014774 2 0001209014807 3 0001209014842 4 0001293444944 5 0001208600188 6 0001208325284 7 0001208325306 8 0001208948703 9 0001658314811 10 0001208155465 11 0001658314822 12 0001208286988 13 0001208329975 14 0001207541834 15 0001207541856 16 0001207488508 17 0001225083363 18 0001641796806 19 0001623973678

Jen0 M.a0

Tg" Ak.4 e,"ak M.a0

No KK

NIK/KITAS/KITAP

Nama Lengkap

%

&

'

(

)

3171032101090867 3171032101090867 3171032101090867 3171031709101015 3171031503110037 3171031701110074 3171031701110074 3171031101097666 3171031101097666 3171031101097666 3171031101097666 3171031101097666 317103080610006 3171032801131026 3171032801131026 3171030105120004 3172022301097699 3171031810121005 3171031006130017

3171031909580002 $O"MAR 3171036409590002 $AI&"M 3171036911870003 NO(ITRI !U(ITA$ARI 3171034101540003 $&A%RIDA HARAHA( 3171031505710017 $A#AR 3171036511590009 $RI $UA$TRI 3171036907760010 RI$NAATI 3171031212560006 #AM#AN) H"RIIDODO $ 3171034611641001 INDI A$IRAH 3171031303950006 MU&A H"NDRAAN 3171035303961001 MA&A $O%A 3171032910071002 AR&A #AKTI KURNIAAN 3171034609480003 TOIROH 3173045305740005 IK$IRI R"TNOATI 3173044808990002 $IVIA ARA$ANTI 3171031208790003 H"RMAAN 3172025004530004 $RI HARTATI 3171030104041003 KHAI#AR %IKRI 3171031808640014 " $UTAR&O

# 5 Pe0e,.a $ 5 Sam % 5 I0., & 5 Anak ' 5 Tam!a1an * 1 3 4 5 1 1 4 1 3 4 4 4 1 3 4 1 1 1 1

20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46 47 48 49 50 51 52 53 54 55 56

0001623973689 0001455655072 0001458273363 0001144788063 0001653817645 0001191588884 0001208547358 0001209057669 0001208743446 0001283836083 0001208610281 0001208610314 0001208610336 0001208610347 0001208842672 0001641795851 0001623973151 0001623973162 0001623973173 0001623973184 0001623973195 0001623973228 0001648346376 0001651181297 0001651181308 0001651181319 0001651181321 0001623971597 0001623971608 0001623971619 0001324909168 0001324909203 0001324909214 0001324909348 0001208076614 0001208076636 0001208076669

3171031006130017 3171030602110026 3171032804100009 3171032105121007 3171032105121007 3171032105121007 3171032301092864 3171032301092864 3171032301092864 3171032301092864 3171031101094220 3171031101094220 3171031101094220 3171031101094220 3171032404121003 3171030312131007 3171031712100015 3171031712100015 3171031712100015 3171031712100015 3171031712100015 3171031712100015 3171030407111015 3171031801092271 3171031801092271 3171031801092271 3171031801092271 3171031808100009 3171031808100009 3171031808100009 3175073004111007 3175073004111007 3175073004111007 3175073004111007 3171031801091431 3171031801091431 3171031801091431

3171030707971004 MUHAMMAD IR%AN 3171031911660005 AHMAD +UNA"DI 3171036005780012 M"I ARTHA #"$AM" 3171033011850008 RINDU O$!AR $UR&ANIN)RAT 3171037110091006 DAVINA A**AHRA 3171056509880004 NURHA&ATI 3171037112740016 IDIA$TUTI 3171031804980002 #A+A DIA$ %A+AR 3171034910061004 %IRDA$ A$NAM"UTIA R 3171034509131002 AI$&AH $AMA 3171035601010006 (UTRI *AHRA *AIKA 3171036209060009 KHAIAH *A$KIA +AMAUDDIN 3171034311070005 *AHA " +AMAUDDIN 3171035907121003 DINDA A&A (RATAMA 3172025909830004 ANA $AKINAH 3216065103690028 $UNDARI 3171032012570007 A-u A:; 3171036207760012 $uryan/ 3171030309970010 I-nu K/r: 3171035309990005 Nuru. %au
4 1 3 1 4 3 3 4 4 4 4 4 4 4 3 3 1 3 4 4 4 4 3 1 3 4 4 2 4 5 1 3 4 4 1 3 4

57 58 59 60 61 62 63 64 65 66 67 68

0001208536907 0001208536942 0001209126666 0001209150731 0001207798683 0001207798705 0000373158819 0001206837101 0001206844323 0001206844334 0001206860499 0001443042832 era un/n #* DESEMER $+#' 0001482196239 0001737673751 ?0001635403263 0001635403274 0001635403285 0001635403296 0001635403307 0001641796356 0001207958804 0001207958556 0001207958602 0001208836113 0001208600559 0001208600561 0001205456769 0001205449503 0001205456771 0001209005436 0001209015753 0001207948522 0001205627657

317103110109882 317103110109882 317103110109882 317103110109882 3171031701098961 3171031701098961 3171031201095959 3171031201093724 3171031201093724 3171031201093724 3171031201093724 3171031201093724

3171031508580005 $U(ARMAN 3171034103650001 $UMIARTI 3171030810890004 ARIAN OKVIAN 3171036904950002 DINDA (RI$!IIA 3171032608520002 MU!H #A$IN AI 3171036404600001 $RI $UMARINA 3171030503370001 ANAM 3171030204750005 HA$AN "%"NDI A$DIN 3171030206770006 NUR&ANAH 3171030405070004 M IRAN V 3171036805080005 IR""N" DI A 3171035505141002 #I'I$ M"IDA *AHRA

1 3 4 4 1 3 1 1 3 4 4 4

3171036406680005 $RI AH&UNI 3173066606880011 $AI&AH 3171031603700006 *UH"MI 3171035008710004 NORMA H"RMA&ATI 3171030506960003 RI*K& KARAMAAH 3171031004010003 MUHAMMAD %ARHAN 3171035805050006 A&!IA A%ARAHI*A 3171031807141006 I&A$ NUR MAUANA 3171036606610001 RITAATI 3171037108901001 RI*'I&AH HA$ANAH 3171035005980001 RI*'& AMANAH 3171031405570001 $"T&O UTOMO 3171032404640005 MO!HHAMAD ANDRI 3171036312640003 $UR&ANA 3171036108590004 $U(RIHATIN 3171032107870008 AHKMAD $&O%&AN 3171031303950005 RAHMAT $A(UTRA 3172030105031002 NUR+ANA 3172033010071004 MUHAMAD AI 3171032808111010 A+IMA RAMDAN 1306011505770003 TONI H"RMANTO

3 1 1 3 4 4 4 1 3 4 4 1 1 3 3 4 4 4 4 4 1

eer>a asnd/r/ ar=u =/da a=/;

99

3171031101094195 3171031710131011 3171031201091004 3171031201091004 3171031201091004 3171031201091004 3171031201091004 3171031208100065 3171031801096579

3171031101094022 3171031101093453 3171031601098694 3171031601098694 3171031601098694 3171031004131007 3171031201092415 3171030510121004

0001205608522 0001205627646 0001228961676 0001641795658 0001383923081 0001887642347 0001635405175 0001635405186 0001635405197 0001641798281 0001641798292 0001641798303 0001641798325 0001372140448 0001372140955 0000374997317 0001623971373 0001207061111 0001208836462 0001208836528 0001208836574 0001651181859 0001393130643 0001208009722 0001324376739 0001324376831 0001737673176 0001737673222 0001737673705 0001737673716 0001737673727 0001737673964 0001737673975 0001208795703 0001208796009 0001208440124 0001209125373

3171030510121004 3171030510121004 317202201093096 3171031409111023 3171032201096901 3171031201090490 3171032703141003 3171032703141003 3171032703141003 3171031201092810 3171031201092810 3171031201092810 3171031201092810 3171032702131024 3171032702131024 3171032311121020 3171031601098707 3171031201090591 3171031101096693 3171031101096693 3171031101096693 3171030304131022 3171032911121003 3171032911121003 3171032911121003 3171032911121003 3171032606141008 3171031201094241 3171031401090163 3171031401090163 3171031401090163 3171031701099229 3171031701099229 3171030406121017 3171030406121017 3171032001094383 3171032001094383

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K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN $"ATAN K"! K"MA&ORAN $"ATAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN $"ATAN K"! K"MA&ORAN $"ATAN K"! K"MA&ORAN $"ATAN K"! K"MA&ORAN $"ATAN K"! K"MA&ORAN $"ATAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MAK"! K"MA&ORAN K"! K"MA&ORAN


K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN 09010300K"! K"MA&ORAN 09010300K"! K"MA&ORAN 09010301K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN $"ATAN K"! K"MA&ORAN $"ATAN K"! K"MA&ORAN $"ATAN K"! K"MA&ORAN $"ATAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN 09010300K"! K"MA&ORAN 09010300K"! K"MA&ORAN 09010300K"! K"MA&ORAN 09010300K"! K"MA&ORAN 09010300K"! K"MA&ORAN 09010300K"! K"MA&ORAN K"! K"MA&ORAN 09010300K"! K"MA&ORAN 09010300K"! K"MA&ORAN 09010300K"! K"MA&ORAN 09010300K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN

$"ATAN $"ATAN $"ATAN $"ATAN

$"ATAN $"ATAN $"ATAN $"ATAN $"ATAN

K"! K"! K"! K"! K"! K"! K"! K"! K"! K"! K"! K"!

K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN

$"ATAN K"! K"MA&ORAN 09010300K"! K"MA&ORAN 09010300K"! K"MA&ORAN 09010300K"! K"MA&ORAN 09010300K"! K"MA&ORAN 09010300K"! K"MA&ORAN 09010300K"! K"MA&ORAN K"! K"MAK"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN $"ATAN K"! K"MA&ORAN $"ATAN K"! K"MA&ORAN $"ATAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN $"ATAN K"! K"MA&ORAN K"! K"MA&ORAN

K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN $"ATAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MAK"! K"MA&ORAN K"! K"MAK"! K"MA&ORAN K"! K"MAK"! K"MA&ORAN K"! K"MAK"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN $"ATAN K"! K"MA&ORAN K"! K"MA&ORAN $"ATAN K"! K"MA&ORAN $"ATAN K"! K"MA&ORAN $"ATAN K"! K"MA&ORAN $"ATAN K"! K"MA&ORAN 09010300K"! K"MA&ORAN 09010300K"! K"MA&ORAN 09010300K"! K"MA&ORAN 09010300K"! K"MA&ORAN 09010300K"! K"MA&ORAN 09010307K"! K"MA&ORAN K"! K"MAK"! K"MA&ORAN 09010300K"! K"MA&ORAN 09010300K"! K"MA&ORAN 09010300K"! K"MA&ORAN 09010300K"! K"MA&ORAN 09010300K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN K"! K"MA&ORAN

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K"! K"MAK"! K"MA K"! K"MAK"! K"MA K"! K"MAK"! K"MA K"! K"MAK"! K"MA K"! K"MAK"! K"MA


No


# $ ( NOPEMER $+#' 1 0001123663601 2 0001801253935 3 0001801255059 4 0001801255836 5 0001623972161 6 0001623972172 7 0001659405429 8 0001635404602 9 0001635404613 10 0001635404624 11 0001635404635 12 13 0001623972317 14 15 16 0001651180915 17 0001207443183 18 0001207443227 19 0001207394087

Jen0 M.a0

Tg" Ak.4 e,"ak M.a0

No KK

NIK/KITAS/KITAP

Nama Lengkap

%

&

'

(

)

3171031801093488 3171031801093488 3171031801093488 3171031801093488 3171032302110065 3171032302110065 3171032402151002 3171031101092046 3171031101092046 3171031101092046 3171031101092046 3171031201093226 3171031201093226 3171032801111031 3171033003100008 3171034112840002 3171032412090020 3171032412090020 3171032412090020

3171030904720006 MUARI( 3171034212820005 $ITI AMAIAH 3171036905030001 MU&ANANDA !HA"RANI 3171035808091001 KHOI%AH KHAIRUNI$A 3601084704860001 II A$IKAH 3171034210051001 ADRI&ANA RA$TI 3171075602890005 V"RA NOVITA 3171030710700007 A!HMAD MUTTAKIN 3201155604710004 N"N"N) AR$IH 3201150204940004 MUHAMMAD ADHA $A(UTRA 3171036908131001 $AKIRA TATIKA $A(UTRI 3171035902060001 DINA %"#RI &OANDA 3171030506131002 DA%%A MAHDI %AIRU$ 3171030203141008 AHMAD A)HI %ARI 3171030808950006 "RIN $"TIAAN 3171034112840002 KRI$NA (U+A RAMA 3171030211810009 MO!HAMAD NOVA 3171035006900003 $RI HANDA&ANI 3171031703060004 MO!HAMAD RA%& A HA#$&I


20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39

0001208819676 0001207137115 0001207153451 0001207124831 0001207129691 0001229393081 0001228539857 0001635406953 0001635406964 0001369217935 0001207928632 0001208819676 00012088119733 0001658314934 0001658314945 0001315261596 0001207947879 0001207947879 0001208982723

3171030111121017 ?3171031301093887 ?3171031301093887 ?3171031301093887 ?3171031301093887 ?3171031301093887 3172021602120002 3171033004141027 3171033004141027 3171031701094744 3171032001097485 3171030111121017 3171030111121017 3171031101094160 3171031101094160 3171031101094160 3171031801096090 3171030311100070 3171030311100070 3171030806121008

3171031610740002 A$"( AK#AR 3171030301720005 $O"R&ADI 3171035304760004 IDA %ARIDA 3171035102980003 )AUH MAURDHI%ATAMI 3171032305061001 )AIH MAUUDHI (RATAMA 3171031402131001 )AAN) MAH"$A VA"NTRI 3172025508500008 RADMA &"TTI 3171036301930004 NURU MUTIA (AMUN)KA$ 3171032504141004 A*AM (UTRA ANU)RAH 3171035409740005 RATNA HANI%AH 3171035912840005 $RI AH&UNI 3171031610740002 A$"( AK#AR 3171036010061003 "I$A RAMADHANI 3171034303620003 INI NUR+ANAH 3171030710810002 A$"( MARDANI 3171036604830002 +UMARIAH A(RI&ANI 3171036710760002 A$TUTI 3171032301990004 ARTHUR !OIN$ OA" 3171030110000004 ANDR" !INTON OA" 3171036503141005 RAI$&A NUR RAHMANIA

1 1 3 4 4 4 4 1 4 4 4 1 4 3 4 4 3 4 4 4

#% NOPEMER $+#' 1 0001206588745 2 0001206588756 3 0001206590376 4 0001206605856 5 0001635405412 6 0001370292726 7 0001207733286 8 0001791240467 9 0001791240748 10 0001229159237 11 0001229159261 12 0001374373326 13 0001208605792 14 0001209125351 15 0001208605847

1301002570 1301002570 1301002570 1301002570 3171031501098601 3171031205151007 3171031205151007 3171030708141008 3171030708141008 3171031901110092 3171031901110092 3171031901110092 3171031101099119 3171031101099119 3171031101099119

Ku/na Kars/ 0950031812660372 $ar:n/ Tarn: 3171036101980001 *AHARA RAMADINI 3171036112971001 ARI&ANTI (ADIAH 3171034302010002 %"#RI&ANTI AIDA A%IA 3171030308930002 D"D"N )INAN+AR $A(UTRA 3171031106141010 +ORD& $&A(UTRA )INAN+AR 3171032304630006 #OA$ UM#AN RA+A 3171037004650006 MANTA$IA (AN+AITAN 3171035005930009 $ANN& MAR$AUINA R 3171032508610005 $UMAD+I 317030508660007 A)U$ $UHADI 3171036505710005 $UTINAH

1 4 4 1 4 1 3 4 1 4 4

16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39

0001229360185 0001635403252 0001228022627 0001658008124 0001208413675 0001208413697 0001209137128 0001209127544 0001208446863 0001372115733 0001372115801 0001372115867 0001372115924 0001372147648 0001372115981 0001658732905 0001641801879 0001641802983 0001208460172 0001208429897 0001208460183 0001209136645 0001636120563 0001636120585

$+ NOPEMER $+#' 1 0001641796593 !"TAK KARTU 2 0001636118111 !"TAK KARTU 3 0001636118122 !"TAK KARTU 4 0001844696452 !"TAK KARTU 5 0001636118133 !"TAK KARTU 6 0001300759244 !"TAK KARTU 7 0001372115687 !"TAK KARTU 0001651181624 !"TAK KARTU 8 9 0001206827019 !"TAK KARTU 10 0001208372793 !"TAK KARTU 11 0001208372883 !"TAK KARTU

3171032010111020 3171031108100051 3171031801091038 3171031801091038 3171031101091322 3171031101091322 3171031101091322 3171031101091322 3171031101091322 3171031101092333 3171031101092333 3171031101092333 3171031101092333 3171031101092333 3171031101092333 3171033009151006 3171031701097942 3171031701097942 3171031101097865 3171031101097865 3171031101097865 3171031101097865 3171031601091091 3171031601091091 3171031601091091 3171031801091145 3171031201090371 3171031201090371 3171031201090371 3171031201090371 3171030302141002 3171030302141002

?3171033112710008 $U(RI&ADI 3171030410131008 A )HA*AI !HUN$I" 3171031707710005 DARMADI 3171034908740006 R"N& "KAATI 3171031907590002 $UR&ADI 3171035005680007 NURIDAH 3171034210910002 NIKA $ARI 3171031007970004 "KA RI&ADI 3171031006020002 KAMAUDIN 3171031105650002 A#DU RA$&ID 3171036511670001 A$MAATI $AIMAH 3171035807870003 IKA RO$&IDA 3171034607930001 *ITTA AR$ITA 3171031802960001 A#DU MA+ID RAMDHANI 3171036210060004 %ITRIA NOOR RA!HMADHANIA 3171036805960002 M"&ANDA $ARI 3171035712490002 +UNANI 3171032302710010 $T"VANU$ MANTIRI 3171035411750009 D"I $U$ANTI 3171031306890005 MO!HAMAD ARI"% 3171035406940003 $ARTIKA 3171033112530012 D+AHIDI 3171032502960004 MUHAMMAD RU$IH 3171031801990004 DONNI 3171031601030004 ANDRI&ADI

3601174107450005 R"$NA 3171031103600007 M #A!HTIAR 3171034604580006 $AANAH 3171032306840008 A!HMAD &UIAN$&AH 3171035310920005 D"#& OKTAVIANI 3326175404780002 $AR&UTI 3171031707141002 RI*K& RAMADHAN 3171032201092300 31710347085000 "M& UMAR 3171031201094238 3171032806760004 RUD& AH&UDI 3171031201092375 3171030505660004 $ANU$I 3171031201092375 3171036002760004 RINI

1 4 1 3 1 3 4 4 4 1 3 4 4 4 4 3 1 4 4 4 4 1 1 4 4 5 1 3 4 4 3 4 1 1 1 3

12 13 14 15 16 17 18 19 20

0001636120484 !"TAK 0001229175685 !"TAK 0001208872901 !"TAK 0001651181782 !"TAK 0001208004884 !"TAK 0001635407403 !"TAK 0001208374312 !"TAK 0001208374301 !"TAK 0001208873428 !"TAK

KARTU KARTU KARTU KARTU KARTU KARTU KARTU KARTU KARTU

3171031201092375 3171032010100004 3171031401151025 3171030201131014 3171030407121026 3171031401098253 3171030807111016 3171030807111016 3171030807111016

3171032604060004 $AND& ("RMANA 3210075012800061 NO(IATI 3171031708151001 $&A%II HAD*AMI NO&A 3171035904151003 $O%I&AH RAHMANDARI 3171031001860012 TAKRODI 3171032304850005 R"N$IU$ $IMON 3302012507850002 A$IMAN 3171035905870009 (U$(ITA$ARI 3171035808111002 AUIA ANI$ATU %ADIAH

4 3 4 4 1 4 1 3 4

Jen0 Ke"amn

Tg" La1,


Tempa. La1,

dd/mm/7777

#5L $5P

8

#+

##

#$

1 2 2 2 2 2 2 1 2 1 2 2 1 1 7 5 1 2 1

1 1 2 2 2 1 2 1 1 2 2 1 1 1 1 1 2 2 1

T")A +AKARTA +AKARTA +AKARTA (AND")AN) (AND")AN) #UKIT TIN))I +AKARTA #O)OR +AKARTA +AKARTA #O)OR +AKARTA +AKARTA #AN&UMA$ +AKARTA +AKARTA +AKARTA +AKARTA

09041972 02121982 29052003 18082009 651985 2102005 2161988 07101970 16041971 02041994 29082013 1922006 562013 232014 881995 1121984 2111981 1061990 1732006

RT

R6

#&

#'

#% $UKA$ARI $UKA$ARI $UKA$ARI $UKA$ARI $UKA MUIA III $UKA MUIA III !"M(AKA $ARI )) $(OOR IV DM )) $(OOR IV DM )) $(OOR IV DM )) $(OOR IV DM )) $(OOR IV DM )) $(OOR IV DM K"MA&ORAN #ARAT K"#ON KO$ON) $UKAMUIA )) $AO )) $AO )) $AO

006 006 006 006 11 11 15 006 006 006 006 9 9 7 7 5 12 12 12

004 004 004 004 1 1 8 005 005 005 005 2 2 6 1 1 4 4 4


#( 10640 10640 10640 10640 10640 10640 10640 10610 10610 10610 10610 10610 10610 10620 10630 10640 10610 10610 10610

#) 1182 1182 1182 1182

1182 1182 1182 1182

Nama Ke:ama.an

Kode De0a

Nama De0a

#*

#8

$+

K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN Keay:ran Keay:ran K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN

33780 33780 33780 33780

82528 82528 82528 82528

HARA(AN MU&A HARA(AN MU&A HARA(AN MU&A HARA(AN MU&A HARA(AN MU&A HARA(AN MU&A HARA(AN MUIA )UNUN) $AHARI )UNUN) $AHARI )UNUN) $AHARI )UNUN) $AHARI )UNUN) $AHARI )UNUN) $AHARI K"MA&ORAN K"#ON KO$ON) HARA(AN MUIA )UNUN) $AHARI )UNUN) $AHARI )UNUN) $AHARI

+AKARTA TA$IKMAA&A +AKARTA +AKARTA +AKARTA +AKARTA (ADAN) +AKARTA +AKARTA +AKARTA M"DAN +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA

Kenda. +aar=a +aar=a +aar=a +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA $AMO$IR M"DAN +AKARTA +AKARTA +AKARTA +AKARTA

16101974 311972 1341976 1121998 2352006 1422013 1581950 23011993 25042014 9141974 12191984 10161974 10202006 331962 1071981 4261983 10271976 1231999 1012000 3252014

3261963 1131987 18121966 1121985 21011998 21121997 322001 381993 1162014 2341963 3041965 1051993 2581961 581966 2551971

1 1 2 2 1 1 2 2 1 2 2 1 2 2 1 2 2 1 1 2

2 2 2 1 1 1 2 2 1 1 2

2 2 2 1 1 1 3 1 2 1 1 2 1 2 1 1 2 2 2 1

HA+I UN) )) MANTRI )) MANTRI )) MANTRI )) MANTRI )) MANTRI $UNT"R +A&A HA+I UN) HA+I UN) $UKAMUIA !"M(AKA #ARU HA+I UN) HA+I UN) )) $(OOR II DM )) $(OOR II DM )) $(OOR II DM !"M(AKA AN)I III )UNUN) $AHARI RA&A )UNUN) $AHARI RA&A !"M(AKA AN)I

5 6 6 6 6 6 8 009 009 10 4 5 5 7 7 7 8 009 009 7

2 1 1 2 1 2 2 1 2 1 1

Kran III Da.a 18 Kran III Da.a 18 Kran III Da.a 18 Kran III Da.a 18 KAM(UN) IRIAN 011 K"MA&ORAN )"M(O 2 K"MA&ORAN )"M(O 2 $UMUR #ATU 3 $UMUR #ATU 3 #AU $A%IR 4 #AU $A%IR 4 #AU $A%IR 4 A$RAMA (ORI K"MA&O2 A$RAMA (ORI K"MA&O2 A$RAMA (ORI K"MA&O2

2 9 9 9 9 9 9 003 003 1 5 2 2 2 2 2 9 007 007 9

10610 10620 10620 10620 10620 10620 10650 10650 10640 10640 10650 10650 10610 10610 10610 10640 10610 10610 10640

1182 1182

1182 1182 1182 1182

K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN TAN+UN) (RIOK K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN

33792 33792

33780 82528 82528 33780

UTAN (AN+AN) K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN $UNT"R +A&A UTAN (A+AN) UTAN (A+AN) HARA(AN MUIA !"M(AKA #ARU UTAN (AN+AN) UTAN (AN+AN) )UNUN) $AHARI )UNUN) $AHARI )UNUN) $AHARI HARA(AN MUIA )UNUN) $AHARI )UNUN) $AHARI HARA(AN MUIA

6 6 6 6 004 9 9 1 1 6 6 6 9 9 9

10650 1182 10630 10630 10640 10640 10640 10640 10640 10610 10610 10610

K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN

33781

$"RDAN) K"#ON KO$ON) K"#ON KO$ON) $UMUR #ARU $UMUR #ARU $UMUR #ARU $UMUR #ARU $UMUR #ARU )UNUN) $AHARI )UNUN) $AHARI )UNUN) $AHARI

KAT"N +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA D"(OK +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA

31121971 4102013 1771971 981974 1971959 1051968 2101991 1071997 1062002 1151965 25111967 1871987 671993 1821996 22102006 5281996 17121949 23021971 14111975 1361989 1461994 31121953 25021996 18011999 16012003

1 1 1 2 1 2 2 1 1 1 2 2 2 1 2 2 2 1 2 1 2 1 1 1 1

2 2 2 2 2 2 1 1 1 2 2 1 1 1 1 2 3 2 1 1 1 2 2 2 2

!"M(AKA #ARU AN)KA$A $UKAMUIA $UKAMUIA #UN)UR #"$AR #UN)UR #"$AR #UN)UR #"$AR #UN)UR #"$AR #UN)UR #"$AR KRAN IV KRAN IV KRAN IV KRAN IV KRAN IV KRAN IV % III !"M(AKA AN)I !"M(AKA AN)I )) $(OOR IV DM )) $(OOR IV DM )) $(OOR IV DM )) $(OOR IV DM D"TA $"RDAN) D"TA $"RDAN) D"TA $"RDAN)

8 11 6 6 2 2 2 2 2 16 16 16 16 16 16 12 008 008 4 4 4 4 003 003 003

(AND")AN) +AKARTA +AKARTA +AKARTA +AKARTA ("KAON)AN +AKARTA KUNIN)AN +AKARTA +AKARTA AM(UN)

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33780 33780 33780

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HARA(AN MU&A HARA(AN MU&A HARA(AN MU&A !"M(AKA #ARU !"M(AKA #ARU $"RDAN) K"#ON KO$ON) K"#ON KO$ON) I K"#ON KO$ON) I )UNUN) $AHARI K"#ON KO$ON) I !"M(AKA #ARU K"#ON KO$ON) )UNUN) $AHARI !"M(AKA #ARU !"M(AKA #ARU !"M(AKA #ARU !"M(AKA #ARU !"M(AKA #ARU

+AKARTA +AKARTA +AKARTA Nan>u Nan>u +aar=a KUNIN)AN ONO$O#O +AKARTA $"RAN) $"RAN) +AKARTA (D $ID"M(UAN A!"H T")A T")A +AKARTA KUNIN)AN +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA $UKOHAR+O +AKARTA +AKARTA MO+OK"RTO +AKARTA #ANDUN) +AKARTA TAN)"RAN) TAN)"RAN) TAN)"RAN) +AKARTA KUNIN)AN +AKARTA +AKARTA

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2 1 1 2 1 2 1 2 1 2 2 2 2 1 2 1 2 1 1 2 1 1 2 2 1 1 2 2 1 2 1 2 1 2 2 1 1

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33787 82529

33780

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HARA(AN MUIA HARA(AN MUIA HARA(AN MU&A )UNUN) $AHARI K"#ON KO$ON) )UNUN) $AHARI )UNUN) $AHARI )UNUN) $AHARI )UNUN) $AHARI )UNUN) $AHARI )UNUN) $AHARI $"RDAN) K"MA&ORAN

D"(OK +AKARTA +AKARTA +AKARTA TA$IKMAA&A +AKARTA +AKARTA $UM"DAN) $UM"DAN) +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA $I+AN)KUN) #"KA$I #"KA$I +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA $OO +AKARTA +AKARTA

14102000 651990 1252012 2181961 22121967 25121998 2572003 671969 111975 24042014 19081981 16082003 06062013 01052014 10011987 08111985 26122011 18072014 20051968 23061998 16112001 12072008 31121961 711994 382000

1 2 1 1 2 2 1 1 2 2 2 1 1 2 1 2 2 1 2 1 2 2 1 2 2

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6 5 5 8 8 8 8 4 4 008 003 003 003 007 005 005 005 003 002 002 002 003 5 5 5

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K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN K"MA&ORAN TAN+UN) (RIOK TAN+UN) (RIOK TAN+UN) (RIOK

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2 2 1 1 1 1 1 2 1

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003 003 6 6 6 6 2 2 2

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33780 33780

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221986 2101989 122013 2331984 10202009 1171980 181996 02091965 12291969 111975 211980 731986 2982007 2962014 14101955 29111957 4111992 15111994 23111970 3112001 2282004 431958 1261960 1661985 2051995 761977 28042001 23082003 25072012 22081981 09121983 28042009 2161978 6111991 2561994 03082013 08022015

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33787

33780 33780 33780

33771 33771

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6121994 30112000 2292011 15101972 08071998 30112005

1 2 1 2 2 1

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33792 33792 33792

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No


Jen0 M.a0

Tg" Ak.4 e,"ak M.a0

No KK

NIK/KITAS/KITAP

Nama Lengkap

#

$

%

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(

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% SEPTEMR $+#' 1 3100024076657 2 3100025109396 3 3100024076758 4 3100024234574 5 3100024234697 0001653816644 6 7 8 9 10 11 12 13 14 15 16 17 18

0001651181051 3100007849837 0001635409247 3100013166352 0001208686398 0001209173753 0001208606534 0001208606602 0001208652142 0001653816238 0001636118897 0001636118908

3172020108110015 3172020108110015 3172020108110015 3172020108110015 3172020108110015

317201807840014 RIA $UANDI 3172024708840020 (ITT"RIA 3172021902080008 M $A%%ARIAN$&AH AMMARUAH  3172022909090006 MUHAMMAD NUR $&AA 3172026606121008 AI$&AH NUR *U%ARIA

3171031101098487 3171032906141004 IR$&AD RAMADHAN $A(UTRA 3171031101097439 3171031201091127 3171031201091127 3171031201091127 3171031201091724 3171031201091724 3171031201091724 3171031201091724 3171031201090901 3171031201090901 3171030403131026 3171030403131026

3171034411141004 A&A (UTRI HUMAIRA 3171032205740006 IMAM %IRDI 3171036508840004 $&ARI%AH 3171035302081002 !AHA&A M"ATI (UTRI 3171033101910003 #UDI MU$AN 3171030109950004 ANDI I+A&A 3171031303980011 %ANDI I+A&A 3171034512020010 !IND& !AUDIA !ANTIKA 3171032306520001 "NDAN) $U(ARD+I 3171035307520001 "T+IN HARTINI 3527041906681469 MOH #AHRAH 3527045005710001 TUTIK

# 5 Pe0e,.a $ 5 Sam % 5 I0., & 5 Anak ' 5 Tam!a1an *

19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41 42 43 44 45 46

0001636118919 0001636118921 0001636118932 3100014618658 3100020426123 3100014618849 0001623972148 0001623972159

0001648346139 0001648346141 0001653817162 0001651180667 0001651180678 0001651180689 0001651180691 0001651180702 0001651180713

3171030403131026 3171030403131026 3171030403131026 317203280311021 317203280311021 317203280311021 3171031305141037 3171031305141037 3171031508111003 3171031508111003 3171031508111003 3171031301091231 3171032310121009 3171032204151006 3171032204151006 3171032204151006 3171031601092851 3171031601092851 3171031301093609 3171031701097291 3171031701097291 3171030405110024 3171031612090006 3171031612090006 3171031612090006 3171031612090006 3171031612090006 3171031612090006

3172020503951002 HAR&ADI 3171031602991002 HAR&ONO 3171031011031001 DONI H"RMAN$&AH 3172021305750009 MUR+AN $ 3172024304770009 AR$INI 3172021411060006 R"HAN R"%ADO 1809050708450003 $U+ONO 1809056909520001 "TI 3313170904780001 $UR&ANTO AM(RI I+A&ANTO 3171046008751001 NAHDI&AH 3171044101101003 *AR"THA (RI!IIA (UTRI 3171034101151004 RI$NAOMI $&AH 3311026107710003 $UMARNI 3172021104680011 MU&ADI 3172024504740014 N"N) +UITA 3172020910020013 THOHHIR 'O#I HA#I#I 3171032510000002 MOHAMMAD "R%ANDA (UR#A 3171035210420002 $RI NURHA&ATI 3171036811880006 RITA NOVIANTI 3171035409470002 MURANI 3171032306710006 MUHAMMAD KAR&ADIAN$&AH 3171035512610001 H ATI%AH HANUM 3171031004810009 #O& "ONARD& 3172056404790005 $UKINI 3171036002011002 MONI!A %"#RIANTI 3171032110041001 O"N $AID 3171031505111005 +"%R"N TANAD& 3171035108131009 NIKITA AN)" TANAD&

& SEPTEMER $+#' 1 0001228565845 2 0001228173592 3 0001228565946 4 0001229326334 5 0001635409135 6 0001635409282 7 0001209246546

3172020108110015 3172020108110015 3172020108110015 3172020108110015 3171031201091127 3171031201091127 317203280311021

317201807840014 RIA $UANDI 3172024708840020 (ITT"RIA 3172021902080008 M $A%%ARIAN$&AH AMMARUAH  3172022909090006 MUHAMMAD NUR $&AA 3171032205740006 IMAM %IRDI 3171035302081002 !AHA&A M"ATI (UTRI 3172021305750009 MUR+AN $

0001651181837 0001651181894 0001648346848 0001641798134 0001641798145 0001641798156 0001651180432 0001651180443

8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35 36 37 38 39 40 41

0001207627299 0001209246579 0001228043261 0001228041731 0001229327673 0001641798753 0001653816194 0001208493551 0001651180342 0001648347423 0001648347434 0001648347445 0001648347456 0001648347467 0001641798865 0001648346275 0001648346286 0001648346297 0001648346894 0001651180746 0001651180757 0001651180768 0001651180779 0001636120664 0001207331256 000120635288 0001206390418 0001206381846 0001206385299 0001206381857 0001651181815 0001651181826 0001651181703 0001635406435

) SEPTEMER $+#' 1 0001636118829

317203280311021 317203280311021 3172022301090469 3172022301090469 3172062004120010 3171030311100123 3171031701099015 3171032201098131 3171031103110042 3171031101096403 3171031101096403 3171031101096403 3171031101096403 3171031101096403 3171031201090983 3171033001121009 3171033001121009 3171033001121009 3171032810111037 3171032808141002 3171032808141002 3171032808141002 3171032808141002 3171031901098744 3171031401094395 3171031501095290 3171031501095290 3171031501095290 3171031501095290 3171031501095290 3171031508111003 3171031508111003 3171031301093609 3171030801100023

3172024304770009 AR$INI 3172021411060006 R"HAN R"%ADO 3172022702840004 $U)ITO 3172025607840016 $UMARNI 3172060707590008 $AMINO 3175105809560001 #ANIH #T H RAI#AN 3171036308640004 #"TRIN"I$ 3171032503460001 DR$ A H THAMRIN 3171030704141001 %AR" A *UHRI 3171031907720011 #O& M"DI ARTO 3171035912780001 D"$$& H"RAATI 3171033012040001 ANDR" RA+A ARTO 3171032002080003 #R&AN A**ARO ARTO 3171030609141009 K"ANU A )HI%%ARI ARTO 3171032603710003 $U(RA&ITNO 3310121408860001 HARTONO 3171034808870001 &U$TININ)$IH 3171036704121005 #"INDA NUR AI$&AH (UTRI ATMO+ 3214111904860001 D"D"N *"NI NUR$A"H 3328024810780002 KHOI%AH 3328026209000003 %ITRI&A I$MATU MUN*IAH 3328022408050004 A$MI %ADURROHMAN IMRON 3328022210080003 M AMNAN #ANU IMRON 3171031512141001 RA%A ARDIAN$&AH 3171034107000005 DI NURHA&ATI 3171032801820005 &OHARI 3171044506860013 %ITRI 3171031811051002 %A!HRI *ID+IAN A 3171032606060001 +OVAN D"ANO 3171035602121002 $A%ANA KHAI$HA (UTRI 3313170904790001 $UR&ANTO AM(RI I+A&ANTO 3171046009751001 NAHDI&AH 3171036811880006 RITA NOVIANTI 3171031707041002 A!HMAD AH&UDI 3171034201100001 NURU KA&A

3171032611121022 3171030507800006 INDRA HARDIAN$AH

1 3 4 4 4 1 1 3 4 1 4 4 4 1

1 3

1

2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34 35

0001636118831 0001636118842 0001636118853 0001636118864 0001651181027 0001651181038 0001651181049 0001635404051 0001635404062 0001651181455

0001651181477

0001651181488 0001635406716 0001653817241 0001641797559 0001648346837 0001621632576 0001207763234 0001653816148 0001208328939 0001228083388 0001209231009 0001207904152 0001207904174 0001207904207 0001207904242 0001207904253

* SEPTEMER $+#' 1 0001228385035

3171032611121022 3171032611121022 3171032611121022 3171032611121022 3171031805111013 3171031805111013 3171031805111013 3171032201151018 3171032201151018 3171032201151018 3171031401099885 3171031401099885 3171031401099885 3171031401099885 3171031804121017 3171031804121017 3171031804121017 3171031804121017 3171031804121017 3171031202151007 3171030605131004 3171032301094092 3171032301094092 3171031101097205 3171031712110004 3171031101090580 3171031410101026 3171031801093510 3171031801097088 3171032201093946 3171032201093946 3171032201093946 3171032201093946 3171032201093946

1807225207850007 $ITI KHOIAH 3171036406101005 +IHAN KAMIAH 3171034106121006 DINDA NA#IA )HA$$ANI 3171034811820012 $ITI (ATIMAH 3171031606620006 (RI&ONO 3171036009650007 $ITI I$NA"NI 3171037108680001 $ITI !HON)IDAH 3171036804950003 A(RIIA 3171031012111006 DION ARDIAN$&AH 3171036412141009 $A%IRA NUR AIAH VIR)IA 3171031505830007 MUH T")UH 3171035807830012 IKA %ITRIA &UIANTINI 3171036109070001 "$A *AIHRA RAMADANI 3171030309111003 MUHAMMAD %AI* A%ARI*I 3172041505670012 RAI$ 3172046302750008 $UA$TRI 3172046910950005 &UNARTI TRIHANDA&ANI 3172042911030006 M IMAM $A(UTRA 3171031611081004 HA%ID* RA%I RA##ANI 3209152106930006 RAHMATUAH 3175064610101003 (UTRI !HOIRUNNI$A 3171031508121011 ADAM $IVA U#I$ 3171032704151005 da@/d s/.@a .u-/s 3171031611131001 ADI $&AHRI MUHARAM 3171032303121002 M")AN 3171034205480003 MUKI&AH 3172024505850004 MA&A ATI 3171030507040003 ANDHIKA $UR&O DI !AH&O 3171035202740007 HARTINI 3171031501700006 DI(RIANTO 3171035905760002 K"!IK $RI AHUUNIN)$IH 3171035112011001 (RIN!INIA $A)ITA RAMADHANI 3171035401051002 $A#RINA UTH%IANA (UTRI 3171031307071001 MUHAMAD #A&U D"ANTO

3171070303100055 3171071901090003 MUHAMMAD A%A

3 4 4 5 1 5 5 1 4 4 1 3 4 4 1 3 4 4 4 1 1 1 4 4 4 4 3 4 3 1 3 4 4 4

4

2 3 4 5 6 7 8 9 10 11 12 13 14

0001207387866 0001209145015 0001208488915 0001641800957 0001641801025 0001208325284

3171070303100055 3171032201096924 3171032201096924 3171032401110139 3171032401110139 3171031701110074 3171031701110074 3171030107131027

0001207403908 0001207403875 0001635407649 0001635407752 0001635407875 0001651180781

3171031702120015 3171031702120015 3171031702120015 3171030401131007

3171072705131010 MUHAMMAD AK#AR A #AIHA'I 3171035408960004 MARIA !ARA !AROINA 3171031704060005 MI!HA" &A#"$T $IMAN+UNTAK 3171035708690013 RIA$ARI KAHAR 3171031411040010 %A+AR RI&ADI 3171036511590009 $RI $UA$TRI 3171036807760010 RI$NAATI 3171032304111006 RI*K& A)HI%AHRI 3171033004840005 RI*AN $"TIAAN 3171031501750008 /e Tay N>a 3171035906060005 R/anna /d/an=/ #aarud/n 3171032401141004 R/,-a. +anuar /d/yana #arud/n 3171031210141010 ADIAN$&AH

## SEPTEMR $+#' 1 2 0001651181771 3 0001208544096 4 0001209127983 5 0001653816982 6 0001653816993 7 8 0001651181534 9 0001651180397 10 0001641796828 11 0001653816058 12 0001653817094 13 0001206378551 14 0001206387371 15 0001206378731 16 0001651180318 18 0001209136476

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3171025907307001 $ARNI 3171030103151001 MUHAMMAD ADI ADRIAN$&AH 3171034112400007 IKAH 3171031106630006 "NDAN) $UKMANA 3171032611860003 RIAN )UNAAN 3171034301930003 ANI$A NUR%ITRI&ANI 3171035105630004 IRIANI 3171032704151001 RAIHAN A(RIIAN$&AH 3171036112141001 *AKI&&AH ATI'AH *AHRA 3518055204790002 MAR%UAH 3171030702151001 %"#RIAN$&AH (UTRA (RATAMAV 3171042104611001 O!IH 3171030403580005 &OHAN 3171035206600003 $UR&ATI 3171035606850015 ANITA 3171035107820006 HIDA &UIANA 3171034110710004 " $ITI AMINAH

4 4 4 3 4 1 4 4 1 1 4 4 1

1 4 1 3 1 3 5 4 4 3 4 5 1 3 4 4 3

Jen0 Ke"amn

Tg" La1,

Tempa. La1,

dd/mm/7777

#5L $5P

8

#+

##

!IA!A( +AKARTA +AKARTA +AKARTA +AKARTA

1871984 781984 1922008 2992009 2662012

+AKARTA

2942014

+AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA $AM(AN) $IMU+A&AN

4112014 2251974 2581984 1322008 3111991 191995 1331998 5122002 2361952 1371952 1961966 1051971

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!IA!A( +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA (UROR"+O

531995 1621999 10112003 1351975 341977 14112006 781945 2991952 941979 2091975 112010 112015 2171971 1141968 541974 9102002 25102000 12101942 28111988 1491947 2361971 15121961 1041981 2441979 2022001 21102004 1552011 1192013

1871984 781984 1922008 2992009 2251974 1322008 1351975

KAT"N +AKARTA )RO#O)AN (ATI ONO)IRI +AKARTA (ADAN) T KARAN) +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA KAT"N KAT"N +AKARTA (URAKARTA ("MAAN) T")A T")A T")A +AKARTA +AKARTA +AKARTA +AKARTA #R"#"$ +AKARTA +AKARTA KARAN)AN&AR INDRAMA&U +AKARTA +AKARTA +AKARTA

341977 14112006 2271984 7161984 771959 9181956 8231964 3251946 472014 19071977 18071977 30122004 20022008 06092014 26031971 14081986 08081967 27042012 4191986 08101978 22092000 24082005 22102008 15122014 172000 2811982 561986 18112005 2662006 1622012 09041979 20091975 28111988 1772004 212010

KUNIN)AN

05071980

1

1

UTAN (AN+AN) III

#RA+A K"N!ANA +AKARTA +AKARTA KUNIN)AN +AKARTA +AKARTA +AKARTA #O)OR +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA T")A T")A +AKARTA #O)OR +AKARTA !IR"#ON +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA #O)OR +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA

+AKARTA

12071985 24062010 01062012 08111982 16061962 20091965 31081968 28041995 10122011 24122014 15051983 18071983 21092007 03092011 15051967 23021975 29101995 29112003 16112008 21061993 06101010 15082012 2742015 16112013 2332012 251948 551985 572004 1221974 1511970 1951976 11122001 1412005 1372007

1912009

2 2 2 2 1 2 2 2 1 2 1 2 2 1 1 2 2 1 1 1 2 1 1

1 2 2 2 2 2 2 1 2 2 1 1 2 2 1 1 2 2 2 1 2 2 1

UTAN (AN+AN) III UTAN (AN+AN) III UTAN (AN+AN) III UTAN (AN+AN) III $"RDAN) #ARU $"RDAN) #ARU $"RDAN) #ARU )) RAHA&U )) RAHA&U )) RAHA&U K"MA&ORAN )"M(O K"MA&ORAN )"M(O K"MA&ORAN )"M(O K"MA&ORAN )"M(O K"MA&ORAN )"M(O K"MA&ORAN )"M(O K"MA&ORAN )"M(O K"MA&ORAN )"M(O K"MA&ORAN )"M(O )) $(OOR IV DAAM K"(U TIMUR $UMUR #ATU K"MA&ORAN $UMUR #ATU K"MA&ORAN

+AKARTA +AKARTA +AKARTA +AKARTA +AKARTA $RA)"N +AKARTA +AKARTA +AKARTA +aar=a #an=are-an #eas/ +AKARTA

2752013 1481996 1742006 1781969 14112004 25111958 2871976 2342011 3041984 1151975 6192006 1242014 12102014

(UROR"+O +AKARTA #O)OR +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA +AKARTA (ONORO)O +AKARTA +AKARTA +AKARTA

1971930 132015 1121940 1161963 26111986 311993 1151963 2742015 21122014 1241979 722015 2141961 431958 1261960 1661985 1171982 1101971

Kode Fa0ke0 Tk
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