Format Pendaftaran Bpjs Kelurahan

PISAT

No

1 1 2 3 4 5 6 7 8 9 10 11 12 13 14 15 16 17 18

No KK

2 7372 737202 0219 1903 0318 1800 0009 09 7372 737202 0219 1903 0318 1800 0009 09 7372 737202 0207 0705 0515 1500 0001 01 7372 737202 0207 0705 0515 1500 0001 01 7372 737202 0219 1905 0514 1400 0001 01 7372 737202 0219 1905 0514 1400 0001 01 7372 737202 0219 1905 0514 1400 0001 01 7372022407100039 7372020907120030 7372022206100077 7372020703180004 7372020703180004 7372021503170003 7372021307150003 7372021307150003 7372021307150003 7372021307150003 7372021111150002

NIK/KITAS/KITAP

3 7372 737202 0267 6712 1203 0300 0002 02 7372 737202 0218 1801 0107 0700 0002 02 7372 737202 0216 1604 0474 7400 0001 01 7372 737202 0267 6707 0775 7500 0001 01 7372 737202 0220 2012 1284 8400 0001 01 7372 737202 0256 5611 1188 8800 0009 09

Nama Lengkap

4 ZULISTIAWATI MUHAMMAD ZULKARNAIN EKO EKO WAH WAHUD UDII

N!ATINI DONI DONISI SIUS US KOSAK OSAK MEL MELT 7372020205160003 HARDIN N!AMPU 7372026303160001 NUR"ATH 7372025907160001 ALIKA NAILA PUTRI 7372026006160002 ARZILA RAMADANI 7372020201870004 ASWAN 7310086208910002 MI"TAHUL JANNAH 7372033112870122 HENDRIK NASIR 7372022009040002 MUHAMMAD RAA 7371026611990002 AUREL SALSA#ILA 7371027103090004 "ATIMAH AZZAHRA 7372025210760002 JAA SAM' SH 6405021108880004 #AU SATRIAWAN

Tgl Lahir

1 * Pe'erta 2 * S(ami 3 * I'tri Tempat Lahir 4 * Anak * Tam+ahan  4 4 2 3 2 3 4 4 4 4 2 3 5 4 4 4 3 2

! PAREPARE PAREPARE WONO!IRI KLATEN "LORES "LORES PAREPARE PAREPARE PAREPARE PAREPARE MA$$O##U #ONTO&#ONTO PAREPARE MAKASSAR PAREPARE PAREPARE MAKASSAR NUNUKAN

en' Stat(' Kelami Ka)in n RT

RW

Kode Po'

11 002 002 002 002 001 001 001 002 JL. ZASILIA 001 JL. SULAWESI NO. 25 001 JL. KALIMANTAN JL. #ASO D!. N!ERAN! N%.16 001 JL. #ASO D!. N!ERAN! N%.16 001 002 JL. TARAKAN 001 JL. #ASO D!. PATOMPO 001 JL. #ASO D!. PATOMPO 001 JL. #ASO D!. PATOMPO 001 JL. #ASO D!. PATOMPO 002 JL. SULAWESI L(.$AMAR

12 009 009 007 007 006 006 006 009 009 008 001 001 009 006 006 006 006 009

13 91114 91114 91114 91114 91114 91114 91114 91114 91114 91114 91114 91114 91114 91114 91114 91114 91114 91114

1*,2*K3*.

Alamat Te Tempat Ti Tinggal

dd/mm/yyyy

1*L 2*P

" 27/12/2003 18/01/2007 13/06/1976 24/07/1975 20/12/1984 16/11/1988 02/05/2016 23/03/2016 19/07/2016 20/06/2016 02/01/1987 22/08/1991 31/12/1987 20/09/2004 26/11/1999 31/03/2009 12/10/1975 11/08/1988

# 2 1 1 2 1 2 1 2 2 2 1 2 1 1 2 2 2 1

$ 1 1 2 2 2 2 1 1 1 1 2 2 1 1 1 1 3 2

1% JL. TARAKAN NO. 20 JL. TARAKAN NO. 20 JL. ZASILIA NO. 03 JL. ZASILIA NO. 03 JL. #ASO D!. PATOMPO JL. #ASO D!. PATOMPO JL. #ASO D!. PATOMPO

Trusted by over 1 million members

Try Scribd FREE for 30 days to access over 125 million titles without ads or interruptions! Start Free Trial Cancel Anytime.













19 20 21 22 23 24 25 26 27 28 29 30 31 32 33 34

7372021111150002 7372022310170039 7372021406120016 7372021406120016 7372022010170037 7372022010170037 7372 737204 0430 3001 0111 1100 0043 43 7372 737202 0211 1105 0507 0704 0434 34 7372022705100004 7372 737202 0227 2705 0510 1000 0004 04 7372 737202 0227 2705 0510 1000 0004 04 7372 737202 0227 2705 0510 1000 0004 04 7372022707100084 7372022707100084 7372020409180006

6405024707920004 7372024108660003 7372024607110001 7372020310870001 7372022302150001 7372027108880005 7372 737204 0422 2204 0408 0800 0001 01 7372 737202 0250 5010 1078 7800 0002 02 7372024510600001 73720241 737202410291 02910001 0001 73720230 737202300592 05920001 0001 73720223 737202230793 07930001 0001 7372022903910009 7372032801980002 7372030203830003 7372026509130001

ULIATI H). HASNAH. R AURA SAHRIMA SAMSUL RIJAL M. USU" ALI WAHUDIN "A "AUZIAH' H

3 1 4 2 4 1

MUH. "AHRI HARTATI SAMAD D(*. H). ANDI KUSMIATI

4 5 1 4 4 4 5 5 1 4 1 4

SITTI ARIS$HA. ARIS$HA. S'Z S'Z MUHAMMAD MUHAMMAD IMAM. IMAM. S'Z MUHAMMAD MUHAMMAD AMIN. AMIN. S RO RO NU N UR SAI"UL IS I SNADI NUR "ITRI AULIA JURMIANI PUTRI KHAIRUN NISA

PAREPARE PAREPARE PAREPARE PAREPARE PAREPARE PAREPARE PAREPARE MAKASSAR PAREPARE PAREPARE PAREPARE PAREPARE AM#ON PAREPARE PAREPARE PAREPARE MAJENE PAREPARE

07/07/1992 01/08/1966 06/07/2011 03/10/1987 23/02/2015 31/08/1988

2 2 2 1 1 2

2 2 1 2 1 2

25/04/2008 10/10/1978 05/10/1960 01/02/1991 30/05/1992 23/07/1993 29/03/1991 1/28/1998 02/03/1983 25/09/2013 03/02/1978 09/092011

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

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

JL. SULAWESI L(.$AMAR JL. KALIMANTAN N%.61 JL. KALIMANTAN N%. 20 JL. KALIMANTAN N%. 20 JL. KALIMANTAN N%.61 JL. KALIMANTAN N%.61 JL. NUSANTARA JL. A. MAPPATOLA N%.5A JL. SULTAN HASANUDDIN N%.5 JL. SULTAN HASANUDDIN N%.5 JL. SULTAN HASANUDDIN N%.5 JL. SULTAN HASANUDDIN N%.5 JL. SULAWESI J+. SULAWESI JL. TARAKAN N%.10 JL. ,ETERAN -ASPOM JL. ,ETERAN -ASPOM

002 002 001 001 002 002 001 001 001 001 001 001 002 002 002

009 009 009 009 009 009 009 001 005 005 005 005 009 009 009

91114 91114 91114 91114 91114 91114 91114 91114 91114 91114 91114 91114 91114 91114 91114 91114 001 003 91141 001 003 91141















































































































Lampiran I : KEPUTUSAN WALIKOTA PAREPARE : NOMOR : TANGGAL Stat('

Kela'























































































































































































































0ATAR PSRTA ,P&S PSRTA 5AN0IRI

N> ,P&S

N> K K

NIK

KTRANAN

NA5A PSRTA 0AN KL?ARA

ALA5AT

1 2 3 4

0001672 00016722743 274362 62 0002171 00021711131 113108 08 0001483653115 0001483653903

73720212 737202120318 0318001 0016 6 73720212 737202120318 0318001 0016 6 7372022407100051 7372022407100051 7372022407100051 7372022407100051

73720222 737202220886 0886002 0025 5 73130743 731307430690 0690000 0005 5 7372023112450072 7372023112450072 7372027112530072 7372027112530072

#ERALIH #ERALIH #ERALIH #ERALIH

AMIRUDDIN' SH SH NARIANI HA"ID MARE MARWATI

JL. SU SULAWESI LO LORON! RT RT.001 / RW.009 JL. SULAWESI LORON! RT.001 / RW.009 JL. TARAKAN NO. 06 RT.002 / RW.009 JL. TARAKAN NO. 06 RT.002 / RW.009

















































































































DAFTAR NAMA AKTIF ULANG

K*( #PJS AP#D * >:(*= *? * *? +* *(:* :;*+* :;*+* %+:= * ;:(<** ** RW RT NO NO KARTU BPJS

1 2 3 4 5  7 ! 9 10 11 12 13 14 15 1

0001940513152 0001 00017 722 225 5!9 !91 1 00017225597 0001722519 000172250! 000172255! 00017225575 00017225349 00001301!203 0002 000219 1999 9973 7345 454 4 00022 000223!1 3!1323 32341 41 0001 0001722 722! !13 13 0001 0001722 722! !24 24 0001 0001722 722! !35 35 0001 0001722 722! !4 4 000172272101

NO KK

NO. NIK

NAMA LENGKAP

737202250150004 737202250150004 73720290!90003 73720290!90003 SRI "ULISTIANI 7372 737202 0223 230 010 1000 004 4 7372023112700095 SUPU 73720229010005 737202511050017 NA&IA 73720229010005 7372025!07100001 NILASARI 73720229010005 73720229030!0001 'A#AR 73720229010005 73720250!!30009 (ASNA( 73720229010005 7372025!07100001 MUSLIA&I 737202250150004 7372022305!70001 RA RAMA&(AN SALAM 7372020101000 7372020707900002 # #U ULI)AR (ANI%E 7372 737202 020 010 101 100 000 0 7304074407910003 ROSTINA 737202 737 20201 0101 0100 000 0 73720 73720255 255011 011700 70002 02 AT(IRA AT(IRA PUTRI PUTRI #ULI)A #ULI)AR R 737202 737 202140 140710 71000 0004 04 73720 73720220 22001 01300 30001 01 AR&I AR&I AMOS AMOS 737202 737 202140 140710 71000 0004 04 73720 7372020 2001 0100 0001 01 MEIT" MEIT" LOM%O LOM%OAN AN 737202 737 202140 140710 71000 0004 04 73720 73720213 213059 059200 20005 05 ARIE ARIE %U&IAW %U&IAWAN AN 737202 737 202140 140710 71000 0004 04 73720 73720242 242029 029!00 !0002 02 NUR SRI SRI A'I'A A'I'A 7372022703140005 73 73720271125!0073 #UMINIK

ALAMAT

#L$ PETTANA RA#ENG NO$ 03 #L$ A$ MANGKAU NO$ 27 % #L$ %AU MASSEPE NO$ 423 #L$ %AU MASSEPE NO$ 423 #L$ %AU MASSEPE NO$ 423 #L$ %AU MASSEPE NO$ 423 #L$ %AU MASSEPE NO$ 423 #L$ PETTANA RA#ENG NO$ 03 #L$ SULAWESI NO$ 57 #L$ SULAWESI NO$ 57 #L$ SULAWESI NO$ NO$ 57 #L$ %ASO &G$ NGERANG #L$ %ASO &G$ NGERANG #L$ %ASO &G$ NGERANG #L$ %ASO &G$ NGERANG #L$ A$ SULOLIPU

RT RW

002 00 001 002 004 001 004 001 00 004 001 004 001 00 004 001 00 004 002 001 001 00 009 001 009 001 009 002 001 002 001 002 001 002 001 001 00 001













29 30 31 32 33 34 35 3 37 3! 39 40 41 42 43 44 45 4 47 4!

0001 00017 722 2271 7123 234 4 000172271245 00017227125 000172299!5 00017227!9 000172272011 000172272022 00012!1104954 00012!112093 00017227!14 00017229592 0001722903 0001722925 00017227792 000200!424!7 00017227!25 00017227!3 00017227!47 00017227!5! 000172272!21

7372 737202 0222 220 010 1000 0040 40 7372 737202 0210 100 099 9900 0001 01 MU(A MU(AMM MMA& A& RISW RISWAN ANAN AN&A &A ROST ROSTAN AN 737202220100040 737202204040001 A,RILIA ROSTAN 737202220100040 73720230900002 SU-I RAMA&(ANI ROSTAN 73720219013000 7372022509130001 NUR 'ITRIAULIA 7372020909130007 737202430390000 NU N URLELA 73720214021!000 73010240!920001 NUR MU($ RI&WAN 73720214021!000 7 7 030!430!950001 LE LENA 737202101000! 737202221070001 MARKAT S" S"AM 737202101000! 737202112!00002 MAWAR$ M 737202040!10002 7372020!09930002 R RE ESK"$ R 737202110507033 73 7 372022707510002 &A &ASRU&" 737202110507033 73 73720242050005 &I &INA 737202110507033 73 7 37202470!330001 (# (#$ AIS"A( 737202130911000 7372022512710003 RU RUSTAM 737202130911000 737202002740002 (A ( AMSINA 737202130911000 73720207990003 SR" ERNI &AMA"ANTI$ R 737202130911000 737202471202000 A AS SWIN$ R 737202130911000 7372021210110002 MU($ RE,AN SETIAWAN$ R 737202130911000 7372027112940045 IS I SNAWATI 737202290710003! 7372027112450120 (# ( #$ (ALI#A

#L$ #L$ KAL KALIM IMAN ANTA TAN N NO$ NO$ 15 & 001 001 00! 00! #L$ KALIMANTAN NO$ 15 & 001 00! #L$ KALIMANTAN NO$ 15 & 001 00! #L$ %A %ASO &G$ PA PATOMPO 001 00 0 0 #L$ %ASO &G$ NGERANG 001 00 001 #L$ %ASO &G$ PATOMPO 001 00 #L$ %ASO &G$ PATOMPO 001 00 00 #L$ %A %ASO &G &G$ PA PATOMPO NO NO$14 001 00 #L$ %ASO &G$ PATOMPO NO$14 001 00 0 0 #L$ %ASO &G$ PATOMPO 001 00 00 #L$ PINGGIR LAUT 001 00 00 #L$ PINGGIR LAUT 001 00 00 #L$ PINGGIR LAUT 001 00 00 #L$ %ASO &G$ PATOMPO 001 00 00 #L$ %ASO &G$ PATOMPO 001 00 00 #L$ %ASO &G$ PATOMPO 001 00 #L$ %ASO &G$ PATOMPO 001 00 00 #L$ %ASO &G$ PATOMPO 001 00 #L$ %ASO &G$ PATOMPO 001 00 00 #L$ NUSANTARA NO$ 1 001 00 009













1 2 3 4 5  7 !

000172222 0001!1211237 0001!1211373 0001!1211575 0001!1211722 0001!1211!5 0001!1212047 0001!1212227

73720210100091 7372022407100017 7372022407100017 7372022407100017 7372022407100017 7372022407100017 7372022407100017 7372022407100017

7372024040!0001 SRI WA WA("UNINGSI( 737202170!20003 AGUS A%&ULLA(+ %-$ KU 73720250050001 (#$ A&RIATI A%U+ %-$ KU 7372022907910001 A A& &IT"A "U&ISTIRA 7372027001930002 GUSNIARI A&)ANIS"A 737202301190002 A A& &)AN AS(ARI 737202550010001 A AS SRINA MAULIN&A 7372024!0104000 ASWIN&A ARMINATI

#L$ %A %ASO &G &G$ PA PATOMPO NO NO$4 #L$ TARAKAN NO$ 4 #L$ TARAKAN NO$ 4 #L$ TARAKAN NO$ 4 #L$ TARAKAN NO$ 4 #L$ TARAKAN NO$ 4 #L$ TARAKAN NO$ 4 #L$ TARAKAN NO$ 4

001 00 002 009 002 009 002 00 0 09 002 00 0 09 002 00 009 002 00 0 09 002 00 0 09

























TANGGAL LAHIR

.29.19!9 12.31.1970 11.1.2005 7.1!.2010 3.29.200! !.25.19!3 .10.19!3 5.23.19!7 7.7.1990 7.4.1991 1.15.2017 3.10.194 1.20.19 5.13.1992 2.2.199! 12.31.195!

JENIS KELAMIN

PEREMPUAN LAKI/LAKI PEREMPUAN PEREMPUAN LAKI/LAKI PEREMPUAN LAKI/LAKI LAKI/LAKI LAKI/LAKI PEREMPUAN PEREMPUAN LAKI/LAKI PEREMPUAN LAKI/LAKI PEREMPUAN PEREMPUAN

KELURAHAN

U#UNG SA SA%%ANG U#UNG SA SA%%ANG U#UNG SA% SA%%A %AN NG U#UNG SA SA%%ANG U#UNG SA SA%%ANG U#UNG SA SA%%ANG U#UNG SA SA%%ANG U#UNG SA SA%%ANG U#UNG SA%%ANG U#UNG SA SA%%ANG U#UNG SA%%ANG U#UNG SA%%ANG U#UNG SA%%ANG U#UNG SA%%ANG U#UNG SA%%ANG U#UNG SA%%ANG















.10.1999 4.22.2004 9.23.200 9.25.2013 3.3.1990 !.24.1992 !.3.1995

LAKI/LAKI PEREMPUAN PEREMPUAN PEREMPUAN PEREMPUAN LAKI/LAKI PEREMPUAN

U#UNG U#UNG U#UNG U#UNG U#UNG U#UNG U#UNG

SA%%ANG SA%%ANG SA%%ANG SA%%ANG SA%%ANG SA%%ANG SA%%ANG













4.24.200! !.17.192 .10.195 7.29.1991 1.30.1993 11.30.1995 .15.2001

PEREMPUAN LAKI/LAKI PEREMPUAN LAKI/LAKI PEREMPUAN LAKI/LAKI PEREMPUAN

U#UNG U#UNG U#UNG U#UNG U#UNG U#UNG U#UNG

SA%%ANG SA%%ANG SA%%ANG SA%%ANG SA%%ANG SA%%ANG SA%%ANG













Format Pendaftaran Bpjs Kelurahan

Recommend Documents