Formulir Penghuni Tambahan (Di luar KK Pemilik)
π Indonesia
1
Identitas
β’
2
Alamat & Rumah
β’
3
Keluarga
β’
4
Dokumen
β’
5
RT 006 Rules
1
Identitas Penghuni
Head of Household Name
*
Enter the full name as shown on the ID or Passport.
Wajib diisi.
Gender
*
Select
Male
Female
Pilih salah satu.
Phone Number
*
Isi nomor HP yang valid (0β¦ atau +62β¦).
Place of Birth
*
Wajib diisi.
Date of Birth
*
Pilih tanggal lahir.
2
Alamat & Rumah
Pilih Rumah (Status: Terisi)
*
-- Pilih Blok & Nomor Rumah --
Blok B - No. 16 β (Penghuni: S******)
Blok B - No. 17 β (Penghuni: A**** H*******)
Blok B - No. 18 β (Penghuni: T*** B** S******** M*******)
Blok B - No. 19 β (Penghuni: Y**** r*** t*********)
Blok B - No. 21 β (Penghuni: S****** W****)
Blok B - No. 22 β (Penghuni: E**** M* S********)
Blok B - No. 22A β (Penghuni: D***** D***** A********)
Blok B - No. 22B β (Penghuni: N******** H****)
Blok B - No. 25 β (Penghuni: R**** G***** P****)
Blok B - No. 26 β (Penghuni: G*** O******)
Blok B - No. 27 β (Penghuni: K*******)
Blok B - No. 28 β (Penghuni: K***** A***** W**** P*****)
Blok B - No. 29 β (Penghuni: G*******)
Blok B - No. 30 β (Penghuni: H***** S********)
Blok B - No. 31 β (Penghuni: R***** B*** M****** T**)
Blok B - No. 32 β (Penghuni: R********)
Blok B1 - No. 12B β (Penghuni: M** S**********)
Blok B1 - No. 15 β (Penghuni: D*** B** S*****)
Blok B1 - No. 16 β (Penghuni: H**** M***** P********** P******)
Blok B1 - No. 17 β (Penghuni: J****** K*******)
Blok B1 - No. 18 β (Penghuni: Z******* S******)
Blok B1 - No. 19 β (Penghuni: M******** R*********)
Blok B1 - No. 21 β (Penghuni: J******* S*******)
Blok B1 - No. 22 β (Penghuni: H*****)
Blok B1 - No. 22A β (Penghuni: T******* E****** S**********)
Blok B1 - No. 22B β (Penghuni: R**** A* P******)
Blok B2 - No. 12
Blok B2 - No. 12A β (Penghuni: L*** N***** S***********)
Blok B2 - No. 12B β (Penghuni: H**** H***)
Blok B2 - No. 15
Blok B2 - No. 16
Blok B2 - No. 17
Blok B2 - No. 18
Blok B2 - No. 22 β (Penghuni: A********)
Blok B4 - No. 1 β (Penghuni: I**** U*******)
Blok B4 - No. 11 β (Penghuni: D** A*** U****)
Blok B4 - No. 12 β (Penghuni: A**** M****** I****)
Blok B4 - No. 3 β (Penghuni: I**** R*****)
Blok B4 - No. 3A β (Penghuni: M******* a***)
Blok B4 - No. 5 β (Penghuni: T*****)
Blok B4 - No. 6 β (Penghuni: A** S********)
Blok B4 - No. 7 β (Penghuni: S**** p*****)
Blok B4 - No. 8 β (Penghuni: A******* T***)
Blok B4 - No. 9 β (Penghuni: M****** s*****)
Blok B5 - No. 10 β (Penghuni: A*** R*****)
Blok B5 - No. 12A β (Penghuni: B****** A** S******)
Blok B5 - No. 12B β (Penghuni: M** f****)
Blok B5 - No. 15 β (Penghuni: T*** W*** G******)
Blok B5 - No. 20 β (Penghuni: N*********)
Blok B5 - No. 3 β (Penghuni: M*** Y*** A**** P*********)
Blok B5 - No. 3A β (Penghuni: R****** t*********)
Blok B5 - No. 5 β (Penghuni: W**** Y**** G*****)
Blok B5 - No. 6 β (Penghuni: H***** W*****)
Blok B5 - No. 7 β (Penghuni: A*** P****)
Blok B5 - No. 8 β (Penghuni: M********* P*********** P****)
Blok B5 - No. 9 β (Penghuni: M**** S****** P****)
Blok B6 - No. 10 β (Penghuni: B**** A**** A********)
Blok B6 - No. 11 β (Penghuni: K****** A***)
Blok B6 - No. 12
Blok B6 - No. 2 β (Penghuni: M***** S******)
Blok B6 - No. 3 β (Penghuni: F***** R**** S******)
Blok B6 - No. 3A β (Penghuni: R**** T*****)
Blok B6 - No. 5 β (Penghuni: H***** S*******)
Blok B6 - No. 6 β (Penghuni: M********)
Blok B6 - No. 7 β (Penghuni: L******* Z*****)
Blok B6 - No. 9 β (Penghuni: P*****)
Blok B7 - No. 10 β (Penghuni: J***** S*****)
Blok B7 - No. 11 β (Penghuni: F*** F********)
Blok B7 - No. 12A β (Penghuni: J******* S*******)
Blok B7 - No. 3 β (Penghuni: H********* M****)
Blok B7 - No. 3A β (Penghuni: A*** A******** M*******)
Blok B7 - No. 6 β (Penghuni: L***** B******* S*********)
Blok B7 - No. 7 β (Penghuni: N*** O**)
Blok B7 - No. 8 β (Penghuni: B**********)
Blok B7 - No. 9 β (Penghuni: N*** M****** S*)
Blok B8 - No. 1 β (Penghuni: J******* S**********)
Blok B8 - No. 11 β (Penghuni: I*******)
Blok B8 - No. 12 β (Penghuni: S******)
Blok B8 - No. 12A β (Penghuni: I**** T**** H******)
Blok B8 - No. 12B β (Penghuni: I**** A*** S******)
Blok B8 - No. 3 β (Penghuni: P**** F*******)
Blok B8 - No. 5 β (Penghuni: Y***** A*****)
Blok B8 - No. 6 β (Penghuni: R**** P******)
Blok B8 - No. 8 β (Penghuni: A*****)
Blok B8 - No. 9 β (Penghuni: S**** L****** B* H*******)
Silakan pilih rumah.
Ketik blok/nomor atau nama penghuni tersensor (mis. βB5β atau βA***β).
Hubungan dengan Pemilik Rumah
*
Select
Saudara Kandung
Anak
Orangtua/Kerabat
Penyewa/Kontrakan
Lainnya
Wajib dipilih.
Address as per KTP
Required if Indonesian citizen.
Citizenship Status
*
WNI (Warga Negara Indonesia)
WNA (Warga Negara Asing)
Pilih kewarganegaraan.
Country of Origin
-- Choose Country --
Afghanistan
Γ land Islands
Albania
Algeria
American Samoa
Andorra
Angola
Anguilla
Antarctica
Antigua and Barbuda
Argentina
Armenia
Aruba
Australia
Austria
Azerbaijan
Bahamas
Bahrain
Bangladesh
Barbados
Belarus
Belgium
Belize
Benin
Bermuda
Bhutan
Bolivia
Bonaire, Sint Eustatius and Saba
Bosnia and Herzegovina
Botswana
Bouvet Island
Brazil
British Indian Ocean Territory
Brunei Darussalam
Bulgaria
Burkina Faso
Burundi
Cambodia
Cameroon
Canada
Cape Verde
Cayman Islands
Central African Republic
Chad
Chile
China
Christmas Island
Cocos (Keeling) Islands
Colombia
Comoros
Congo
Cook Islands
Costa Rica
CΓ΄te d'Ivoire
Croatia
Cuba
CuraΓ§ao
Cyprus
Czechia
Democratic Republic of the Congo
Denmark
Djibouti
Dominica
Dominican Republic
Ecuador
Egypt
El Salvador
Equatorial Guinea
Eritrea
Estonia
Eswatini
Ethiopia
Falkland Islands
Faroe Islands
Fiji
Finland
France
French Guiana
French Polynesia
French Southern Territories
Gabon
Gambia
Georgia
Germany
Ghana
Gibraltar
Greece
Greenland
Grenada
Guadeloupe
Guam
Guatemala
Guernsey
Guinea
Guinea-Bissau
Guyana
Haiti
Heard Island and McDonald Islands
Holy See
Honduras
Hong Kong
Hungary
Iceland
India
Indonesia
Iran
Iraq
Ireland
Isle of Man
Israel
Italy
Jamaica
Japan
Jersey
Jordan
Kazakhstan
Kenya
Kiribati
Kosovo
Kuwait
Kyrgyzstan
Laos
Latvia
Lebanon
Lesotho
Liberia
Libya
Liechtenstein
Lithuania
Luxembourg
Macao
Madagascar
Malawi
Malaysia
Maldives
Mali
Malta
Marshall Islands
Martinique
Mauritania
Mauritius
Mayotte
Mexico
Micronesia (Federated States of)
Moldova
Monaco
Mongolia
Montenegro
Montserrat
Morocco
Mozambique
Myanmar
Namibia
Nauru
Nepal
Netherlands
New Caledonia
New Zealand
Nicaragua
Niger
Nigeria
Niue
Norfolk Island
North Korea
North Macedonia
Northern Mariana Islands
Norway
Oman
Pakistan
Palau
Palestine, State of
Panama
Papua New Guinea
Paraguay
Peru
Philippines
Pitcairn
Poland
Portugal
Puerto Rico
Qatar
RΓ©union
Romania
Russian Federation
Rwanda
Saint BarthΓ©lemy
Saint Helena, Ascension and Tristan da Cunha
Saint Kitts and Nevis
Saint Lucia
Saint Martin (French part)
Saint Pierre and Miquelon
Saint Vincent and the Grenadines
Samoa
San Marino
Sao Tome and Principe
Saudi Arabia
Senegal
Serbia
Seychelles
Sierra Leone
Singapore
Sint Maarten (Dutch part)
Slovakia
Slovenia
Solomon Islands
Somalia
South Africa
South Georgia and the South Sandwich Islands
South Korea
South Sudan
Spain
Sri Lanka
Sudan
Suriname
Svalbard and Jan Mayen
Sweden
Switzerland
Syrian Arab Republic
Taiwan
Tajikistan
Tanzania
Thailand
Timor-Leste
Togo
Tokelau
Tonga
Trinidad and Tobago
Tunisia
Turkey
Turkmenistan
Turks and Caicos Islands
Tuvalu
Uganda
Ukraine
United Arab Emirates
United Kingdom
United States
United States Minor Outlying Islands
Uruguay
Uzbekistan
Vanuatu
Venezuela
Vietnam
Virgin Islands (British)
Virgin Islands (U.S.)
Wallis and Futuna
Western Sahara
Yemen
Zambia
Zimbabwe
Required for foreign nationals.
Religion
*
-- Choose Religion --
Buddha
Hindu
Islam
Katolik
Khonghucu
Kristen
Lainnya
Pilih agama.
3
Data Keluarga
Data Pasangan (opsional)
0
pasangan
+ Tambah Pasangan
Children Data
0
anak
+ Add Child
4
Dokumen
Upload KTP
Upload Family Card (KK)
Upload Passport
Upload KITAS
5
RT 006 Rules
I have read and agree to the RT 006 rules above
Mohon setujui aturan.
Submit