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<html> <head> <style type="text/css" media="print,screen"> @page{ size:A4; } table.renggang tr{ line-height: 0.65cm; } table.renggang1 tr{ line-height: 0.5cm; } tr.renggang{ line-height: 1.5cm; } </style> <link href="../../java/cetak/css/style.css" rel="stylesheet" type="text/css"/> </head> <body> <table width="100%" class="font15"> <tr> <td width="8%" height="20"></td> </tr> <tr> <td><b>No. KK</b></td> <td width="1%">:</td> <td width="91%"><b>3372031705100001</b></td> </tr> <tr> <td><b>NIK</b></td> <td>:</td> <td><b>3572026907000005</b></td> </tr> </table> <table width="93%" class="renggang1 tengah"> <tr> <td colspan="3"><img src="../../bootstrap/v5/assets/img/garuda.jpg" height="115" width="115" /></td> </tr> <tr> <td class="font18" colspan="3"><strong>BIODATA PENDUDUK WARGA NEGARA INDONESIA</strong></td> </tr> <tr> <td width="18%"></td> <td bgcolor="#000000" width="60%"></td> <td width="18%"></td> </tr> </table> <table width="93%"> <tr> <td height="20"></td> </tr> <tr> <td><strong>DATA PERSONAL </strong></td> </tr> </table> <table width="93%"> <tr class="atas"> <td width="3%">1.</td> <td width="27%">Nama Lengkap</td> <td width="1%"><strong>:</strong></td> <td width="52%"><b> INA JELENA HARIYANTO</b> </td> <td width="17%" rowspan="8" class="atas" align="center"> </td> </tr> <tr class="atas"> <td>2.</td> <td>Tempat Lahir</td> <td><strong>:</strong></td> <td>BLITAR</td> </tr> <tr class="atas"> <td>3.</td> <td>Tanggal Lahir</td> <td><strong>:</strong></td> <td>29-07-2000</td> </tr> <tr class="atas"> <td>4.</td> <td>Jenis Kelamin</td> <td><strong>:</strong></td> <td>PEREMPUAN</td> </tr> <tr class="atas"> <td>5.</td> <td>Golongan Darah</td> <td><strong>:</strong></td> <td>TIDAK TAHU</td> </tr> <tr class="atas"> <td>6.</td> <td>Agama</td> <td><strong>:</strong></td> <td>KATHOLIK</td> </tr> <tr class="atas"> <td>7.</td> <td>Pendidikan Terakhir</td> <td><strong>:</strong></td> <td>BELUM TAMAT SD/SEDERAJAT</td> </tr> <tr class="atas"> <td>8.</td> <td>Jenis Pekerjaan</td> <td><strong>:</strong></td> <td>PELAJAR/MAHASISWA</td> </tr> <tr class="atas"> <td>9.</td> <td>Penyandang Cacat</td> <td><strong>:</strong></td> <td>-</td> <td rowspan="7" class="atas" align="center"><img src="http://127.0.0.1:80/Siak/tmpbarcode/qrcode//NIK/3572026907000005-o.png?_=1511949590" /></td> </tr> <tr class="atas"> <td>10.</td> <td>Status Perkawinan</td> <td><strong>:</strong></td> <td>BELUM KAWIN</td> </tr> <tr class="atas"> <td>11.</td> <td>Status Hubungan Dalam Keluarga</td> <td><strong>:</strong></td> <td>ANAK</td> </tr> <tr class="atas"> <td>12.</td> <td>NIK Ibu</td> <td><strong>:</strong></td> <td>-</td> </tr> <tr class="atas"> <td>13.</td> <td>Nama Ibu</td> <td><strong>:</strong></td> <td>RINI AMBARWATI</td> </tr> <tr class="atas"> <td>14.</td> <td>NIK Ayah</td> <td><strong>:</strong></td> <td>-</td> </tr> <tr class="atas"> <td>15.</td> <td>Nama Ayah</td> <td><strong>:</strong></td> <td>HARYANTO</td> </tr> <tr class="atas"> <td>16.</td> <td>Alamat Sebelumnya</td> <td><strong>:</strong></td> <td> -</td> <td rowspan="2" class="atas" align="center"><img src="http://127.0.0.1:80/Siak/tmpbarcode/qrcode//NIK/3572026907000005.png?_=1511949591" /></td> </tr> <tr class="atas"> <td>17.</td> <td>Alamat Sekarang</td> <td><strong>:</strong></td> <td> ALAMAT : - <br /> RT. 001 RW. 014 DUSUN : <br />DESA/KELURAHAN SEMANGGI <br />KECAMATAN PASAR KLIWON <br />KOTA SURAKARTA <br />PROVINSI JAWA TENGAH</td> </tr> </table> <table width="100%"> <tr> <td><strong>DATA KEPEMILIKAN DOKUMEN </strong></td> </tr> </table> <table width="100%"> <tr> <td width="3%">18.</td> <td width="25%">Nomor Kartu Keluarga (No. KK)</td> <td width="1%"><strong>:</strong></td> <td width="44%">3372031705100001</td> <td width="27%"></td> </tr> <tr> <td>19.</td> <td>Nomor Paspor</td> <td><strong>:</strong></td> <td>-</td> <td> </td> </tr> <tr> <td>20.</td> <td>Tanggal Berakhir Paspor</td> <td><strong>:</strong></td> <td>-</td> <td> </td> </tr> <tr> <td>21.</td> <td>No. Akta/Surat Kenal Lahir</td> <td><strong>:</strong></td> <td>-</td> <td> </td> </tr> <tr> <td>22.</td> <td>No. Akta Perkawinan/Buku Nikah</td> <td><strong>:</strong></td> <td>-</td> <td> </td> </tr> <tr> <td>23.</td> <td>Tanggal Perkawinan</td> <td><strong>:</strong></td> <td>-</td> <td> </td> </tr> <tr> <td>24.</td> <td>No. Akta Perceraian/Surat Cerai</td> <td><strong>:</strong></td> <td>-</td> <td> </td> </tr> <tr> <td>25.</td> <td>Tanggal Perceraian</td> <td><strong>:</strong></td> <td>-</td> <td> </td> </tr> </table> <table width="93%"> <tr> <td width="54%" height="10"></td> </tr> <tr class="tengah"> <td></td> <td width="1%"></td> <td width="45%">KOTA SURAKARTA, 29-11-2017</td> </tr> <tr class="tengah"> <td>Yang Bersangkutan,</td> <td></td> <td>a.n. </td> </tr> <tr class="tengah"> <td></td> <td></td> <td></td> </tr> <tr class="tengah"> <td height="60"></td> </tr> <tr class="tengah"> <td><u>INA JELENA HARIYANTO</u></td> <td></td> <td><u></u></td> </tr> <tr class="tengah" style="line-height:4px"> <td></td> <td></td> <td>NIP. </td> </tr> </table> </body> </html>
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