FORMULIR PENDAFTARAN JAMAAH UMROH

• FORMULIR PENDAFTARAN JAMAAH UMROH

  FNH - BATAS UTAMA BATAM

TANGGAL MENDAFTAR
dd-MMM-yyyy
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Tanggal-Bulan-Tahun
NOMOR KTP
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NOMOR PASPOR
Invalid value
*kosongkan jika belum memiliki paspor.
FOTO DIRI
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*foto setengah badan
NAMA
Nama Depan Nama Belakang
Invalid value
JENIS KELAMIN
Laki-laki Perempuan
Invalid value
KEWARGANEGARAAN
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ALAMAT DOMISILI
Alamat Jalan/Kelurahan/Desa
Kecamatan
Kabupaten Provinsi
Kode Pos -Select- Åland Islands Afghanistan Akrotiri Albania Algeria American Samoa Andorra Angola Anguilla Antarctica Antigua and Barbuda Argentina Armenia Aruba Ashmore and Cartier Islands Australia Austria Azerbaijan Bahrain Bangladesh Barbados Bassas Da India Belarus Belgium Belize Benin Bermuda Bhutan Bolivia Bosnia and Herzegovina Botswana Bouvet Island Brazil British Indian Ocean Territory British Virgin Islands Brunei Bulgaria Burkina Faso Burma Burundi Cambodia Cameroon Canada Cape Verde Caribbean Netherlands Cayman Islands Central African Republic Chad Chile China Christmas Island Clipperton Island Cocos (Keeling) Islands Colombia Comoros Cook Islands Coral Sea Islands Costa Rica Cote D'Ivoire Croatia Cuba Curaçao Cyprus Czech Republic Democratic Republic of the Congo Denmark Dhekelia Djibouti Dominica Dominican Republic Ecuador Egypt El Salvador Equatorial Guinea Eritrea Estonia Ethiopia Europa Island Falkland Islands (Islas Malvinas) Faroe Islands Federated States of Micronesia Fiji Finland France French Guiana French Polynesia French Southern and Antarctic Lands Gabon Gaza Strip Georgia Germany Ghana Gibraltar Glorioso Islands Greece Greenland Grenada Guadeloupe Guam Guatemala Guernsey Guinea Guinea-bissau Guyana Haiti Heard Island and Mcdonald Islands Holy See (Vatican City) Honduras Hong Kong Hungary Iceland India Indonesia Iran Iraq Ireland Isle of Man Israel Italy Jamaica Jan Mayen Japan Jersey Jordan Juan De Nova Island Kazakhstan Kenya Kiribati Kosovo Kuwait Kyrgyzstan Laos Latvia Lebanon Lesotho Liberia Libya Liechtenstein Lithuania Luxembourg Macau Macedonia Madagascar Malawi Malaysia Maldives Mali Malta Marshall Islands Martinique Mauritania Mauritius Mayotte Mexico Moldova Monaco Mongolia Montenegro Montserrat Morocco Mozambique Myanmar Namibia Nauru Navassa Island Nepal Netherlands Antilles Netherlands New Caledonia New Zealand Nicaragua Niger Nigeria Niue Norfolk Island North Korea Northern Mariana Islands Norway Oman Pakistan Palau Palestine Panama Papua New Guinea Paracel Islands Paraguay Peru Philippines Pitcairn Islands Poland Portugal Puerto Rico Qatar Republic of the Congo Reunion Romania Russia Rwanda Saint Barthélemy Saint Helena Saint Kitts and Nevis Saint Lucia Saint Martin 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 Slovakia Slovenia Solomon Islands Somalia South Africa South Georgia and the South Sandwich Islands South Korea South Sudan Spain Spratly Islands Sri Lanka Sudan Suriname Svalbard Swaziland Sweden Switzerland Syria Taiwan Tajikistan Tanzania Thailand The Bahamas The Gambia Timor-leste Togo Tokelau Tonga Trinidad and Tobago Tromelin Island Tunisia Turkey Turkmenistan Turks and Caicos Islands Tuvalu Uganda Ukraine United Arab Emirates United Kingdom United States Uruguay Uzbekistan Vanuatu Venezuela Vietnam Virgin Islands Wake Island Wallis and Futuna West Bank Western Sahara Yemen Zambia Zimbabwe Negara
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NOMOR HANDPHONE
Number
Invalid value
PEKERJAAN
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DATA WALI

NAMA

Nama Depan Nama Belakang

Invalid value

KEWARGANEGARAAN

Invalid value

NOMOR HANDPHONE

Number

Invalid value

KELENGKAPAN BERKAS DOKUMEN YANG DIBUTUHKAN

Berkas fisik dikirimkan ke Kantor FNH-BATAS UTAMA BATAM

FOTO KTP

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*tulisan data pada gambar harus jelas

FOTO PASPOR DAN ENDORSMEN NAMA (JIKA ADA)

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*tulisan data pada gambar harus jelas/kosongkan jika belum memiliki paspor

FOTO KARTU KELUARGA

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*tulisan data pada gambar harus jelas
DP MINIMAL 5 JUTA RUPIAH *
Invalid value
Formulir ini diisi dengan sebenar-benarnya dan penuh tanggung jawab. *
Invalid value