PMB Online - Universitas Ibn Khaldun Bogor

Nama Lengkap *
Full Name Sesuai Akta Lahir/Ijazah Pendidikan Terakhir According to Birth Certificate/High School Diploma

Jenis Kelamin *
Gender

Laki-Laki (Male) Perempuan (Female)

Agama *
Religion

Kewarganegaraan *
Nationality

Nomor Induk Kependudukan (NIK) *
National Identity Number

Nomor Induk Siswa Nasional (NISN) *
National Student Number

Nomor Pokok Sekolah Nasional (NPSN) *
National School Number

Nama Ibu Kandung (Nama Tanpa Gelar) *
Mother’s Maiden Name (Without Academic Title)

Tempat Lahir *
Place of Birth Sesuai Akta Lahir/Ijazah Pendidikan Terakhir According to Birth Certificate/High School Diploma

Tanggal Lahir *
Date of Birth Sesuai Akta Lahir/Ijazah Pendidikan Terakhir According to Birth Certificate/High School Diploma

Negara *
Country

Provinsi *
City

Kabupaten/Kota *
City

Kecamatan *
District

Desa/Kelurahan *

Dusun

Kode Pos *
Zip Code

Alamat *
Address

RT *

RW *

Suku Daerah *
Regional Tribes

JAWA SUNDA BUGIS LAINNYA

Lainnya *

No. HP (Whatsapp) *
Mobile Phone Number

Nomor Whatsapp Yang Aktif (Contoh: 0878********) Active Mobile Phone Number With Country Code (Example: 62878*******)

No. HP Orang Tua
No. Parent's HP

Email *
Email Email Yang Aktif Active Email

Ulangi Email *
Confirm Email

Program Studi (Department)

Status Pendaftaran *
Registration Status

Program Studi Utama *
Main Department

Program Studi Pilihan 1 *
Choice Department 1

Kelas *
Class

Jaket *
Jacket

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