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[]
[{"$nulls":32},"F-2.01"]
[null,"Provinsi",null,null,null,":",null,"KALIMANTAN BARAT"]
[]
[null,"Kabupaten/Kota",null,null,null,":",null,"SINTANG"]
[]
[null,"Kecamatan",null,null,null,":"]
[]
[null,"Desa/Kelurahan",null,null,null,":",{"$nulls":14},"Email**",null,null,":"]
[]
[null,"Kode Wilayah",null,null,null,":",{"$nulls":14},"No.Handphone**",{"$nulls":6},":"]
[]
[null,"FORMULIR PELAPORAN PENCATATAN SIPIL DI DALAM WILAYAH NKRI"]
[null,"Jenis Pelaporan Pencatatan Sipil"]
[]
[]
[null,null,"Kelahiran",{"$nulls":15},"Pengakuan Anak"]
[]
[null,null,"Lahir Mati",{"$nulls":15},"Pengesahan Anak"]
[]
[null,null,"Perkawinan",{"$nulls":15},"Perubahan Nama"]
[]
[null,null,"Pembatalan Perkawinan",{"$nulls":15},"Perubahan Status Kewarganegaraan"]
[]
[null,null,"Perceraian",{"$nulls":15},"Pencatatan Peristiwa Penting Lainnya"]
[]
[null,null,"Pembatalan Perceraian",{"$nulls":15},"Pembetulan Akta"]
[]
[null,"√","Kematian",{"$nulls":15},"Pembatalan Akta"]
[]
[null,null,"Pengangkatan Anak",{"$nulls":15},"Pelaporan Pencatatan Sipil dari Luar Wilayah NKRI"]
[]
[null,"DATA PELAPOR"]
[]
[null,"Nama",null,null,null,":"]
[]
[null,"NIK",null,null,null,":"]
[]
[null,"Nomor Dokumen Perjalanan*",null,null,null,":"]
[]
[null,"Nomor Kartu Keluarga",null,null,null,":"]
[]
[null,"Kewarganegaraan",null,null,null,":"]
[]
[]
[null,"DATA SAKSI I"]
[]
[null,"Nama",null,null,null,":"]
[]
[null,"NIK",null,null,null,":"]
[]
[null,"Nomor Kartu Keluarga",null,null,null,":"]
[]
[null,"Kewarganegaraan",null,null,null,":"]
[null,"DATA SAKSI II"]
[]
[null,"Nama",null,null,null,":"]
[]
[null,"NIK",null,null,null,":"]
[]
[null,"Nomor Kartu Keluarga",null,null,null,":"]
[]
[null,"Kewarganegaraan",null,null,null,":"]
[]
[]
[null,"DATA ORANG TUA** (hanya diisi untuk keperluan pencatatan kelahiran, lahir mati dan kematian)"]
[]
[null,"Nama Ayah",null,null,null,":"]
[]
[null,"NIK Ayah",null,null,null,":"]
[]
[null,"Tempat Lahir Ayah",null,null,null,":"]
[]
[null,"Tanggal Lahir Ayah",null,null,null,":",null,"Tgl :",null,null,null,"Bln :",null,null,null,"Thn:"]
[]
[null,"Kewarganegaraan",null,null,null,":"]
[]
[]
[]
[]
[null,"Nama Ibu",null,null,null,":"]
[]
[null,"NIK Ibu",null,null,null,":"]
[]
[null,"Tempat Lahir Ibu",null,null,null,":"]
[]
[null,"Tanggal Lahir Ibu",null,null,null,":",null,"Tgl :",null,null,null,"Bln :",null,null,null,"Thn:"]
[]
[null,"Kewarganegaraan",null,null,null,":"]
[]
[]
[null,"YANG LAHIR MATI"]
[]
[null,"1.","Lamanya dalam Kandungan",null,null,":",null,null,null,"Bulan"]
[]
[null,"2.","Jenis Kelamin",null,null,":",null,null,"1.","Laki-laki",{"$nulls":4},"2.","Perempuan"]
[]
[null,"3.","Tanggal Lahir Mati",null,null,":",null,"Tgl :",{"$nulls":4},"Bln :",{"$nulls":4},"Thn:"]
[]
[null,"4.","Jenis Kelahiran",null,null,":",null,null,"1.","Tunggal",null,null,null,"2.","Kembar 2",{"$nulls":4},"3.","Kembar 3",{"$nulls":4},"4.","Kembar 4",{"$nulls":4},"5.","Lainnya"]
[]
[null,"5.","Anak Ke",null,null,":"]
[]
[null,"6.","Tempat Dilahirkan",null,null,":",null,null,"1.","RS/RB",null,null,null,"2.","Puskesmas",{"$nulls":5},"3.","Polindes",{"$nulls":4},"4.","Rumah",null,null,null,"5.","Lainnya"]
[]
[null,"7.","Penolong Kelahiran",null,null,":",null,null,"1.","Dokter",null,null,null,"2.","Bidan/Perawat",{"$nulls":6},"3.","Dukun",null,null,null,"4.","Lainnya"]
[]
[null,"8.","Sebab Lahir Mati",null,null,":"]
[]
[null,"9.","Yang Menentukan",null,null,":",null,null,"1.","Dokter",null,null,null,"2.","Bidan/Perawat",{"$nulls":5},"3.","Tenaga Kes",{"$nulls":4},"4.","Kepolisian",{"$nulls":4},"5.","Lainnya"]
[]
[null,"10.","Tempat Kelahiran",null,null,":"]
[]
[]
[null,"KEMATIAN (data yang meninggal)"]
[]
[null,"1.","NIK",null,null,":"]
[]
[null,"2.","Nama Lengkap",null,null,":"]
[]
[null,"3.","Anak Ke",null,null,":"]
[]
[null,"4.","Pukul",null,null,":",null,null,null,":"]
[]
[null,"5.","Sebab Kematian",null,null,":",null,null,"1.","Sakit Biasa/Tua",{"$nulls":6},"2.","Wabah Penyakit",{"$nulls":6},"3.","Kecelakaan"]
[]
[{"$nulls":8},"4.","Kriminalitas",{"$nulls":6},"5.","Bunuh Diri",{"$nulls":6},"6.","Lainnya"]
[]
[null,"6.","Tempat Kematian",null,null,":"]
[]
[null,"7.","Tanggal Kematian",null,null,":",null,"Tgl.",{"$nulls":4},"Bulan",{"$nulls":5},"Tahun"]
[]
[null,"8.","Yang Menerangkan",null,null,":",null,null,"1.","Dokter",null,null,null,"2.","Tenaga Kesehatan",{"$nulls":7},"3.","Kepolisian",{"$nulls":4},"4.","Lainnya"]
[]
[]
[]
[null,null,"Mengetahui :",{"$nulls":18},"………………, ………………………. 20 …"]
[null,null,"Kepala Desa/Lurah",{"$nulls":18},"Pelapor,"]
[null,null,"Pejabat Dukcapil Yang Membidangi,"]
[]
[]
[]
[null,null,"( ………………………………………………… )",{"$nulls":18},"( ………………………………………………… )"]
[]
[null,"*","Jika ada"]
[null,"**","Wajib diisi"]
[]
[null,"PERSYARATAN AKTA KEMATIAN :"]
[]
[null,null,"Fotocopy KK"]
[]
[null,null,"Surat Keterangan Kematian dari Kepala Desa / Lurah; dan atau"]
[]
[null,null,"Keterangan Kematian dari Dokter / Paramedis / Rumah Sakit"]
[]
[null,null,"Fotocopy KTP-el Pelapor / Pemohon"]
[]
[null,null,"Fotocopy KTP-el 2 Orang Saksi"]