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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,"√","Perceraian",{"$nulls":15},"Pencatatan Peristiwa Penting Lainnya"]
[]
[null,null,"Pembatalan Perceraian",{"$nulls":15},"Pembetulan Akta"]
[]
[null,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 SUBJEK AKTA KESATU"]
[]
[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 SUBJEK AKTA KEDUA (JIKA ADA)"]
[]
[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,"PERCERAIAN ATAU PEMBATALAN PERCERAIAN"]
[]
[null,"Yang Mengajukan Perceraian/Pembatalan Perceraian**"]
[]
[null,"1.","Nomor Akta Perkawinan",null,null,":"]
[]
[null,"2.","Tanggal Akta Perkawinan",null,null,":",null,"Tgl :",{"$nulls":4},"Bln :",{"$nulls":4},"Thn:"]
[]
[null,"3.","Tempat Pencatatan Perkawinan",null,null,":"]
[]
[null,"4.","Nama Pengadilan",null,null,":"]
[]
[null,"5.","Tanggal Putusan Pengadilan",null,null,":",null,"Tgl :",{"$nulls":4},"Bln :",{"$nulls":4},"Thn:"]
[]
[null,"6.","Nomor Putusan Pengadilan",null,null,":"]
[]
[null,"7.","Nomor Surat Keterangan Panitera",null,null,":"]
[null,null,"Pengadilan"]
[]
[null,"8.","Tanggal Surat Keterangan Panitera",null,null,":",null,"Tgl :",{"$nulls":4},"Bln :",{"$nulls":4},"Thn:"]
[null,null,"Pengadilan"]
[]
[null,"9.","Tanggal Melapor",null,null,":",null,"Tgl :",{"$nulls":4},"Bln :",{"$nulls":4},"Thn:"]
[]
[null,"Bagi Pemohon Pembatalan Perceraian Harap Mengisi Data di Bawah ini :"]
[]
[null,"1.","Nomor Akta Perceraian",null,null,":"]
[]
[null,"2.","Tanggal Akta Perceraian",null,null,":",null,"Tgl :",{"$nulls":4},"Bln :",{"$nulls":4},"Thn:"]
[]
[null,"3.","Tanggal Pelaporan Perceraian",null,null,":",null,"Tgl :",{"$nulls":4},"Bln :",{"$nulls":4},"Thn:"]
[null,null,"dari Luar Negeri"]
[]
[]
[]
[]
[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 PERCERAIAN :"]
[]
[null,null,"Kutipan Akta Perkawinan Asli Suami dan Isteri"]
[]
[null,null,"Fotocopy KTP-el dan KK Suami Isteri"]
[]
[null,null,"Fotocopy KTP-el 2 (dua) Orang Saksi"]
[]
[null,null,"Putusan / Penetapan Pengadilan (asli)"]
[]
[null,null,"Pas Photo Pemohon Ukuran 3x4 sebanyak 5 Lembar (latar belakang merah)"]