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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":14},"√","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 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,"PEMBETULAN AKTA**"]
[]
[null,"1.","Nomor Akta yang akan dibetulkan/",null,null,":"]
[null,null,"ditarik"]
[]
[null,"2.","Atas Nama",null,null,":"]
[]
[null,"3.","Yang dimohon untuk dibetulkan",null,null,":"]
[]
[null,null,"- Semula Tertulis",null,null,":"]
[]
[]
[]
[]
[]
[]
[null,null,"- Menjadi",null,null,":"]
[]
[null,"4.","Nama Ayah/Ibu/Wali",null,null,":"]
[null,null,"(bagi yang di bawah umur)"]
[]
[null,"5.","NIK Ayah/Ibu/Wali",null,null,":"]
[]
[]
[]
[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 PEMBETULAN AKTA CATATAN SIPIL :"]
[]
[null,null,"Kutipan Akta (Kelahiran / Perkawinan / Kematian / Perceraian) Asli"]
[]
[null,null,"Fotocopy Kartu Keluarga (KK)"]
[]
[null,null,"Fotocopy KTP-el Pemohon / Orang Tua bagi yang belum wajib KTP"]
[]
[null,null,"Fotocopy KTP-el 2 Orang Saksi"]
[]
[null,null,"Fotocopy Data Pendukung Lainnya (Ijazah / SK / Dll)"]