formulir pendaftaran calon komuni i

Jalan Melawai Raya No. 197, Kebayoran Baru - JAKSEL 12130
Telephone : 021-7220763 - Fax : 021-7220558

FORMULIR PENDAFTARAN CALON KOMUNI PERTAMA
Nama Lengkap

: ...........................................................................................

Nama Permandian

: ...........................................................................................

Tempat, Tanggal Lahir

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Nama Lengkap Ayah

: ...........................................................................................

Nama Lengkap Ibu

: ...........................................................................................

Tempat/Tgl Baptis

: ...........................................................................................

Nomer Surat Baptis

: ...........................................................................................

Alamat lengkap

: ...........................................................................................
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Telpon dan HP

: ...........................................................................................

Lingkungan

: ...........................................................................................

Wilayah

: ...........................................................................................

Jakarta, ................................................
Mengetahui,

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---------------------------------------------------Ketua Lingkungan ................................
NB: Mohon dilampiri salinan surat baptis