formulir pendaftaran calon krisma

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

FORMULIR PENDAFTARAN CALON KRISMA
Nama Lengkap

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

Nama Permandian

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

Tempat, Tanggal Lahir

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

Nama Lengkap Ayah

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

Nama Lengkap Ibu

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

Tempat/Tgl Baptis

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

Nomer Surat Baptis

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

Alamat lengkap

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

Telpon dan HP

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

Lingkungan

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

Wilayah

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

Jika telah menikah:
- pernikahan yg sekarang merupakan pernikahan yg ke-berapa?
: ...........................................................................................
- nama suami/istri

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

- agama suami/istri

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

- tempat/tgl pernikahan

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

- dengan cara apa?

: Sipil / Adat / KUA / Gereja Kristen / Gereja Katolik
(coret yg tdk sesuai)

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

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