Registration
Registration
User & Sponsor Information
Transaction Code
*
Recruiter No.
*
Placement No.
*
BC
Personal Information
Full Name
*
*
Full name must be equal to bank account name
ID Number
*
(KTP/SIM/Passport)
Gender
*
Male
Female
Birth Date
*
Birth Place
*
Address
*
Country
*
- Choose Country -
INDONESIA
Province / State
*
- Not Available -
ACEH
BALI
BANTEN
BENGKULU
DI YOGYAKARTA
DKI JAKARTA
GORONTALO
JAMBI
JAWA BARAT
JAWA TENGAH
JAWA TIMUR
KALIMANTAN BARAT
KALIMANTAN SELATAN
KALIMANTAN TENGAH
KALIMANTAN TIMUR
KALIMANTAN UTARA
KEPUALUAN BANGKA BELITUNG
KEPULAUAN RIAU
LAMPUNG
MALUKU
MALUKU UTARA
NUSA TENGGARA BARAT
NUSA TENGGARA TIMUR
PAPUA
PAPUA BARAT
RIAU
SULAWESI BARAT
SULAWESI SELATAN
SULAWESI TENGAH
SULAWESI TENGGARA
SULAWESI UTARA
SUMATERA BARAT
SUMATERA SELATAN
SUMATERA UTARA
City
*
- Not Available -
---Not Available---
Post Code
*
Residential Phone No.
Office Phone No.
Mobile Phone No.
*
*
Ex: 0812xxxxxxx, 0219xxxxxxx (For CDMA, use area code)
Fax No.
Email
*
Status
*
- Choose One -
Married
Single
Widowed
Spouse Name
Spouse Birth Place
Spouse Birth Date
Bank Information
Please make sure your bank account is valid so the bonus can be transfered
Bank Account No.
*
Bank Account Name
*
Bank
*
Select Bank
BANK BCA
BANK BNI
BANK BRI
BANK MANDIRI
Bank Branch
*
Bank City
NPWP No.
NPWP Name
Please make sure your bank account is valid so the bonus can be transfered
Beneficiary Information
Beneficiary Name
*
Relation
*
Login Information
Login Id
*
Same with Member ID
Password
*
*
Min 4 characters & Max 12 characters
Confirm Password
*
Mother Maiden Name
*
*
For forget password use only
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NAuto 3-B
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Approval of Membership
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