puskesos-20231102100449.pdf

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PEMERINTAH KABUPATEN CIREBON
SISTEM LAYANAN DAN RUJUKAN TERPADU
PUSAT KESEJAHTERAAN SOSIAL
DESA CIKALAHANG KECAMATAN DUKUPUNTANG
SURAT KETERANGAN
Nomor: 16/2002/1/PUSKESOS/11/2023
Yang bertanda tangan dibawah ini PUSKESOS Desa Cikalahang Kecamatan Dukupuntang Kabupaten
Cirebon, menerangkan bahwa :
Nama Lengkap :DEWI SILVA ANGGRAENI
Nomor Induk Kependudukan :3209166604090003
Nomor Kartu Keluarga :3209162605110005
Tempat, Tanggal Lahir :CIREBON, 26-04-2009
Jenis Kelamin :Perempuan
Agama :Islam
Pekerjaan :Belum / Tidak Bekerja
Status Perkawinan :Belum Kawin
Alamat :BLOK III, RT 001 RW 003
Desa Cikalahang, Kecamatan Dukupuntang
Nama Kepala Keluarga :MUHAMAD NURJATI
Nomor Induk Kependudukan :3209161611760001
Tempat, Tanggal Lahir :BOGOR, 16-11-1976
Pekerjaan :Wiraswasta
Alamat :BLOK III, RT 001 RW 003
Desa Cikalahang, Kecamatan Dukupuntang
Berdasarkan hasil verifikasi oleh PUSKESOS Desa Cikalahang, bahwa pemohon tersebut merupakan warga
Desa Cikalahang Kecamatan Dukupuntang yang saat ini termasuk dalam kategori Keluarga Miskin. Surat
keterangan ini digunakan untuk dengan dokumen persyaratan
Pengajuan Kartu Indonesia Pintar (KIP)
terlampir.
Demikian surat keterangan ini dibuat untuk dipergunakan sebagaimana mestinya dan sebagai bahan
pertimbangan lebih lanjut sesuai peraturan yang berlaku.
Cirebon, 02 November 2023
Mengetahui
Kuwu Cikalahang
Diverifikasi Secara Digital Oleh:
Kuwu
Cikalahang
OOM KOMARUDIN
Koordinator PUSKESOS
Cikalahang
Diverifikasi Secara Digital Oleh:
Koordinator PUSKESOS
Cikalahang
HASANUDIN
Dokumen ini telah tersimpan pada Situs SiPEPEK Kabupaten Cirebon.
Pindai Kode QR (QR Code) disamping untuk menelusuri keaslian dokumen.
https://v1.sipepek.cirebonkab.go.id

Formulir ini berisi informasi pendaftaran Helda Nofitasari untuk mengikuti Ujian Kompetensi Guru pada program studi Pendidikan Agama Islam. Data diri yang tercantum meliputi NIM, Nama, Jenis Kelamin, Agama, Tempat/Tanggal Lahir, Alamat, Nomor Telepon/HP, Email, Nama Orang Tua, Asal Perguruan Tinggi, Waktu dan Tempat Pelaksanaan Ujian secara daring, serta Link Grup Whatsapp untuk bergabung di ruang ujian virtual.

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puskesos-20231102100449.pdf

1. PEMERINTAH KABUPATEN CIREBON SISTEM LAYANAN DAN RUJUKAN TERPADU PUSAT KESEJAHTERAAN SOSIAL DESA CIKALAHANG KECAMATAN DUKUPUNTANG SURAT KETERANGAN Nomor: 16/2002/1/PUSKESOS/11/2023 Yang bertanda tangan dibawah ini PUSKESOS Desa Cikalahang Kecamatan Dukupuntang Kabupaten Cirebon, menerangkan bahwa : Nama Lengkap :DEWI SILVA ANGGRAENI Nomor Induk Kependudukan :3209166604090003 Nomor Kartu Keluarga :3209162605110005 Tempat, Tanggal Lahir :CIREBON, 26-04-2009 Jenis Kelamin :Perempuan Agama :Islam Pekerjaan :Belum / Tidak Bekerja Status Perkawinan :Belum Kawin Alamat :BLOK III, RT 001 RW 003 Desa Cikalahang, Kecamatan Dukupuntang Nama Kepala Keluarga :MUHAMAD NURJATI Nomor Induk Kependudukan :3209161611760001 Tempat, Tanggal Lahir :BOGOR, 16-11-1976 Pekerjaan :Wiraswasta Alamat :BLOK III, RT 001 RW 003 Desa Cikalahang, Kecamatan Dukupuntang Berdasarkan hasil verifikasi oleh PUSKESOS Desa Cikalahang, bahwa pemohon tersebut merupakan warga Desa Cikalahang Kecamatan Dukupuntang yang saat ini termasuk dalam kategori Keluarga Miskin. Surat keterangan ini digunakan untuk dengan dokumen persyaratan Pengajuan Kartu Indonesia Pintar (KIP) terlampir. Demikian surat keterangan ini dibuat untuk dipergunakan sebagaimana mestinya dan sebagai bahan pertimbangan lebih lanjut sesuai peraturan yang berlaku. Cirebon, 02 November 2023 Mengetahui Kuwu Cikalahang Diverifikasi Secara Digital Oleh: Kuwu Cikalahang OOM KOMARUDIN Koordinator PUSKESOS Cikalahang Diverifikasi Secara Digital Oleh: Koordinator PUSKESOS Cikalahang HASANUDIN Dokumen ini telah tersimpan pada Situs SiPEPEK Kabupaten Cirebon. Pindai Kode QR (QR Code) disamping untuk menelusuri keaslian dokumen. https://v1.sipepek.cirebonkab.go.id

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puskesos-20231102100449.pdf

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puskesos-20231102100449.pdf