
FORMULIR
ANGGOTA BOGOR MOTOR TUA CLUB


ds. Leuweungkolot, kec.cibungbulang Bogor
Data Diri Lengkap:
No. Anggota :
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Nama Lengkap :
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Tempat/ Tgl Lahir :
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No. KTP :
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No. SIM C :
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Agama :
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Alamat :
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No. HP/PIN :
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Pekerjaan :
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Status :
Menikah /Belum Menikah ....................................................................
Jenis Motor :
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No. Seri Motor :
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Motifasi Masuk Club :
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Atas kesadaran sendiri, saya ingin menjadi anggota
BOGOR MOTOR TUA CLUB (BMTC) dan bersedia mentaati peraturan perkempulan yang
berlaku, memegangkode etik club, menghargai dan menghormati sesama anggota dan
mematuhi AD/ART club.
Data Pendukung Yang di Lampirkan :
1.
Fotocopy KTP : 1 Lembar
2.
Fotocopy SIM C : (Jika Ada)
3.
Fotocopy STNK : (Jika Ada)
4.
Pas Foto 3x4 : 2 Lembar
5.
Buat KTA : Rp. 20.000 00,-
6.
Colour/Emblem : Rp. 40.000 00,-
7.
Rompi/Jaket : Rp. 120.000 00,-
8.
Kas Awal Club : Rp. 20.000 00,-
Bogor,
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Ketua Presiden Direktur Pemohon
(TIAN) ( WA.
SIMON) (..........................)