Technician Registration Form

Full Name *

Required

Must match ID Card

Full Address *

Required

Must match ID Card

Full Address

Fill if different with ID Card

ID Card Number *

Required

Phone Number *

+62

Required

Email *

Required

ID Card Photo *

add-photo

Choose file

Required

Last Education Certificate *

add-photo

Choose file

Required

Driving License *

add-photo

Choose file

Required

Other Certificate

add-photo

Choose file

Maximum file size: 2 MB

File extension: .JPG .JPEG .PNG

Please make sure the data you filled in is correct