LSP-Perasuransian Syariah

Formulir
Permohonan Sertifikasi Kompetensi

FR-APL-01

ASESMEN MANDIRI

Tahap 1

FR-APL-01

Data Pribadi

Bagian 1 : Rincian Data Pemohon Sertifikasi

Pada bagian ini, cantumkan data pribadi, data pendidikan formal serta data pekerjaan anda pada saat ini.

Nama Lengkap

No. KTP/NIK

Tempat lahir

Tanggal Lahir

Kebangsaan

Alamat Rumah

Tlp. Rumah

Nomer Handphone

Kode Pos

No. Tlp Kantor

Kualifikasi/Pendidikan

Jenis Kelamin :

Laki-laki Wanita

Tahap 2

FR-APL-01

Data Pekerjaan Sekarang

Bagian 1 lanjutan: Data Pekerjaan Sekarang

Pada bagian ini, cantumkan data pekerjaan anda pada saat ini.

Perusahaan/ Lembaga

Jabatan

Alamat Rumah

Tlp. Rumah

Nomer Handphone

Kode Pos

Fax

Tahap 3

FR-APL-01

Data Sertifikasi

Bagian 2 : Data Sertifikasi

Tuliskan Judul dan Nomor Skema Sertifikasi serta Daftar Unit Kompetensi sesuai kemasan pada skema sertifikasi yang anda ajukan untuk mendapatkanpengakuan sesuai dengan latar belakang pendidikan, pelatihan serta pengalaman kerja yang anda miliki.

Judul Skema

Nomor

Daftar Unit Kompetensi:

No	Kode Unit	Judul Unit	Jenis Standar ( SKKNI/Standar Internasional/Standar Khusus )
1	K.651ASR01.002.02	Memasarkan Produk Asuransi dan Reasuransi	SKKNI Perasuransian
2	K.651ASR01.011.02	Mengelola Aspek Hukum Perasuransian	SKKNI Perasuransian

Tahap 4

FR-APL-01

Bukti persyaratan dasar pemohon

Bagian 3 : Bukti persyaratan dasar pemohon

Tuliskan persyaratan yang dibawa yang ada dan kemudian pilih salah satu dari 3 pilihan dibawahnya :

Jika bukti peryaratannya ada dan memenuhi syarat maka pilih MEMENUHI SYARAT
Jika bukti peryaratannya ada tetapi tidak memenuhi syarat maka pilih TIDAK MEMENUHI SYARAT
Jika bukti peryaratannya tidak ada maka pilih TIDAK ADA

Masukan Bukti Persyaratan +

No	File	Bukti Persyaratan	Keterangan
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus
1	File	System Architect	Edinburgh	Ubah	Hapus
2	File	Geralt Of Rivia	Rivia	Ubah	Hapus
3	File	Yennefer Of Vengenberg	Vengenberg	Ubah	Hapus
4	File	Ciri Of Cintra	Lion Of Cintra	Ubah	Hapus
5	File	Finn Of Nifhelm	Lion Of Nifhelm	Ubah	Hapus

Rekomendasi (diisi oleh LSP) : (Diterima/ Tidak diterima *) sebagai asesi	Pemohon
	Nama
	Tanggal
	Tanda Tangan
Catatan :	Administrasi
	Nama
	Tanggal
	Tanda Tangan

Formulir Sertifikasi Keahlian

Formulir Permohonan Sertifikasi Kompetensi

Tahap 1

Data Pribadi

Tahap 2

Data Pekerjaan Sekarang

Tahap 3

Data Sertifikasi

Tahap 4

Bukti persyaratan dasar pemohon

Formulir
Sertifikasi Keahlian

Formulir
Permohonan Sertifikasi Kompetensi