Kode:
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SURAT
MUTASI NUPTK
Yang bertanda tangan di bawah ini :
Nama : ...............................................................................................................
Tempat dan Tgl. Lahir : ...............................................................................................................
NIP/NIGB : ...............................................................................................................
Nomor NUPTK : ...............................................................................................................
Asal Instansi : ...............................................................................................................
Alamat Instansi : ...............................................................................................................
Kabupaten :
...............................................................................................................
Mutasi ke :
Nama Instansi : ...............................................................................................................
Alamat Instansi : ...............................................................................................................
Kecamatan/Kabupaten :
......................................................../......................................................
x
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No dan Tanggal SK. : ...............................................................................................................
TMT :
...............................................................................................................
Untuk Guru
Tugas Mengajar : ...............................................................................................................
Jumlah Jam Mengajar : ...............................................................................................................
Untuk Pengawas
Tugas Mengawas : TK / SD / SMP / SMA / SMK
Mata Pelajaran : ...............................................................................................................
Jumlah Sekolah Binaan : ...............................................................................................................
Alamat Rumah:
Alamat :
...............................................................................................................
Desa / Kode Pos : ....................................................../........................................................
Kecamatan/Kabupaten :
....................................................../........................................................
No Telp / HP : ....................................................../........................................................
Mengetahui,
Kepala
Instansi Asal
…………………………………………
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Bandung, ……………………………
Yang bersangkutan :
……………………………………
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Tim
Data NUPTK
Kab/Kota
……………………………..
Tanggal ...............................
…………………………………………….
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Mengetahui,
Kepala
Instansi yang menerima,
……………………………………..
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Catatan :
1.
Bagi yang mutasi antar Kabupaten/Kota harus
diketahui/diterangkan oleh Operator/Penanggungjawab NUPTK Kabupaten/Kota yang
ditinggalkan.
2.
Lampirkan
SK Tugas di tempat yang baru
3.
Bagi
Mutasi antar Kab/Kota/Propinsi, arsip untuk LPMP Jawa Barat : SK dan Surat
Mutasi
Approval LPMP Jabar
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