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Bpjs ketenagakerjaan formulir 4

Coursehero file72617282Formulir Pengajuan Pembayaran JHT docx - N o N o 1 0 Nama 2025

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4.9 out of 5

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The document is a payment application form for death benefits under the BPJS Ketenagakerjaan program. It includes sections for applicant data, participant data, payment methods, and required supporting documents. The form outlines necessary information such as personal details of the applicant and deceased, relationship to the participant, and documentation needed to process the claim.

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Click ‘Get Form’ to open it in the editor.
Begin by filling out Section A, 'Data Pemohon'. Enter your name, NIK, address, phone number, email, and your relationship to the participant. Ensure all details are accurate.
If applicable, provide information for the guardian of a child under 18 years old in the designated fields.
Proceed to Section B, 'Data Peserta'. Fill in the participant's name, NIK or passport number (if applicable), participant number, place and date of birth, mother's name, and last company name.
Indicate the cause of death and date of death as required. If there are children under 23 years old who are eligible for benefits, check the appropriate box.
In Section C, select your preferred payment method and provide bank details if transferring funds.
Finally, gather all supporting documents listed in Section D and ensure they are ready for submission.

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Versions	Form popularity	Fillable & printable
2021	4.9 Satisfied (20 Votes)
2015	4.4 Satisfied (26 Votes)

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