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First Name
*
Last Name
*
Username
*
Email
*
Password
*
Place of Birth
*
Date of Birth
*
Address
*
Gender
*
Select Gender
Male
Female
Religion
*
Select Religion
Islam
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Hinduism
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Other
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Blood Type
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A
B
AB
O
I don't know
WhatsApp Number
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Instagram Account
ID Card Number
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Profile Picture
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JPG, JPEG, PNG. Max 4MB. Square (1:1) picture recommended.
Driving License (SIM C) File
*
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JPG, JPEG, PNG, PDF. Max 4MB.
Motorcycle Type
Select your motorcycle type
Bike VIN Number
Bike Registration Number (Plat Nomor)
Bike Registration Letter (STNK)
*
Choose File
JPG, JPEG, PNG, PDF. Max 4MB.
Emergency Contact Name
*
Emergency Contact Number
*
Emergency Contact Name 2
Emergency Contact Number 2
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