Application Form - TECH Indonesia

Enrollment form

Name

Surname 1

Surname 2

E-mail

Telephone

KTP (Kartu Tanda Penduduk)

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Payment Modes and Methods

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Cash payment

Split payment

Deadlines

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Credit card

Account

Internship program Diabetes

Start: to choose

Cash price

Rp.117,818,128

Installment price

Rp.55,085,500 of tuition + 5 fees of Rp.16,555,125

Total amount

Initial payment

Installment fees