Graduation Confirmation Form

This is to certify the following information is right and BINUS UNIVERSITY has the right to use any of the information,
and for validity of Graduation Documents Printing.
It is the student's responsibility to update / report any changes to the institution.
All data submitted cannot be changed.

Main Personal Data
FULL NAME

PLACE OF BIRTH

DATE OF BIRTH

Personal Data
NATIONAL ID (Citizen of Indonesia)
PASSPORT NUMBER (Foreign Citizen)

HOME ADDRESS
HOME PHONE
MOBILE PHONE
EMAIL ADDRESS
EMAIL ADDRESS 2

Work Information

COMPANY NAME
DIVISION
POSITION
OFFICE ADDRESS
OFFICE PHONE
Thesis Title
IN BAHASA

IN ENGLISH

Enrichment/Internship Information
1st ENRICHMENT/INTERNSHIP COMPANY

1st ENRICHMENT/INTERNSHIP PERIOD

2nd ENRICHMENT/INTERNSHIP COMPANY

2nd ENRICHMENT/INTERNSHIP PERIOD