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Timestamp Email Nama Lengkap (sesuai KTP) Nama Panggilan Tempat Lahir Tanggal Lahir Bulan Lahir Tahun

mpat Lahir Tanggal Lahir Bulan Lahir Tahun Lahir Jenis Kelamin Golongan Darah Alamat Lengkap Provinsi Kotamadya / Kabupaten Kecamatan Kode Pos NO HP/ WA No. KTP No. SIM Jabatan PP IOF (1822) No. KTA IOF (apabila ada) Pengurus Daerah Pengurus Cabang Nama Klub No Registrasi Klub Facebook Instagram Foto KTP Foto Pribadi Status Pembayaran Data to Form List Anggota
8/14/2019 7:58:42 hidayat.jajat@gmail.com Jajat Hidayat Zuky Pandeglang 7 7 1977 Laki-laki AB Komplek BPI blok i 2 No.6 RT. 03/ 06 Rokoy Ds. Sukasari Banteb Pandeglang Kaduhejo 42256 087773126777 3601190707770002 SIM A 770713210640 / SIM C 770713210246 Banten Kabupaten Pandeglang Badak Adventure Community ID: 11.02.01 Jajat Hidayat Jajat_Hidayat https://drive.google.com/open?id=1KUlYGLSFVSvt7od66Rf1QxDChbphKG_j
https://drive.google.com/open?id=1rFbxy4KmhY3HFp3GZ3mrUFnQqOhkVlba
Lunas Submitted
8/26/2019 10:11:48 ronitnb@yahoo.com Roni Syahrul Roni Padang Panjang 16 6 1972 Laki-laki O Jl Karang Bolong II No 08 Bencongan Kelapa Dua, Tangerang BAnten Tangerang Kelapa dua 15811 628135778700 3.60328E+15 720612193751 Banten Kota Cilegon KRAKATAU STEEL OFFROAD https://drive.google.com/open?id=1-aCgj8J4rWhH0Kfu9LcLRlMvRNQNFLNR
https://drive.google.com/open?id=1UPTY40HZ66O-xs-G803YSSyU7Kn-wi1P
Lunas Submitted
9/11/2019 15:34:10 jonrebopaing@gmail.com Joni Damhudi Joni Jakarta 15 6 1967 Laki-laki A Jln shelo blok L 8 komp garuda Banten Tangerang kota Cipondoh 15142 081398792345 3173011506670026 6706120552215 ( B1 ) Banten Kota Tangerang TDI Chapter Banten Raya 006 jonrebopaing jonrebopaing https://drive.google.com/open?id=1ov9b0VSngx_AJ3z2PwmLPgah7vH9EcHZ
https://drive.google.com/open?id=19J9Uf0ufYzokeD-7ql9fct6DqBw4bV1_
9/13/2019 11:36:50 prayoga165@gmail.com Prayoga Prayoga Malang 23 5 1958 Laki-laki B Jl. Taman Lotus Merah No.05 RT/RW: 05/10 Banten Cilegon Purwakarta 42433 081210979800 3672072305500001 162578836668 Banten Kota Cilegon Krakatau Steel Offroad https://drive.google.com/open?id=1MrTuvb9aPQmOtmOzN9r2YvD_5ZnsDgUf
https://drive.google.com/open?id=1LLVdhZ3aAtK48IkqRKDDO2WtsFcOelth
Lunas Submitted
9/13/2019 17:40:30 inraja.ij@gmail.com Rindra.S Widi Malang 1 11 1968 Laki-laki O Jl. Arjuna No. 13 Kav. Blok E RT 15 RW 05 Banten Cilegon Cilegon 42415 081911000125 3672020111690003 157385009465 Banten Kota Cilegon Baja Offroad arbni_ayajdneos https://drive.google.com/open?id=1Qn8smyXupgLvHE3-BMCQf9WAdhf9TZYA
https://drive.google.com/open?id=1Xh-95VIRrkt9mNeggEvftyrJonJF7Yxn
9/26/2019 10:23:27 fqih.fjr@gmail.com fiqih fajrian fiqih jakarta 8 4 1985 Laki-laki O Villa pamulang Jl. Arjuna 5 Blok DF 1 No. 25 Pamulang Banten Tangerang Selatan Pamulang 15418 081382915322 3671010804850001 850412193164 Banten Kota Tangerang Selatan Dono Club https://drive.google.com/open?id=1dMfYYFv0EeOEKNM84k89aB2HVzenrZEf
https://drive.google.com/open?id=1Bp4AquMSYU9em9RQvYrjvdL8koODWZJV
10/9/2019 19:03:20 jonrebopaing@gmail.com Joni Damhudi Joni Jakarta 15 6 1967 Laki-laki O Jln Shelo L 8 komplek garuda Banten Tangerang kota Cipondoh 15148 081398792345 3173011506670026 B 6706120552215 Banten Kota Tangerang TDI Banten Raya 006 Jon rebo paing Jonrebopaing67 https://drive.google.com/open?id=1IIhK1Vvy0LX4vEYDqXCWZZuo1el-lnTp
https://drive.google.com/open?id=148Vro52VU9psH094i26DdORz_LKoJsut
10/21/2019 16:52:25 Yendewiyulianti@gmail.com
Yen dewi yulianti Yen Bandung 5 7 1975 Perempuan A Teratai griya asri blok d5 no. 3 legok Banten Tangerang Legok 15820 081287053757 3.6032E+15 750712195194 Banten Kabupaten Tangerang GMB Prengus Yen virgy Yen dewi https://drive.google.com/open?id=1LuMURWgEcr4CuxnPGQSn3uXwCyG0PMOL
https://drive.google.com/open?id=1KFgYfl5T3lp5WIhGj7GNbr1tZXZd8Z4z
10/29/2019 20:49:24 ricky_cliff@yahoo.com Ricky Adiarso Ricky Jakarta 13 6 1974 Laki-laki A Komp mabad 124, JL gn gede G 112 .Rempoa Banten Tangsel Ciputat 15412 081906004228 3674051306740004 A7406122250154, C 7406122250155 13 04 04 016 Banten Kota Tangerang Selatan DF https://drive.google.com/open?id=1qBsQD3xBEbTyO7salBkn2vmSRlk2uS7d
https://drive.google.com/open?id=1S_Ng2Yod5msCH9Z9VhcSzo9DlnwCr5QO
2/10/2020 22:04:20 mandiri171@gmail.com Suganda P Simanjuntak Rendi Jakarta 17 7 1971 Laki-laki O Jl batu mutiara no 5 Rt 004 Rw 10 Dki jakarta Jakarta timur Pulogadung 13210 082170994333 3175021707710004 A7307120553841, C7107120513747 Banten Kota Tangerang Selatan Taft Diesel Indonesia (TDI) 022 Suganda https://drive.google.com/open?id=1Dbda6A1HO8QzMNBdDBzsHjnkbt8lmSy_
https://drive.google.com/open?id=1shLrG8wRknr6AfInDGJyCawv1QZiEKCH
2/11/2020 5:59:32 Kongsibaru76@gmail.comUus suryana Yana Sukabumi 7 1 1975 Laki-laki AB Claster puri asri 2 blok b8 rt 004/03 kel.poris plawad utara kec.cipondoh
Bantenkota tangerang
Kotamadya Cipondoh 15141 081222292477 3671110701750001 A12197501000013 Banten Kota Tangerang TDI capter banten https://drive.google.com/open?id=1lyimV9NeWM4UW8SZrmkOA069d6O741sN
https://drive.google.com/open?id=1D4MieMJeyjP9aWmta-QeiZV9KpYJwnI4
2/11/2020 14:22:05 hutri72@gmail.com Hutri agus setiawan Wawan Malang 18 8 1972 Laki-laki O Jl Dadang Suprapto no 18A Rt 01 RW 01 pasarbaru Banten Tangerang Karawaci 15112 081717827270 3671071808720003 A720812193456 , C720812193452 Banten Kota Tangerang TDI Banten raya Hutri mbos https://drive.google.com/open?id=1tj7N7oqClvEp1WZbb4EqdhSgSVcfZTDz
https://drive.google.com/open?id=1DyMSQt_w7nM9RxyYgYmxXqXwe8CJVhlB
3/10/2020 11:41:55 alimubarok1310@gmail.com
Ali Mubarok Ali Brebes 28 6 1984 Laki-laki A Puri Serpong cluster Chrysant blok ah 8 no 18 banten Tangerang Selatan Setu 15345 085223558591 3.67406E+15 840612192575 Banten Kota Tangerang Selatan SCCI Region Banten 001 Ali Mubarok Ali Mubarok https://drive.google.com/open?id=1dd4M4p5VcZL084ladSbgTYK3DdBzTYUA
https://drive.google.com/open?id=1wgOA-iZeKr4EKZuSNUyF8Ypdqe4CvsYr
3/19/2020 13:17:42 erwinsuteja425@gmail.com
Erwin Suteja Kusuma Erwin Bandung 31 12 1961 Laki-laki A Komp. BBS II, Jln. Pala Blok A2 No. 83 Banten Cilegon Cilegon 42411 08121959915 3672023101610002 13216112000007 Banten Kota Cilegon Skin Banten 001 Erwin Suteja Kusuma Tidak ada https://drive.google.com/open?id=1170Gjzfxq-3d_LBhwLhbyfFAJbZnV9qk
https://drive.google.com/open?id=1FS9pUL8w5fYR4gjbrDkMY7ijgCX8ohK7
3/19/2020 13:17:43 erwinsuteja425@gmail.com
Erwin Suteja Kusuma Erwin Bandung 31 12 1961 Laki-laki A Komp. BBS II, Jln. Pala Blok A2 No. 83 Banten Cilegon Cilegon 42411 08121959915 3672023101610002 13216112000007 Banten Kota Cilegon Skin Banten 001 Erwin Suteja Kusuma Tidak ada https://drive.google.com/open?id=1vl_HUSs82IGMxhkVRUn09ctKsLXwbNNc
https://drive.google.com/open?id=1-9e0Gcj5db5v8hE7ItYXJeG5yGWv90RE
5/12/2020 1:24:44 cheppy.mandala@gmail.com
cepi wahyu mandala cepi pandeglang 25 12 1985 Laki-laki B Komp. Sukapura 007/001. No. 39. Sukapura DKI jakarta jakarta utara cilincing 22102 85693453478 3601172512850001 A1222170401750 Banten Kota Cilegon bkantara offroad https://www.facebook.com/cheppy.putra.mandala https://drive.google.com/open?id=1XXkuEZ3_X3Y0y4GI5FCbivuaTHHSaVvf
https://drive.google.com/open?id=1ImSBPkJMhZjbeAPK8EtR773gjyaMe5hN
6/24/2020 21:51:03 ditahendra.tujuh@gmail.com
DITA HENDRADIATNA KARTIKA PUTRA
DIDIT/AMBON JAKARTA 1 5 1987 Laki-laki O Perum. SARUA PERMAI, JL.KEPODANG C22/9 BANTEN TANGERANG SELATAN PAMULANG 15415 087843282999 3674060105870008 A8705122250133 Banten Kota Tangerang Selatan KAKI LIMA/K5 12345678910 Jimun Garage diditahendra https://drive.google.com/open?id=1XeVioqEjWVIeuU0EWyXx-w8lruHhD8q3
https://drive.google.com/open?id=1yT6U11O-1Z-W3oXvAQ-xuAYVb2AbK-9c
6/26/2020 10:17:46 ditahendra.tujuh@gmail.com
DITA HENDRADIATNA KARTIKA PUTRA
DIDIT/AMBON JAKARTA 1 5 1987 Laki-laki O Perum. SARUA PERMAI, JL.KEPODANG C22/9 BANTEN TANGERANG SELATAN PAMULANG 15415 087843282999 3674060105870008 A8705122250133 Banten Kota Tangerang Selatan KAKI LIMA/K5 12345678910 Jimun Garage diditahendra https://drive.google.com/open?id=1RZHQby8ReFOOqjuKl4_er3Wc9Q9vJwin
https://drive.google.com/open?id=1rdJAB-YjT2oO5pF0_yt41MZaFUIeBSRj
7/27/2020 20:13:39 diditahendra.7tujuh@gmail.com
IDUP MAULANA ENGKONG BABEH TANGGERANG 12 4 1962 Laki-laki AB BAMBU APUS TIMUR 007/003 BANTEN TANGERANG SELATAN PAMULANG 15416 089686611729 3.67406E+15 A1234567810 Banten Kota Tangerang Selatan K5 ENGKONG GARAGE https://drive.google.com/open?id=11LVsI0qlF1KjyxJuu7I1alrZM-sKl5l8
https://drive.google.com/open?id=1s5NuLUub0DXrzZOUzldxnefIqMK1YFcq
REKAPITULASI
*Mohon tidak merubah data di bawah ini.

KTA Anggota
Pembayaran Lunas Anggota Terdaftar [1] KTA Di Terima Pengda KTA Di Terima Member

69 75 65 48
KTA Club
Pembayaran Lunas Club Terdaftar Sertifikat Di Terima

10 16 14
Jumlah Anggota Berdasarkan Club
Nama Club Jumlah Anggota Keterangan
Taft Diesel Indonesia Chapter Banten Raya 9
Indonesia Adventure Community (IAC) 4
Krakatau Steel Offroad 9
Babad Banten Adventure (BBA) 7
SEDULUR BANTEN 4X4 4
MONTELA OFFROAD 6
BAJA OFFROAD 15
CAT Kota Baja 4
BELANTARA OFFROAD 5
GMB PRENGUS 3
Badak Adventure Community (BAC) 7
Suzuki Jip Adventure (SJA) 5
SKIN Banten 1
Crazy Sam's Motorsport Offroad Club 8
Paguyuban Landrover Banten (PLRB) 0
KIA Sportage Satu (KSS) 0
Total Jumlah Anggota 87
No Email Nama Lengkap (sesuai KTP) Nama Panggilan Tempat Lahir Tgl Lahir Bln Lahir Thn Lahir Sex Gol. Darah Alamat Lengkap Provinsi Kota/Kabupaten Kecamatan K. Pos NO HP/ WA No. KTP No. SIM Jabatan PP IOF (1822) No. KTA IOF (apabila ada) Pengda Pengcab Nama Klub No Registrasi Klub Facebook Instagram Foto KTP Foto Pribadi Status Pembayaran Data to PP KTA Progress Nomor KTA Masa Berlaku KTA Nomor Keterangan
1 iwan_darmawan80@ymail.com Iwan Darmawan, SE Lebak 21 9 1980 1 A JL. RASAMALA NO.5 KOMPLEK PEMDA CIJOROPASIR, Rangkasbitung 11 42316 081210052420 3602142109800004 11 155 SEDULUR BANTEN 4X4 Lunas Submitted Received by PENGDA 11.01.01.001 09/2019 1925011155000525
2 budiprogs@yahoo.co.id Budi Santoso AP,M.Si Nganjuk 20 7 1975 1 B KP. DALEUM PASIR RT/RW 01/02 KADUAGUNG TIMUR, kec. Cibadak. Lebak 11 42317 081297172717 3602182007750002 11 155 SEDULUR BANTEN 4X4 Lunas Submitted Received by PENGDA 11.01.01.002 09/2019 1918011155000615
3 zidanealhafizh12@gmail.com Muhammad Zidane Al Hafizh Lebak 1 6 2002 1 B KP. DALEUM PASIR RT/RW 01/02 KADUAGUNG TIMUR, kec. Cibadak. Lebak 11 42317 081213333704 3602180106020001 11 155 SEDULUR BANTEN 4X4 Lunas Submitted Received by PENGDA 11.01.01.003 09/2019
4 iwan_rgblighting@yahoo.com Iwan Maryana, S.I.Kom Lebak 18 12 1986 1 B KP. CIPANCAR RT/RW 01/03 DESA SANGKANMANIK. KEC. CIMARGA. LEBAK 11 42361 085777751987 3602111812860001 11 155 SEDULUR BANTEN 4X4 Submitted Received by PENGDA 11.01.01.004 09/2019
5 montelaoffroad@gmail.com H. Andi Dian Putra Padang 18 7 1977 1 B Komp. PCI Blok E 19 No. 33 Desa Kedaleman. Kel Cibeber, Cilegon 11 42423 087718071977 3672011807770004 11 159 MONTELA OFFROAD Lunas Submitted Received by Member 11.05.08.001 09/2019 19250111590000526
6 rivo.putra1985@gmail.com Rivo Putra Padang 17 8 1985 1 B Perum Bumi Cibeber Kencana Blok E 13 No.1. Cilegon 11 42423 085218080546 3216071708850015 11 159 MONTELA OFFROAD Lunas Submitted Received by Member 11.05.08.002 09/2019 1918011159000616
7 pt.kurniabintangmandiri@gmail.com H. David Kurnia Padang 18 1 1981 1 AB Mutiara Gading Timur Blok M3 No 28 Bekasi 12 17158 081285038111 7310061801810002 11 159 MONTELA OFFROAD Lunas Submitted Received by Member 11.05.08.003 09/2019 1918011159000617
8 Koriiwan@gmail.com Maidir Wandarma Padang 10 6 1972 1 O Jl. Kebagusan III Pasar Minggu Jakarta Selatan 13 12520 081311222948 3174041006720004 11 159 MONTELA OFFROAD Lunas Submitted Received by Member 11.05.08.004 09/2019 1918011159000618
9 sofian@apindoms.com Sofian Curup 1 12 1972 1 B BBS III Blok A-1 No. 02 Kel. Ciwaduk. Cilegon 11 42415 081932323535 3672020112720002 11 159 MONTELA OFFROAD Lunas Submitted Received by Member 11.05.08.005 09/2019 1918011159000619
10 adagsar@gmail.com Adang Sutadi Bandung 2 12 1974 1 O Komp PCI Blok D 113 No. 12 Cilegon 11 42423 081297369287 3672010212740001 11 159 MONTELA OFFROAD Lunas Submitted Received by Member 11.05.08.006 09/2019 191811159000620
11 nanangrohimat06@gmail.com Nanang Rohimat Banjar 4 7 1968 1 B Komp. TWI FWA 135 no 03 RT 001/007 Citangkil, Cilegon 11 42443 081315460901 3672080407680003 11 159 BAJA OFFROAD Submitted Received by Member 11.03.01.010 09/2019
12 saikuls@yahoo.com Muhammad Syaikhul Islam Jakarta 10 9 1978 1 A Pinang Griya Permai. Jalan Cenderawasih Raya C:59. Pinang Tangerang 15145 12 15145 08568811000 3671111009780001 11 159 BAJA OFFROAD Lunas Submitted Received by Member 11.03.01.011 09/2019 1925011161000528
13 triasmale1979@gmail.com Trias Priambodo Jakarta 27 4 1979 1 O Duta Bintaro Ubud 1 Blok G2 No.2 RT 001 RW 011 Kel. Kunciran Kec. Pinang 13 14144 085710123458 3671112704790002 11 159 BAJA OFFROAD Lunas Submitted Received by PENGDA 11.03.01.012 09/2019 1925011162000529
14 lmx125kampret@gmail.com Sulaeman Tangerang 14 4 1982 1 O Kp. Lengkong Gudang RT 004/004 Kel. Lengkong Gudang. Kec. Serpong Tangerang 12 15321 087771245858 3674012404820007 11 159 BAJA OFFROAD Lunas Submitted Received by PENGDA 11.03.01.013 09/2019 1925011162000530
15 wibawa.n.utama@gmail.com Moch. Ridwan Serang 22 12 1978 1 B Jl. Arga Salak Blok D6 No. 10 RT 013/004 Kel. Kotasari Cilegon 11 42436 085211101111 3672062212780001 11 159 BAJA OFFROAD Submitted Received by Member 11.03.01.014 09/2019 1925011159000531
16 alen.suryotomo@gmail.com Alen Suryotomo Kotabumi 2 12 1987 1 A Perum persada banten, block TE4, no12a, Banten 11 42183 081293565658 1803090212870000 11 159 Taft Diesel Indonesia Chapter Banten Raya Lunas Submitted Received by Member 11.05.07.001 09/2019 1925011159000541
17 dimas.adisaputra92@gmail.com Dimas Adi Saputra Lebak 14 11 1994 1 O Rt 02 Rw 10 Rangkasbitung Timur Kab. Lebak Banten 11 42313 087775183732 3602141411940000 11 159 Taft Diesel Indonesia Chapter Banten Raya Lunas Submitted Received by Member 11.05.07.002 09/2019 1925011159000542
18 abankcuuex@gmail.com Edi Sutiadi Serang 24 8 1971 1 O Jl. Raya Pandeglang Km. 4 05/03 Lingk. Karundang Cipager Banten 11 42125 087871234588 3604022408710890 11 159 Taft Diesel Indonesia Chapter Banten Raya Lunas Submitted Received by Member 11.05.07.003 09/2019 1925011159000543
19 ekojokosugiarto@gmail.com Ir. Eko Joko Sugiarto Merak 1 3 1973 1 A Link. Gerem Raya No. 01, BANTEN 11 42438 08164618888 3672060103730006 11 159 Taft Diesel Indonesia Chapter Banten Raya Lunas Submitted Received by Member 11.05.07.004 09/2019 1925011159000544
20 tdibantenraya@gmail.com Fadli Afrialdhi Firmansyah Jakarta 12 4 1993 1 A+ Perumahan Permata Safira Regency Blok B2 No.1 RT13/RW06 Serang Banten 42162 11 42162 082312112234 3603281204930000 11 159 Taft Diesel Indonesia Chapter Banten Raya Lunas Submitted Received by Member 11.05.07.005 09/2019 1925011159000545
21 edisantosoe@yahoo.com Edi Santoso Surakarta 27 12 1972 1 O Link Lebak Indah Rt/Rw 002/009 Banten 11 0813118303103 3672032712730001 11 159 Indonesia Adventure Community (IAC) Lunas Submitted Received by Member 11.05.04.001 09/2019 1925011159000546
22 djoko.suyanto64@gmail.com Djoko Suyanto Banjarmasin 19 3 1964 1 A Perum BCK Blok C 02 No 21 Rt/Rw 04/10 11 081314194054 3672011903640001 11 159 Indonesia Adventure Community (IAC) Lunas Submitted Received by Member 11.05.04.002 09/2019 1925011159000547
23 aridwiheryanto@gmail.com Ari Dwi Heryanto Ujung padang 5 1 1971 1 O Jl. Puri 1 Blok A II No 17 Kota bengkulu 11 081290314642 1771050501710001 11 159 Indonesia Adventure Community (IAC) Lunas Submitted Received by PENGDA 11.05.04.003 09/2019
24 Agustanita@gmail.com Agus Tani Serang 17 8 1971 1 A Link sumur jaya Rt/Rw 004/006 11 082121414503 3672031708710002 11 159 Indonesia Adventure Community (IAC) Lunas Submitted Received by PENGDA 11.05.04.004 09/2019
25 ariefbudiyanto.354@gmail.com Arief Budiyanto Musi Rawas 7 7 1989 1 B Jl Besi III No 10 Komplek Krakatau Steel, Cilegon 11 087834685935 3374040707890000 11 159 Krakatau Steel Offroad Lunas Submitted Received by Member 11.05.03.001 09/2019
26 andritoc@gmail.com Andri Karang Anyar 7 6 1985 1 O Jl Warna sari No 27 Komplek Krakatau Steel 11 081931387326 327305206850005 11 159 Krakatau Steel Offroad Lunas Submitted Received by Member 11.05.03.002 09/2019
27 yacub_h@yahoo.com Yakub Haliq Jambi 22 12 1969 1 B Jl Baja III No 14 Komplek Krakatau Steel Cilegon 11 0818178618 367202212690004 11 159 Krakatau Steel Offroad Lunas Submitted Received by Member 11.05.03.003 09/2019
28 edwin.sumiroza@gmail.com Edwin Sumiroza Sukabumi 23 7 1969 1 O BBS III Blok A No 18 Ciwaduk, Cilegon 11 087771300730 367202230769001 11 159 Krakatau Steel Offroad Lunas Submitted Received by PENGDA 11.05.03.004 09/2019
29 muhammad.pangerang@gmail.comMuhammmad Pangerang Palembang 6 11 1986 1 B Perum Bumi Cibeber Kencana Bok D 19 No 8 11 08111218206 3604010511860050 11 159 Krakatau Steel Offroad Lunas Submitted Received by PENGDA 11.05.03.005 09/2019
30 iketuttruastika@gmail.com I Ketut Truastika Bali 16 9 1959 1 B Komplek LBS Blok F No 6 Tegal Cabe, Cilegon 11 081310180410 3672071609590000 11 159 Krakatau Steel Offroad Lunas Submitted Received by PENGDA 11.05.03.006 09/2019
31 sugiarto.bambang1807@gmail.comBambang Sugiarto Surabaya 5 2 1961 1 A Jl. Baja III/5 Komplek Krakatau Steel Cilegon 11 0811126499 3672070502610000 11 159 Krakatau Steel Offroad Lunas Submitted Received by PENGDA 11.05.03.007 09/2019
32 nana.teknikmandiri@gmail.com Rasikun Ciamis 15 1 1961 1 B Komplek BPP Blok G 6/01, Pelamunan, Serang 11 085105559697 3604051501610001 11 159 Babad Banten Adventure (BBA) Lunas Submitted Received by Member 11.05.05.005 09/2019
33 cakrapmumpusinga@gmail.com Cakra Purnarekha Muranai ST Cilegon 29 8 1985 1 O Jl. Nusa indah No. 45 RT/RW 017/005 Kel. Ciwedus Kec. Cilegon,Kota Cilegon Banten 11 08176561376 3672022908850000 11 159 Suzuki Jip Adventure (SJA) Submitted 11.05.01.001 06/2019
34 Deny Den indrawireja Purwakarta 5 7 1975 1 O Metro Cendana M17/1F RT/RT 001009 Kel kebon dalem, Kec Purwakarta Kota Cilegon Banten 11 081295712145 3672070507750000 11 159 Suzuki Jip Adventure (SJA) Submitted 11.05.01.002 06/2019
35 ferrypermatagemilang@yahoo.co.idFerry Iman Cahyadi Serang 9 2 1972 1 O Komp makmur jaya RT/RW 002/009 Kel. Drangong Kec Taktakan,Kota Serang Provinsi Bantenn 11 081906399900 3604040902720270 11 159 Suzuki Jip Adventure (SJA) Submitted 11.05.01.003 06/2019
36 rangga.widoo123@gmail.com Rangga Saputra Widodo Serang 17 4 1984 1 AB Kp. Cipete langgar RT/RW 008/004 Kel sukalaksana Kec Curug,Kota serang banten 11 087877000434 3673041704840000 11 159 Suzuki Jip Adventure (SJA) Submitted 11.05.01.004 06/2019
37 gusdoughter@yahoo.co.id Whendi Trivicta Serang 20 6 1979 1 O Jl. Simpang tiga no 4 RT/RW 002/001 Kel ramanuju,kecamatan purwakarta kota cilegon banten 11 081807573498 3672072006790000 11 159 Suzuki Jip Adventure (SJA) Submitted 11.05.01.005 06/2019
38 suklast@gmail.com Nugroho Suklastowo, SH Semarang 18 12 1961 1 O Kp. CIBARU RT: 010/04 Desa Cikonengkecamatan ANYAR 081220222447 360430181261001 11 159 BAJA OFFROAD Lunas Submitted Received by Member 11.03.01.002 06/2019 1918011159000626
39 atoflashmaker@yahoo.co.id Muhammad Ato Cilegon 13 2 1968 1 O Pci Blok D-12 No. 11 Rt/Rw : 001/007,Kelurahan Kedaleman, Kecamatan Cibeber, Cilegon 11 0817897607 3672051302680000 11 159 BAJA OFFROAD Lunas Submitted Received by Member 11.03.01.001 06/2019 1918011159000627
40 irfanbanten2017@gmail.com Irfan, ST, M.Si Cilegon 14 3 1974 1 B Jl. Flamboyan Indah No. 4 Temuputih,Rt/Rw 002/002 081315800134 3672021403740000 11 159 BAJA OFFROAD Lunas Submitted Received by Member 11.03.01.003 06/2019
41 safullah.asep@gmail.com Asep Saefulloh Serang 22 2 1978 1 AB Jl. R. Suprapto No. 25 Rt/Rw 008/004,Kel. Ramanuju, Kec. Purwakarta 087777810222 3672072202780000 11 159 BAJA OFFROAD Lunas Submitted Received by Member 11.03.01.004 06/2019 1918011159000629
42 yayan_eman@yahoo.com Yayan Eman Aprii yandi Serang 21 4 1985 1 O Link. Sambimanis No. 20 Rt/Rw : 003/005,Kel. Citangkil, Kec. Citangkil 085959938483 3672082104850000 11 159 BAJA OFFROAD Lunas Submitted Received by PENGDA 11.03.01.006 06/2019 1.91801E+15
43 rizalarif.clg@gmail.com Rizal Arif Baihaqi Jakarta 25 9 1987 1 B Bmi Blok A9, No. 11, Rt/Rw : 004/009,Kel. Serang, Kec. Serang 11 089678943467 3602242510870000 11 159 BAJA OFFROAD Lunas Submitted Received by PENGDA 11.03.01.007 06/2019 1918011159000631
44 saipulb755@gmail.com Saepul Bahri Serang 24 9 1998 1 O Kp. Cigodag, Jangkaran, Rt/Rw : 003/001 0895324141733 3604052410980000 11 159 BAJA OFFROAD Lunas Submitted Received by Member 11.03.01.008 06/2019 1918011159000632
45 jakapermana930@gmail.com Jaka Permana Lebak 12 12 1971 1 O Kp. Cigodag, Jangkaran Rt/Rw : 003/001 081311601706 3604051212710000 11 159 BAJA OFFROAD Lunas Submitted Received by Member 11.03.01.009 06/2019 1918011159000633
46 adeasnawi2@gmail.com H. Ade Asnawi Pandeglang 12 1 1972 1 A Kp Calingcing Rt/Rw 001/002 Kel/Desa Citeureup,Kec. Labuan Kab Pandeglang Banten 11 08176625399 360106017660082 11 159 Badak Adventure Community (BAC) Lunas Submitted Received by Member 11.02.01.001 06/2019 1918011159000634
47 gemilangbantenjaya@gmail.com H.Wahyudin Wahab, SH Pandeglang 6 5 1967 1 O Kp Jaha Masjjid Rt/Rw 010/003 Kel/Desa Sukamaju,Kec. Labuan Kab. Pandeglang Banten 11 087772218636 3601121905680000 11 159 Badak Adventure Community (BAC) Lunas Submitted Received by Member 11.02.01.002 06/2019 1918011159000635
48 rafka.maula@gmail.com Fajar Maula Pandeglang 26 1 1986 1 A Kp. Cililin Rt/Rw 006/003 Kel/Desa Kadudampit Kec. Saketi,Pandeglang Banten 11 087773456806 3601250107860000 11 159 Badak Adventure Community (BAC) Lunas Submitted Received by Member 11.02.01.003 06/2019 1918011159000636
49 alseman09@gmail.com Supriatman Sukabumi 5 1 1970 1 O Kp. Kebonmaju 001/001 Desa Parigi Kec. Saketi,Kabupaten Pandeglang Banten 11 081211109970 3601140501700000 11 159 Badak Adventure Community (BAC) Lunas Submitted Received by Member 11.02.01.004 06/2019 1918011159000637
50 akijihan03@gmail.com Suratman Lampung 3 6 1964 1 A Komp Bpi Blok E.1 No 11 Rt/Rw 005/006 Desa/Kel Sukasari,Kec. Kaduhejo Kab. Pandeglang Banten 11 082298530974 3601190307640000 11 159 Badak Adventure Community (BAC) Lunas Submitted Received by Member 11.02.01.005 06/2019 1918011159000638
51 hidayat.jajat@gmail.com Jajat Hidayat Pandeglang 7 6 1977 1 AB Komp. Bpi Blok 1.2 No 06 Rt/Rw 003.006 Kel.Desa Sukasari,Kec. Kaduhejo Kab. Pandeglang Banten 11 087773126777 3601190707770002 11 159 Badak Adventure Community (BAC) Lunas Submitted Received by Member 11.02.01.006 06/2019 1918011159000639
52 davidalexanderp2s@gmail.com David Alexander Pandang 18 10 1972 1 O Komplek TCI blok C3 No. 12, Sukmajaya, Jombang 3672051810720000 11 159 Babad Banten Adventure (BBA) Lunas Submitted Received by Member 11.05.05.001 06/2019 1.91801E+15
53 emansule940@gmail.com Eman Suleman Garut 6 9 1977 1 O Puri Krakatau Hijau clkuster Dream park Blok A10/14, Kotasari, Gerogol 11 3672060609770003 11 159 Babad Banten Adventure (BBA) Lunas Submitted Received by Member 11.05.05.002 06/2019 1918011159000641
54 agussoloban2@gmail.com Agus Hariyadi Wonogiri 3 10 1974 1 AB Link Kadipaten, RTRW 02/02, Kedaleman, Cibeber 11 3672010310740000 11 159 Babad Banten Adventure (BBA) Lunas Submitted Received by Member 11.05.05.003 06/2019 191811159000642
55 nanasukarnaiof@yahoo.com Nana Sukarna Bandung 28 4 1963 1 O Kampung Cibelut RT RW 01/01, Cibogo, Cisauk 11 3603232804630002 11 159 Babad Banten Adventure (BBA) Lunas Submitted Received by Member 11.05.05.004 06/2019 1918011159000643
56 sugalandy.75@gmail.com Agus Salim Palembang 24 8 1975 1 A JL. Letkol Endro Suratmin No. 179B LK.II Rt.007 Kec. Sukarame, Bandar Lampung 0813-79766666 1871022408750004 11 159 Crazy Sam's Motorsport Offroad Club Submitted Received by PENGDA 11.05.06.001 06/2019
57 Agus Subekti Tuban 14 8 1995 1 O Perum Villa Permata CB 10 No.63 Rt.002 Rw.012 ds. Jejalenjaya Kec. Tambun Utara, Tuban 0882-11288485 3523021408950001 11 159 Crazy Sam's Motorsport Offroad Club Submitted 11.05.06.002 06/2019
58 Insan5394@gmail.com Insan Kamil Kediri 6 12 1991 1 O Ds. Surowono Rt.002 Rw.017 Ds. Canggu Kec. Badas, Kediri 0856-3516277 3506260612910001 11 159 Crazy Sam's Motorsport Offroad Club Submitted 11.05.06.003 06/2019
59 masluqman.lq@gmail.com Luqman Hakim Tuban 13 5 1976 1 B Permata Bonang C 1/15 Rt.004 Rw.008 ds. Perbon Kec Tuban, Tuban 0821-11210111 3523161305760004 11 159 Crazy Sam's Motorsport Offroad Club Submitted 11.05.06.004 06/2019
60 marjani@ptskp.co.id Marjani Kediri 8 1 1969 1 O Ds. Surowono Rt.001 Rw.017 Ds. Canggu Kec. Badas, Kediri '0813-10553033 3506260801690001 11 159 Crazy Sam's Motorsport Offroad Club Submitted 11.05.06.005 06/2019
61 Rochani Tulung Agung 9 10 1959 1 O Kp. Sukakarya Rt.003 Rw.002 Kel. Anyar Kec. Anyar, Serang 0813-17240970 3604300910590001 11 159 Crazy Sam's Motorsport Offroad Club Submitted 11.05.06.006 06/2019
62 Yani Madyani Pandeglang 7 4 1994 1 O Kp. Kadu Salak Rt.004 Rw.002 Kel. Juhut Kec. Karang Tanjung, Pandeglang 11 0852-11984688 3601254107950055 11 159 Crazy Sam's Motorsport Offroad Club Submitted 11.05.06.007 06/2019
63 radjandraputra@gmail.com Yusuf Gerning 8 6 1990 1 O Gerning Rt.004 Rw.001 desa Gerning kec. Tegineneng Kab. Pesawaran, Lampung 0812-18518811 1809030806900005 11 159 Crazy Sam's Motorsport Offroad Club Submitted 11.05.06.008 06/2019
64 Prakitama.pradana@gmail.com H. CHAIRUS SALEH CILEGON 22 1 1978 1 O JL. Kakap No. 06 Kavling Blok C RT 004/006 Kel. Masigit Kec. Jombang 11 42414 085920001117 3672052201780001 11 159 CAT Kota Baja Lunas Submitted Received by Member 11.05.09.001 09/2019
65 deykeprakitama69@gmail.com Rifki Abdullah Tomohon 17 12 1969 1 O Link. Ciwaduk Gede No. 02 RT 006/003 Kel. Ciwaduk Cilegon 11 42421 08176581227 3672021712640001 11 159 CAT Kota Baja Lunas Submitted Received by Member 11.05.09.002 09/2019
66 triyono_cm@yahoo.com Triyono Klaten 12 11 1972 1 O Teloyo Kulon RT 001/001 kel. Teloyo kec wonosari 14 57473 087809713643 3672081211720005 11 159 CAT Kota Baja Lunas Submitted Received by Member 11.05.09.003 09/2019
67 zam_hui71@yahoo.com Partoyodi Singkawang 2 10 1971 1 O Jl. Pagebangan Link. Baru RT 001/008 Kel. Jombang Wetan. Kec Jombang 20 42411 081345279999 3672050210710000 11 159 CAT Kota Baja Lunas Submitted Received by Member 11.05.09.004 09/2019
68 ronny.g4g4k@gmail.com Ronny Rachmansyah Sn Bekasi 1 1 1987 1 A+ Jl. Piere Tendean Pegantungan No. 20 RT/RW 007/007 Kel. Jombang Wetan 12 42411 08170764947 3604060106870000 11 159 BELANTARA OFFROAD Lunas Submitted Received by Member 11.05.10.001 09/2019
69 rinjanikaryapersada_cv@yahoo.comRudi Nawawi Serang 3 8 1975 1 O Link. Kaligandu Bujang Baros RT/RW : 015/006 Kel. Purwakarta kec purwakarta, Cilegon 11 42437 081288354391 3672070308750001 11 159 BELANTARA OFFROAD Lunas Submitted Received by Member 11.05.10.002 09/2019
70 susantokharis@gmail.com Kharis Susanto Jambi 14 9 1987 1 O Gedong Cilegon Damai Blok S2 No. 05 RT.01 RW.06 KEL. KALITIMBANG 6 42426 08179190997 3672011409870000 11 159 BELANTARA OFFROAD Lunas Submitted Received by Member 11.05.10.003 09/2019
71 nugrohosilva87@gmail.com Yudha Nugroho, SE. Jakarta 16 8 1987 1 O Link. Ciwaduk Gede RT.06 RW.03 Kel. Ciwaduk 13 42415 081315708991 3604051608870000 11 159 BELANTARA OFFROAD Lunas Submitted Received by Member 11.05.10.004 09/2019
72 kholil140408@gmail.com Kholil Azmi Serang 10 7 1995 1 O Link. Cigading RT/RW 01/01 Kel. Tegal Ratu 11 42445 081284328582 3672041007940000 11 159 BELANTARA OFFROAD Lunas Submitted Received by Member 11.05.10.005 09/2019
73 gatotsusilo2199@gmail.com GATOT SUSILO LAMPUNG 5 5 1978 1 B KOMP BAP 1 BLOK T9 NO 4 RT 02 RW 023 KEL UNYUR SERANG 10 42111 081384013605 3604010505780960 11 159 BAJA OFFROAD Lunas Submitted Received by PENGDA 11.03.01.015 09/2019 1925011159000538
74 radjandraputra@gmail.com ISMAIL YUSUF, SH SUKARAJA 3 4 1977 1 O KP. RAWA BUAYA RT. 03/04 KEL. MEDANG KEC. PAGEDANGAN 11 15334 087775752098 3172060304770001 13 161 GMB PRENGUS Lunas Submitted Received by Member 13.04.09.001 09/2019 1925013161000539
75 tubaguswilldanbanten@gmail.com Wildan Hidayatullah LEBAK 8 4 1994 1 O Kp.Umbulan Rt.002/001 Ds.Mekaragung Kec. Cibadak 11 42357 087806704627 3602180804940003 13 161 GMB PRENGUS Submitted Received by PENGDA 13.04.09.002 09/2019 1925013161000540
76 ronitnb@yahoo.com Roni Syahrul Padang Panjang 16 6 1972 1 O Jl Karang Bolong II No 08 Bencongan Kelapa Dua, Tangerang 11 15811 081395778700 3603281606720000 11 159 Krakatau Steel Offroad Lunas Submitted Received by Member
77 agussetyawanbmw@gmail.com Agus Setiawan Madiun 12 9 1980 1 O Citra garden blok F1 no 3 Wanayasa kramatwatu 11 42161 081310069899 3604051209800002 11 159 Babad Banten Adventure (BBA) Lunas Submitted Received by Member 1918011159000625
78 Wahyu Rahardjo 081380998899 Need Correction
79 H. Anugerah Chaerullah Chaeron, SE 087888890333 Need Correction
80 robin.jkt@gmail.com Robin Need Correction
81 jonrebopaing@gmail.com Joni Damhudi Joni Jakarta 15 6 1967 1 A Jln shelo blok L 8 komp garuda 11 Tangerang kota Cipondoh 15142 081398792345 3173011506670026 6706120552215 11 159 Taft Diesel Indonesia Chapter Banten Raya 006 jonrebopaing jonrebopaing https://drive.google.com/open?id=1ov9b0VSngx_AJ3z2PwmLPgah7vH9EcHZ
https://drive.google.com/open?id=19J9Uf0ufYzokeD-7ql9fct6DqBw4bV1_
82 prayoga165@gmail.com Prayoga Prayoga Malang 23 5 1958 1 B Jl. Taman Lotus Merah No.05 RT/RW: 05/10 11 Cilegon Purwakarta 42433 081210979800 3672072305500001 162578836668 11 159 Krakatau Steel Offroad https://drive.google.com/open?id=1MrTuvb9aPQmOtmOzN9r2YvD_5ZnsDgUf Lunas
https://drive.google.com/open?id=1LLVdhZ3aAtK48IkqRKDDO2WtsFcOelth Submitted
83 inraja.ij@gmail.com Rindra.S Widi Malang 1 11 1968 1 O Jl. Arjuna No. 13 Kav. Blok E RT 15 RW 05 11 Cilegon Cilegon 42415 081911000125 3672020111690003 157385009465 11 159 BAJA OFFROAD arbni_ayajdneos https://drive.google.com/open?id=1Qn8smyXupgLvHE3-BMCQf9WAdhf9TZYA
https://drive.google.com/open?id=1Xh-95VIRrkt9mNeggEvftyrJonJF7Yxn
84 robin.jkt@gmail.com Robin Robin Medan 4 11 1978 1 O Kp. Blosong. RT/RW: 002/006. Serdang. Kramatwatu 11 Kabupaten Serang Serdang 08121058687 3604050411780001 11 159 Babad Banten Adventure (BBA) Lunas Submitted
85 Yendewiyulianti@gmail.com Yen Dewi Yulianti Yen Bandung 5 7 1975 0 A Teratai griya asri blok d5 no. 3 legok 11 Kabupaten TangerangLegok 15820 081287053757 3603204507750010 11 161 GMB PRENGUS https://drive.google.com/open?id=1LuMURWgEcr4CuxnPGQSn3uXwCyG0PMOL
https://drive.google.com/open?id=1KFgYfl5T3lp5WIhGj7GNbr1tZXZd8Z4z
Lunas Submitted
86 mulyadidion052@gmail.com Mulyadi Dion Lebak 21 12 1974 1 O Kp.Sukatani. Rt/RW: 002/001. Jelupangmulya. Leuwidamar. Lebak. Banten. 11 Kabupaten Lebak Leuwidamar 42362 085819678935 3602062112740001 11 161 SKIN Banten Lunas
87 mandiri171@gmail.com Suganda P Simanjuntak Rendi Jakarta 17 7 1971 1 O Jl batu mutiara no 5 Rt 004 Rw 10. Pulogadung. Jakarta Timur. DKI Jakarta. 11 Jakarta Timur Pulogadung 13210 082170994333 3175021707710004 11 159 Taft Diesel Indonesia Chapter Banten Raya https://drive.google.com/open?id=1Dbda6A1HO8QzMNBdDBzsHjnkbt8lmSy_ Lunas
https://drive.google.com/open?id=1shLrG8wRknr6AfInDGJyCawv1QZiEKCH
88 Kongsibaru76@gmail.com Uus suryana Yana Sukabumi 7 1 1975 1 AB Claster puri asri 2 blok b8 rt 004/03 kel.poris plawad utara kec.cipondoh kota tangerang 11 Kota Tangerang Cipondoh 15141 081222292477 3671110701750001 11 159 Taft Diesel Indonesia Chapter Banten Raya https://drive.google.com/open?id=1lyimV9NeWM4UW8SZrmkOA069d6O741sN Lunas
https://drive.google.com/open?id=1D4MieMJeyjP9aWmta-QeiZV9KpYJwnI4
89 hutri72@gmail.com Hutri agus setiawan Wawan Malang 18 8 1972 1 O Jl Dadang Suprapto no 18A Rt 01 RW 01 pasarbaru 11 Kota Tangerang Karawaci 15112 081717827270 3671071808720003 11 159 Taft Diesel Indonesia Chapter Banten Raya https://drive.google.com/open?id=1tj7N7oqClvEp1WZbb4EqdhSgSVcfZTDz Lunas
https://drive.google.com/open?id=1DyMSQt_w7nM9RxyYgYmxXqXwe8CJVhlB
90 alimubarok1310@gmail.com Ali Mubarok Ali Brebes 28 6 1984 1 A Puri Serpong cluster Chrysant blok ah 8 no 18 11 Kota Tangerang Selatan
Setu 15345 085223558591 3674062806840010 11 159 https://drive.google.com/open?id=1dd4M4p5VcZL084ladSbgTYK3DdBzTYUA Lunas
https://drive.google.com/open?id=1wgOA-iZeKr4EKZuSNUyF8Ypdqe4CvsYr
91 kuya.sheva@gmail.com Erin Fabiana Kuya Pandeglang 11 1 1981 1 B Taman Widya Asri Blok B3 No.6. RT/RW: 003/010. LontarBaru. Kota Serang.Banten 11 Kota Serang Serang 42115 0818154255 3673011102810004 11 159 Badak Adventure Community (BAC) Lunas
92
93
94
95
96
97
Daftar Nama Club Pengda Banten

Payment Status
No Club Name Email Club Certificate No Sertifikat Masa BerlakuSertifikat Note [2]
Pengda [3] PP [4]
1 Taft Diesel Indonesia Chapter Banten Raya tdibantenraya@gmail.com
2 Indonesia Adventure Community (IAC) edisantosoe@yahoo.com 11.05.04
3 Krakatau Steel Offroad yacub_h@yahoo.com
4 Babad Banten Adventure (BBA) nana.teknikmandiri@gmail.com 11.05.05 Sdh disetor ke pusat saat MUSDA
5 SEDULUR BANTEN 4X4 iwan_darmawan80@ymail.com
6 MONTELA OFFROAD montelaoffroad@gmail.com
7 BAJA OFFROAD bajamx.adv@gmail.com 11.03.01 Sdh disetor ke pusat saat MUSDA
8 CAT Kota Baja prakitama.pradana@gmail.com
9 BELANTARA OFFROAD rinjanikaryapersada_cv@yahoo.com
10 GMB PRENGUS singagmbprengus4x4@gmail.com Belum registrasi ulang (data klub dari pusat)
11 Badak Adventure Community (BAC) rafka.maula@gmail.com 11.02.01 Sdh disetor ke pusat saat MUSDA
12 Suzuki Jip Adventure (SJA) ferrypermatagemilang@yahoo.co.id 11.05.01 Sdh disetor ke pusat saat MUSDA
13 SKIN Banten 11.06.01 Data Anggota masih kosong
14 Crazy Sam's Motorsport Offroad Club sugalandy99@gmail.com 11.05.06
15 Paguyuban Landrover Banten (PLRB)
16 KIA Sportage Satu (KSS) Belum registrasi ulang (data klub dari pusat)
17
18
19
20
Jumlah KTA No Nama di KTP No KTA Masa Berlaku KTA KLUB 2
Suzuki Jip Adventure (SJA) 600
1 1 Cakra Purnarekha Muranai ST 11.05.01.001 06/23
2 2 Deny Den indrawireja 11.05.01.002 06/23
3 3 Ferry Iman Cahyadi 11.05.01.003 06/23
4 4 Rangga Saputra Widodo 11.05.01.004 06/23
5 5 Whendi Trivicta 11.05.01.005 06/23

Baja Offroad 600


6 1 Nugroho Suklastowo, SH 11.03.01.002 06/23 350
7 2 Muhammad Ato 11.03.01.001 06/23 350
8 3 Irfan, ST, M.Si 11.03.01.003 06/23 350
9 4 Asep Saefulloh 11.03.01.004 06/23 350
10 5 Yayan Eman Aprii yandi 11.03.01.006 06/23 350
11 6 Rizal Arif Baihaqi 11.03.01.007 06/23 350
12 7 Saepul Bahri 11.03.01.008 06/23 350
13 8 Jaka Permana 11.03.01.009 06/23 350

Badak Adventure Community (BAC) 600


14 1 H. Ade Asnawi 11.02.01.001 06/23 350
15 2 H.Wahyudin Wahab, SH 11.02.01.002 06/23 350
16 3 Fajar Maulna 11.02.01.003 06/23 350
17 4 Supriatman 11.02.01.004 06/23 350
18 5 Suratman 11.02.01.005 06/23 350
19 6 Jajat Hidayat 11.02.01.006 06/23 350

Klub Babad Banten Adventure (BBA) 350 600


20 1 David Alexander 11.05.05.001 06/23 350
21 2 Eman Suleman 11.05.05.002 06/23 350
22 3 Agus Hariyadi 11.05.05.003 06/23 350
23 4 Nana Sukarna 11.05.05.004 06/23 350
24 5 Rasikun 350
25 6 Agus Setiawan 350

Crazy Sam's Motorsport Offroad Club


26 1 Agus Salim 11.05.06.001 06/23
27 2 Agus Subekti 11.05.06.002 06/23
28 3 Insan Kamil 11.05.06.003 06/23
29 4 Luqman Hakim 11.05.06.004 06/23
30 5 Marjani 11.05.06.005 06/23
31 6 Rochani 11.05.06.006 06/23
32 7 Yani Madyani 11.05.06.007 06/23
33 8 Yusuf 11.05.06.008 06/23

TDI Banten Raya 600


34 1 Alen Suryotomo 350
35 2 Dimas Adi Saputra 350
36 3 Edi Sutiadi 350
37 4 Ir. Eko Joko Sugiarto 350
38 5 Fadli Afrialdhi Firmansyah 350

Indonesia Adventure Community (IAC) 600


39 1 Edi Santoso 350
40 2 Djoko Suyanto 350
41 3 Ari Dwi Heryanto 350
42 4 Agus Tani 350

Krakatau Steel Offroad 600


43 1 Arief Budiyanto 350
44 2 ANDRI 350
45 3 Yakub Haliq 350
46 4 Edwin Sumiroza 350
47 5 Muhammmad Pangerang 350
48 6 I Ketut Truastika 350
49 7 Bambang Sugiarto 350

CILEGON ADVENTURE TRAIL - KOTABAJA (CAT KOTABAJA) 600


50 1 H. CHAIRUS SALEH 350
51 2 Rifki Abdullah 350
52 3 Triyono 350
53 4 Partoyodi 350

SEDULUR BANTEN 4X4, 4X2 600


54 1 Iwan Darmawan, SE 350
55 2 BUDI SANTOSO, AP,M.Si 350
56 3 MUHAMMAD ZIDANE AL HAFIZH 350
57 4 IWAN MARYANA, S.I.Kom

MONTELA OFFROAD 600


58 1 H. Andi Dian Putra 350
59 2 Rivo Putra 350
60 3 H. David Kurnia 350
61 4 Maidir Wandarma 350
62 5 Sofian 350
63 6 Adang Sutadi 350

BAJA OFFROAD
64 1 Nanang Rohimat
65 2 Muhammad Syaikhul Islam 350
66 3 Trias Priambodo
67 4 Sulaeman
68 5 Moch. Ridwan
69 6 GATOT SUSILO 350
11.550.000 3.600.000

Belum bayar pendaftaran


Bayar Tunai lwt sekjen
Sdh disetor ke pusat saat MUSDA

BELANTARA OFFROAD
70 Ronny Rachmansyah Sn
71 Rudi Nawawi
72 Kharis Susanto
73 Yudha Nugroho, SE.
74 Kholil Azmi

GMB PRENGUS
75 ISMAIL YUSUF, SH
76 Wildan Hidayatullah
No. Tanggal Setor Jumlah Sertifikat Klub Di terima KTA Di terima
14 65
17/05/2019 2100000 300000 290000
17/05/2019 1650000 4200000 18850000
17/05/2019 4400000
18/05/2019 200000 Total 23050000
28 Agustus 2019 13990000
Total Setor 22340000

Klub 10 x 300000 3000000


19340000
KTA Anggota 66.68965517 Pembulatan anggaran untuk 67 KTA
KTA tercetak 31

KTA Yang di daftarkan 77


Nilai KTA yang di setorkan 290000
Total di setorkan untuk KTA 22330000

KTA Belum Lunas 59


Pembayaran KTA 290000
Total Hutang Anggota Terdaftar 17110000

Setor untuk KTA (77-59) 18


Pembayaran KTA 290000
5220000

KTA+KLUB 25330000
Tersetor 22340000
2990000
Tanda Terima KTA IOF Pengda Banten

No Nama Tanggal Terima Tanda Tangan Nomor


1 Iwan Darmawan, SE
2 H. Andi Dian Putra
3 Nanang Rohimat
4 Muhammad Syaikhul Islam
5 Trias Priambodo
6 Sulaeman
7 Moch. Ridwan
8 Alen Suryotomo
9 Dimas Adi Saputra
10 Edi Sutiadi
11 Ir. Eko Joko Sugiarto
12 Fadli Afrialdhi Firmansyah
13 Edi Santoso
14 Djoko Suyanto
15 Arief Budiyanto
16 Andri
17 Yakub Haliq
18 Edwin Sumiroza
19 Muhammmad Pangerang
20 I Ketut ruastika
21 Bambang Sugiarto
22 Rasikun
23 H. CHAIRUS SALEH
24 Ronny Rachmansyah Sn
25 Rudi Nawawi
26 Kharis Susanto
27 Yudha Nugroho, SE.
28 Kholil Azmi
29 GATOT SUSILO
30 ISMAIL YUSUF, SH
31 Wildan Hidayatullah
No Nama Tanggal Terima Tanda Tangan Nomor
32 Budi Santoso, AP, M.Si
33 Rivo Putra
34 H. David Kurnia
35 Maidir Wandarma
36 Sofian
37 Adang Sutadi
38 Rifki Abdullah
39 Triyono
40 Partoyodi
41 Roni Syahrul
42 Agus Setiawan
43 Nugroho Suklastowo, SH
44 Muhammad Ato
45 Irfan, ST, M.Si
46 Asep Saefulloh
47 Yayan Eman Apri yandi
48 Rizal Arif Baihaqi
49 Saepul Bahri
50 Jaka Permana
51 H. Ade Asnawi
52 H.Wahyudin Wahab, SH
53 Fajar Maula
54 Supriatman
55 Suratman
56 Jajat Hidayat
57 David Alexander
58 Eman Suleman
59 Agus Hariyadi
60 Nana Sukarna

No Nama Tanggal Terima Tanda Tangan Nomor


61 Agus Salim
62 Ari Dwi Heryanto
63 Agus Tani
64 Muhammad Zidane Al Hafizh
65 Iwan Maryana, S.I.Kom
[1] Telah mendapatkan Nomor KTA IOF

[2] Di Bayar / Transfer ke ? tanggal?

[3] Status pembayaran Ke Pengda

[4] Status Pembayaran Ke PP