Daftar Peserta — ICC Platform

Account Info

Email Address *

Password *

Personal Info

Full Name *

Japanese Name (Katakana) *

NIK Number *

Passport Number

Phone / WhatsApp *

Gender *

Place of Birth *

Date of Birth *

Religion *

Last Education *

Previous training? *

Marital Status

Address

Province *

City / Regency *

District *

Village *

Postal Code

Full Address *

Physical & Health

Height (cm) *

Weight (kg) *

Blood Type *

Dominant Hand *

Shirt Size *

Waist Size (cm) *

Shoe Size *

Left Eye Vision *

Right Eye Vision *

Family Data

Must fill at least 2 family members (e.g. Father & Mother).

Work History in Indonesia

Optional — leave empty if you have not worked in Indonesia.

Work History in Japan

Optional — fill if you have worked or are working in Japan.