Lampiran III

Formulir A

DATA DASAR GUGUSDEPAN

Nama Gudep: ............................................................ No Gudep: .............  (diisi oleh Kwarcab)

Alamat Gudep: .....................................................................................................................

....................................................................................................  Kode Pos:   .....................

Tel: .................................................................................  Fax:  ...........................................

 

Nama Pembina Gudep: ........................................................................................................

Pekerjaan: .............................................................................................................................

Alamat Pembina Gudep: ......................................................................................................

....................................................................................................  Kode Pos:   .....................

Tel: .................................................................................  Fax:  ...........................................


Jumlah Satuan

Jumlah Kelompok

Jumlah Peserta

 

Jumlah Pembina

Jumlah Pembantu Pembina

Jumlah

 

Perindukan Siaga

 

Barung

 

 

 

 

 

 

Pasukan Penggalang

 

Regu

 

 

 

 

 

 

Ambalan Penegak

 

Sangga

 

 

 

 

 

 

Racana  Pandega

 

 

 

 

 

 

 

 

 

 

Jumlah

 

 

 

 

 

 

Lain-lain Keterangan : ...............................................................................................................................................

................................................................................................................................................

................................................................................................................................................

===============================================================

Mengetahui:                                                                         Diisi di:

Tanggal:                                                                               Tanggal:

Instansi:                                                                                Permbina Gudep:

Nama Jelas:                                                                          Nama Jelas:       

 

Lampiran III Formulir A :  Registrasi bagi Gugusdepan Baru

Lampiran III

Formulir B

 

REGISTRASI GUDEP TAHUN 200..

KWARCAB:   ...........................................................................  Nomor Kwarcab: .............

Nama Gudep:   ..........................................................................  Nomor Gudep:  ................

Alamat Gudep:  .....................................................................................................................

....................................................................................................  Kode Pos:   .....................

Tel: .................................................................................  Fax:  ...........................................

 

Nama Pembina Gudep:  .......................................................................................................

Pekerjaan: .............................................................................................................................

Alamat Pembina Gudep: ......................................................................................................

....................................................................................................  Kode Pos:   .....................

Tel: .................................................................................  Fax:  ...........................................

No

Pramuka

 

Pembina Pramuka

Pembantu Pembina

Jumlah Pembina

Golongan

Jumlah

 

1

Siaga

 

 

 

 

 

2

Penggalang

 

 

 

 

 

3

Penegak

 

 

 

 

 

4

Pandega

 

 

 

 

 

Jumlah :

 

 

 

 

 

 

Lain-lain Keterangan   ……………………................................................................................................................

................................................................................................................................................

................................................................................................................................................

................................................................................................................................................

===============================================================

 Diisi di:

 Tanggal:

 Permbina Gudep:

 Nama Jelas :

 

 

 

Lampiran III Formulir B :  Registrasi bagi Gugusdepan yang telah ada (pemutakhiran)