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No	No Pengajuan	Nama Bank	KC/KP	No KTP	No Telepon	Gender	No Peserta	Nama Peserta	Tgl. Lahir	Usia	TB	BB	Mulai Asuransi	Akhir Asuransi	Masa Asuransi	Nilai Manfaat Asuransi	Dana Tabarru	Dana Ujrah	Kontribusi	Extra Mortality	Extra Kontribusi	Total Kontribusi	Tgl Stnc	UL	Ket