<style type="text/css">
	table.disdukcapil {
		font-size: 10pt;
		width: 100%;
		/*border-collapse: collapse;*/
	}

	table.disdukcapil td {
		padding: 1px 1px 1px 3px;
	}

	table.disdukcapil td.satu {
		width: 10px;
		text-align: center;
	}

	table.disdukcapil td.padat {
		padding: 0px;
		margin: 0px;
		font-size: 9.5pt;
	}

	table.disdukcapil td.kotak {
		border: solid 1px #000000;
	}

	table.disdukcapil td.kanan {
		text-align: right;
	}

	table.disdukcapil td.tengah {
		text-align: center;
	}

	table.pengikut {
		font-size: 10pt;
		margin-top: 25px;
		border-collapse: collapse;
		border: solid 1px black;
		width: 100%;
	}

	table.pengikut td,
	th {
		border: solid 1px black;
		padding: 1px 1px 1px 3px;
	}

	table.pengikut th {
		text-align: center;
		vertical-align: middle;
	}

	table.pengikut td.tengah {
		text-align: center;
	}

	table.ttd {
		margin-top: 20px;
		width: 100%;
	}

	table.ttd td {
		text-align: center;
	}
</style>

<page orientation="portrait" format="210x330" style="font-size: 10pt">
	<table align="right" style="padding: 5px 20px; border: solid 1px black;">
		<tr>
			<td><strong><?= $input['kode_format'] ?></strong></td>
		</tr>
	</table>
	<table style="margin-top: 10px;" class="disdukcapil">
		<col style="width: 26%;">
		<col span="6" style="width: 4%;">
		<col style="width: 50%;">
		<tr>
			<td>PROVINSI</td>
			<td>:</td>
			<?php for ($i = 0; $i < 2; $i++) : ?>
				<td class="kotak tengah">
					<?php if (isset($config['kode_propinsi'][$i])) : ?>
						<?= $config['kode_propinsi'][$i]; ?>
					<?php else : ?>
						&nbsp;
					<?php endif; ?>
				</td>
			<?php endfor; ?>
			<td colspan=2>&nbsp;</td>
			<td class="kanan">*)</td>
			<td class="kotak"><?= $config['nama_propinsi']; ?></td>
		</tr>
		<tr>
			<td>KABUPATEN/KOTA</td>
			<td>:</td>
			<?php for ($i = 0; $i < 2; $i++) : ?>
				<td class="kotak tengah">
					<?php if (isset($config['kode_kabupaten'][$i])) : ?>
						<?= substr($config['kode_kabupaten'], 2, 4)[$i]; ?>
					<?php else : ?>
						&nbsp;
					<?php endif; ?>
				</td>
			<?php endfor; ?>
			<td colspan=2>&nbsp;</td>
			<td class="kanan">*)</td>
			<td class="kotak"><?= $config['nama_kabupaten']; ?></td>
		</tr>
		<tr>
			<td>KECAMATAN</td>
			<td>:</td>
			<?php for ($i = 0; $i < 2; $i++) : ?>
				<td class="kotak tengah">
					<?php if (isset($config['kode_kecamatan'][$i])) : ?>
						<?= substr($config['kode_kecamatan'], 4, 6)[$i]; ?>
					<?php else : ?>
						&nbsp;
					<?php endif; ?>
				</td>
			<?php endfor; ?>
			<td colspan=2>&nbsp;</td>
			<td class="kanan">*)</td>
			<td class="kotak"><?= $config['nama_kecamatan']; ?></td>
		</tr>
		<tr>
			<td>DESA/KELURAHAN</td>
			<td>:</td>
			<?php for ($i = 0; $i < 4; $i++) : ?>
				<td class="kotak tengah">
					<?php if (isset($config['kode_desa'][$i])) : ?>
						<?= substr($config['kode_desa'], 6, 10)[$i]; ?>
					<?php else : ?>
						&nbsp;
					<?php endif; ?>
				</td>
			<?php endfor; ?>
			<td class="kanan">*)</td>
			<td class="kotak"><?= $config['nama_desa']; ?></td>
		</tr>
		<tr>
			<td>DUSUN/DUKUH/KAMPUNG</td>
			<td>:</td>
			<td colspan=6 class="kotak"><?= $individu['dusun']; ?></td>
		</tr>
	</table>
	<p style="text-align: center;">
		<strong style="font-size: 12pt;">FORMULIR PERMOHONAN PINDAH WNI</strong><br>
		<?= $input['judul_format'] ?><br>
		No. .................................
	</p>

	<table class="disdukcapil">
		<col style="width: 3%;">
		<col style="width: 24.4%;">
		<col span="22" style="width: 3.3%">
		<tr>
			<td colspan=2><strong>DATA DAERAH ASAL</strong></td>
			<td colspan=22>&nbsp;</td>
		</tr>
		<tr>
			<td>1.</td>
			<td>Nomor Kartu Keluarga</td>
			<?php for ($i = 0; $i < 16; $i++) : ?>
				<td class="kotak satu">
					<?php if (isset($individu['no_kk'][$i])) : ?>
						<?= $individu['no_kk'][$i]; ?>
					<?php else : ?>
						&nbsp;
					<?php endif; ?>
				</td>
			<?php endfor; ?>
			<td colspan=6>&nbsp;</td>
		</tr>
		<tr>
			<td>2.</td>
			<td>Nama Kepala Keluarga</td>
			<td colspan=22 class="kotak"><?= $individu['kepala_kk']; ?></td>
		</tr>
		<tr>
			<td>3.</td>
			<td>Alamat</td>
			<td colspan=12 class="kotak"><?= $individu['alamat']; ?></td>
			<td colspan=2 style="text-align: center;">RT</td>
			<?php for ($i = 0; $i < 3; $i++) : ?>
				<td class="kotak satu">
					<?php if (isset($individu['rt'][$i])) : ?>
						<?= $individu['rt'][$i]; ?>
					<?php else : ?>
						&nbsp;
					<?php endif; ?>
				</td>
			<?php endfor; ?>
			<td colspan=2 style="text-align: center;">RW</td>
			<?php for ($i = 0; $i < 3; $i++) : ?>
				<td class="kotak satu">
					<?php if (isset($individu['rw'][$i])) : ?>
						<?= $individu['rw'][$i]; ?>
					<?php else : ?>
						&nbsp;
					<?php endif; ?>
				</td>
			<?php endfor; ?>
		</tr>

		<tr>
			<td colspan=2>&nbsp;</td>
			<td colspan=7>Dusun/Dukuh/Kampung</td>
			<td colspan=15 class="kotak"><?= $individu['dusun']; ?></td>
		</tr>

		<tr>
			<td>&nbsp;</td>
			<td>a. Desa/Kelurahan</td>
			<td colspan=8 class="kotak"><?= $config['nama_desa']; ?></td>
			<td colspan=4>c. Kab/Kota</td>
			<td colspan=10 class="kotak"><?= $config['nama_kabupaten']; ?></td>
		</tr>

		<tr>
			<td>&nbsp;</td>
			<td>b. Kecamatan</td>
			<td colspan=8 class="kotak"><?= $config['nama_kecamatan']; ?></td>
			<td colspan=4>d. Provinsi</td>
			<td colspan=10 class="kotak"><?= $config['nama_propinsi']; ?></td>
		</tr>

		<tr>
			<td colspan=2>&nbsp;</td>
			<td colspan=3>Kode Pos</td>
			<?php for ($i = 0; $i < 5; $i++) : ?>
				<td class="kotak satu">
					<?php if (isset($config['kode_pos'][$i])) : ?>
						<?= $config['kode_pos'][$i]; ?>
					<?php else : ?>
						&nbsp;
					<?php endif; ?>
				</td>
			<?php endfor; ?>
			<td colspan=2 style="padding-left: -2px;">Telepon</td>
			<?php for ($i = 0; $i < 12; $i++) : ?>
				<td class="kotak satu">
					<?php if (isset($input['telepon'][$i])) : ?>
						<?= trim($input['telepon'][$i]); ?>
					<?php else : ?>
						&nbsp;
					<?php endif; ?>
				</td>
			<?php endfor; ?>
		</tr>

		<tr>
			<td>4.</td>
			<td>NIK Pemohon</td>
			<?php for ($i = 0; $i < 16; $i++) : ?>
				<td class="kotak satu">
					<?php if (isset($individu['nik'][$i])) : ?>
						<?= $individu['nik'][$i]; ?>
					<?php else : ?>
						&nbsp;
					<?php endif; ?>
				</td>
			<?php endfor; ?>
			<td colspan=6>&nbsp;</td>
		</tr>

		<tr>
			<td>5.</td>
			<td>Nama Lengkap</td>
			<td colspan=22 class="kotak"><?= $individu['nama']; ?></td>
		</tr>
		<tr>
			<td colspan=24>&nbsp;</td>
		</tr>
		<tr>
			<td colspan=2><strong>DATA KEPINDAHAN</strong></td>
			<td colspan=22>&nbsp;</td>
		</tr>

		<tr>
			<td rowspan="2">1.</td>
			<td rowspan="2">Alasan Pindah</td>
			<td rowspan="2" class="kotak satu"><?= trim($input['alasan_pindah_id'], "'"); ?></td>
			<td rowspan="2">&nbsp;</td>
			<td colspan=4 class="padat">1. Pekerjaan</td>
			<td colspan=4 class="padat">3. Keamanan</td>
			<td colspan=4 class="padat">5. Perumahan</td>
			<td colspan=8 class="padat">7. Lainnya (sebutkan)</td>
		</tr>

		<tr>
			<td colspan=4 class="padat">2. Pendidikan</td>
			<td colspan=4 class="padat">4. Kesehatan</td>
			<td colspan=4 class="padat">6. Keluarga</td>
			<td colspan=8 class="padat">
				<?php if ($input['sebut_alasan']) : ?>
					<span style='text-decoration: none; border-bottom: 1px dotted black;'><?= $input['sebut_alasan']; ?></span>
				<?php else : ?>
					..............................
				<?php endif; ?>
			</td>
		</tr>

		<tr>
			<td>2.</td>
			<td>Alamat Tujuan Pindah</td>
			<td colspan=12 class="kotak"><?= $input['alamat_tujuan']; ?></td>
			<td colspan=2 style="text-align: center;">RT</td>
			<?php for ($i = 0; $i < 3; $i++) : ?>
				<td class="kotak satu">
					<?php if (isset($input['rt_tujuan'][$i])) : ?>
						<?= $input['rt_tujuan'][$i]; ?>
					<?php else : ?>
						&nbsp;
					<?php endif; ?>
				</td>
			<?php endfor; ?>
			<td colspan=2 style="text-align: center;">RW</td>
			<?php for ($i = 0; $i < 3; $i++) : ?>
				<td class="kotak satu">
					<?php if (isset($input['rw_tujuan'][$i])) : ?>
						<?= $input['rw_tujuan'][$i]; ?>
					<?php else : ?>
						&nbsp;
					<?php endif; ?>
				</td>
			<?php endfor; ?>
		</tr>

		<tr>
			<td colspan=2>&nbsp;</td>
			<td colspan=7>Dusun/Dukuh/Kampung</td>
			<td colspan=15 class="kotak"><?= $input['dusun_tujuan']; ?></td>
		</tr>

		<tr>
			<td>&nbsp;</td>
			<td>a. Desa/Kelurahan</td>
			<td colspan=8 class="kotak"><?= $input['desa_tujuan']; ?></td>
			<td colspan=4>c. Kab/Kota</td>
			<td colspan=10 class="kotak"><?= $input['kabupaten_tujuan']; ?></td>
		</tr>
		<tr>
			<td>&nbsp;</td>
			<td>b. Kecamatan</td>
			<td colspan=8 class="kotak"><?= $input['kecamatan_tujuan']; ?></td>
			<td colspan=4>d. Provinsi</td>
			<td colspan=10 class="kotak"><?= $input['provinsi_tujuan']; ?></td>
		</tr>
		<tr>
			<td colspan=2>&nbsp;</td>
			<td colspan=3>Kode Pos</td>
			<?php for ($i = 0; $i < 5; $i++) : ?>
				<td class="kotak satu">
					<?php if (isset($input['kode_pos_tujuan'][$i])) : ?>
						<?= $input['kode_pos_tujuan'][$i]; ?>
					<?php else : ?>
						&nbsp;
					<?php endif; ?>
				</td>
			<?php endfor; ?>
			<td colspan=2 style="padding-left: -2px;">Telepon</td>
			<?php for ($i = 0; $i < 12; $i++) : ?>
				<td class="kotak satu">
					<?php if (isset($input['telepon_tujuan'][$i])) : ?>
						<?= trim($input['telepon_tujuan'][$i]); ?>
					<?php else : ?>
						&nbsp;
					<?php endif; ?>
				</td>
			<?php endfor; ?>
		</tr>

		<tr>
			<td rowspan="2">3.</td>
			<td rowspan="2">Jenis Kepindahan</td>
			<td rowspan="2" class="kotak satu"><?= trim($input['jenis_kepindahan_id'], "'"); ?></td>
			<td colspan=11 class="padat">1. Kep. Keluarga</td>
			<td colspan=10 class="padat">3. Kep. Keluarga dan Sbg. Angg. Keluarga</td>
		</tr>
		<tr>
			<td colspan=11 class="padat">2. Kep. Keluarga dan Seluruh Angg. Keluarga</td>
			<td colspan=10 class="padat">4. Angg. Keluarga</td>
		</tr>

		<tr>
			<td>4.</td>
			<td>Status KK Bagi Yang Tidak Pindah</td>
			<td class="kotak satu"><?= ($input['status_kk_tidak_pindah_id']) ? $input['status_kk_tidak_pindah_id'] : "-"; ?></td>
			<td colspan=5 class="padat">1. Numpang KK</td>
			<td colspan=6 class="padat">2. Membuat KK Baru</td>
			<td colspan=7 class="padat">3. Nomor KK Tetap</td>
		</tr>

		<tr>
			<td>5.</td>
			<td>Status KK Bagi Yang Pindah</td>
			<td class="kotak satu"><?= $input['status_kk_pindah_id']; ?></td>
			<td colspan=5 class="padat">1. Numpang KK</td>
			<td colspan=6 class="padat">2. Membuat KK Baru</td>
			<td colspan=7 class="padat">3. Nomor KK Tetap</td>
		</tr>
		<tr>
			<td>6.</td>
			<td>Keluarga Yang Pindah</td>
			<td colspan=20>&nbsp;</td>
		</tr>
	</table>

	<table class="pengikut">
		<tr>
			<th style="width: 5%">NO.</th>
			<th style="width: 35%" colspan=16>NIK</th>
			<th style="width: 33%">NAMA</th>
			<th style="width: 17%">MASA BERLAKU KTP S/D</th>
			<th style="width: 10%" colspan=2>SHDK</th>
		</tr>

		<?php
		for ($i = 0; $i < MAX_PINDAH; $i++) :
			$nomor = $i + 1;
			if ($i < count($input['id_cb'])) :
				$id = trim($input['id_cb'][$i], "'");
				$penduduk = $this->penduduk_model->get_penduduk($id); ?>

				<tr>
					<td class="tengah"><?= $nomor; ?></td>
					<?php for ($j = 0; $j < 16; $j++) : ?>
						<td class="tengah">
							<?php if (isset($penduduk['nik'][$j])) : ?>
								<?= $penduduk['nik'][$j]; ?>
							<?php else : ?>
								&nbsp;
							<?php endif; ?>
						</td>
					<?php endfor; ?>
					<td><?= $penduduk['nama']; ?></td>
					<td>
						<?php if ($input['ktp_berlaku'][$i]) : ?>
							<?= $input['ktp_berlaku'][$i]; ?>
						<?php else : ?>
							&nbsp;
						<?php endif; ?>
					</td>
					<?php $shdk = str_pad($penduduk['kk_level'], 2, "0", STR_PAD_LEFT); ?>
					<?php for ($j = 0; $j < 2; $j++) : ?>
						<td class="tengah">
							<?= $shdk[$j]; ?>
						</td>
					<?php endfor; ?>
				</tr>

			<?php else : ?>
				<tr>
					<?php for ($k = 0; $k < 21; $k++) : ?>
						<td>&nbsp;</td>
					<?php endfor; ?>
				</tr>
			<?php endif; ?>
		<?php endfor; ?>

	</table>

	<table class="ttd">
		<col style="width:35%">
		<col style="width:30%">
		<col style="width:35%">
		<tr>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td><?= $config['nama_desa'] ?>, <?= tgl_indo(date("Y m d")); ?></td>
		</tr>
		<tr>
			<td>Mengetahui,</td>
			<td>Mengetahui,</td>
			<td>Pemohon,</td>
		</tr>
		<tr>
			<td>Camat <?= $config['nama_kecamatan']; ?></td>
			<td><?= $this->penandatangan_lampiran($data); ?></td>
			<td></td>
		</tr>
		<tr style="font-size: 20mm; line-height: normal;">
			<td>&nbsp;</td>
			<td>&nbsp;</td>
			<td>&nbsp;</td>
		</tr>
		<tr>
			<td><?= $config['nama_kepala_camat']; ?></td>
			<td><?= $input['pamong'] ?></td>
			<td><?= $individu['nama'] ?></td>
		</tr>
		<tr>
			<td>NIP : <?= $config['nip_kepala_camat']; ?></td>
			<td></td>
			<td></td>
		</tr>
	</table>
	<p>
		<strong>Keterangan:</strong><br>
		*) Diisi Oleh Petugas
	</p>

</page>