A signed statement acknowledging that providing false information can lead to legal prosecution or the requirement to refund any incorrectly received allowances. Where to Download Form Model DK (DOC)

When filling out the , ensure the following fields are accurately filled:

List each dependent's birth date, occupation, and whether they are currently receiving an allowance from another source to avoid double-dipping.

Many regional education offices (Dinas Pendidikan) or universities provide these templates. For instance, the Direktorat Pendidikan at UM offers a Model DK/KP-4 template .

Local government portals (e.g., Kabupaten Blitar or Kutai Barat) often provide localized versions for their specific staff. Key Sections to Complete

The primary government department you belong to (e.g., Dinas Pendidikan).

Your rank (Pangkat), grade (Golongan), and TMT (Effective Date of Grade).