| No. | Nama | Paraf |
|---|---|---|
| 1 | SUS SETYOWATI | |
| 2 | DJATMIKO | |
| 3 | SLAMET RIYADI | |
| 4 | TASBICHUN | |
| 5 | TOBI'UN | |
| 6 | M. HABIB EFFENDI BA | |
| 7 | NAWIRRUDIN | |
| 8 | ROCHMAT | |
| 9 | ISWANDI | |
| 10 | MUSLIH HIDAYAT | |
| 11 | SUMADI | |
| 12 | SUKADI | |
| 13 | SODIKUN | |
| 14 | CHAERUN | |
| 15 | MUBASIR | |
| 16 | NGADIRAN | |
| 17 | HADI RUS SUMARSIHONO | |
| 18 | JAMAL | |
| 19 | RETNAWAN |