BUKU INDUK

Pas Fhoto 3X4

I.SISWA : NOMOR INDUK :.................................................................. 1. Nama : .................................................................................................... 2. Jenis Kelamain : .................................................................................................... 3. Tempat dan Tanggal Lahir : ................................................................................................... 4. Anak Ke : .................................................................................................... 5. Jumlah Saudara : Kandung : ....................................Orang Tiri : ..................................... Orang 6. Alamat : .................................................................................................... .................................................................................................... II. ORANG TUA WALI 7. Nama Orang Tua : Ayah................................................Ibu....................................... 8. Pendidikan Orang Tua : Ayah................................................Ibu....................................... 9. Pekerjaan Orang Tua : Ayah................................................Ibu....................................... 10. Agama : Ayah................................................Ibu....................................... 11. Alamat Orang Tua : .................................................................................................... 12. Nama Wali : .................................................................................................... 13. Pendidikan Wali : .................................................................................................... 14. Agama : .................................................................................................... 15. Alamat : .................................................................................................... 16. Masuk di MI Tahun : Pas Fhoto

BUKU INDUK

3X4

I.SISWA : NOMOR INDUK :.................................................................. 1. Nama : .................................................................................................... 2. Jenis Kelamain : .................................................................................................... 3. Tempat dan Tanggal Lahir : ................................................................................................... 4. Anak Ke : .................................................................................................... 5. Jumlah Saudara : Kandung : ....................................Orang Tiri : ..................................... Orang 6. Alamat : .................................................................................................... .................................................................................................... II. ORANG TUA WALI 7. Nama Orang Tua : Ayah................................................Ibu....................................... 8. Pendidikan Orang Tua : Ayah................................................Ibu....................................... 9. Pekerjaan Orang Tua : Ayah................................................Ibu....................................... 10. Agama : Ayah................................................Ibu....................................... 11. Alamat Orang Tua : .................................................................................................... 12. Nama Wali : .................................................................................................... 13. Pendidikan Wali : .................................................................................................... 14. Agama : .................................................................................................... 15. Alamat : .................................................................................................... 16. Masuk di MI Tahun :

MADRASAH IBTIDAIYAH NAHDLATUL WATHAN KEKALE DESA SENGKOL KECAMATAN PUJUT KABUPATEN LOMBOK TENGAH

PROVINSI NUSA TENGGARA BARAT

BUKU INDUK SISWA

TAHUN 2005