SURAT PERMOHONAN PINDAH SEKOLAH

Kepada Yth.
Kepala Sekolah Dasar
SDN. Lebak Bulus 03 Pagi
Di
Jakarta

Dengan hormat,
Yang bertanda tangan dibawah ini :

Nama

: ...............................................................................................................................

Pekerjaan

: ...............................................................................................................................

Alamat

: ...............................................................................................................................
................................................................................................................................

Nomor HP/ telepon

: ……………………………………………………………………………………………………………………….

Bapak / Ibu Orang Tua dari :

Nama

: ................................................................................................................. ( L/P )

Nomor Induk/ NISN

: ................................................................................................................................

Tempat/Tgl.lahir

: ...............................................................................................................................

Siswa Kelas

: ................................................................................................................................

Mengajukan permohonan pindah belajar untuk siswa tersebut di atas ke SD ………………………………………….
...................................................... di Desa / Kelurahan .................................................................................
Kecamatan ................................................................... Provinsi...................................................................
Dengan alasan ...............................................................................................................................................

Demikianlah permohonan kami, atas perhatian dan kerja sama saudara kami sampaikan. Terima kasih.

Jakarta.

2012
Hormat kami

________________
(Nama Lengkap)

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