Surat Pernyataan Kebenaran Data

SURAT PERNYATAAN KEBENARAN DATA
Yang bertanda tangan di bawah ini:

1. Sekola
h: :
2. N a m
a :
3. Jabata
n :
SMP Negeri 1 Tarakan .
4. Telp/H
P:
5. E-mail
:
......................................................................................................
.............................
......................................................................................................
............................
......................................................................................................
............................
......................................................................................................
............................
Menyatakan dengan sesungguhnya bahwa:

a. Bersedia melaksanakan penginputan data PPDB 2013 sesuai dengan data
sesungguhnya
b.
Bersedia mematuhi Kode Etik dan Kode Tata Laku serta semua
ketentuan
yang
telah ditetapkan oleh Kesepakatan Team Panitia PPDB
2013.
c. Apabila di kemudian hari ditemukan bahwa data dalam dokumen yang
diberikan tidak benar dan/atau melanggar kode etik dan kode tata laku
serta melanggar ketentuan yang telah ditetapkan oleh Team Panitia PPDB
2013, bersedia dikenakan sanksi .
Demikian pernyataan ini dibuat dengan sebenarnya dan penuh tanggungjawab
untuk dipergunakan sebagaimana mestinya.
...................., .................
.. 20.... Yang membuat
pernyataan,
...............................................
.

1. Sekola
h: :
2. N a m
a :
3. Jabata
n :
4. Telp/H
P:
5. E-mail
:
......................................................................................................
.............................
......................................................................................................
............................
......................................................................................................
............................
......................................................................................................
............................

sesungguhnya
b.
ketentuan
yang
2013.
...................., .................
pernyataan,
...............................................
.

1. Sekola
h: :
2. N a m
a :
3. Jabata
n :
4. Telp/H
P:
5. E-mail
:
......................................................................................................
.............................
......................................................................................................
............................
......................................................................................................
............................
......................................................................................................
............................

sesungguhnya
b.
ketentuan
yang
2013.
...................., .................
pernyataan,
...............................................
.

1. Sekola
h: :
2. N a m
a :
3. Jabata
n :
4. Telp/H
P:
5. E-mail
:
......................................................................................................
.............................
......................................................................................................
............................
......................................................................................................
............................
......................................................................................................
............................

sesungguhnya
b.
ketentuan
yang
2013.
...................., .................
pernyataan,
...............................................
.

1. Sekola
h: :
2. N a m
a :
3. Jabata
n :
4. Telp/H
P:
5. E-mail
:
......................................................................................................
.............................
......................................................................................................
............................
......................................................................................................
............................
......................................................................................................
............................

sesungguhnya
b.
ketentuan
yang
2013.
...................., .................
pernyataan,
...............................................
.

1. Sekola
h: :
2. N a m
a :
3. Jabata
n :
4. Telp/H
P:
5. E-mail
:
......................................................................................................
.............................
......................................................................................................
............................
......................................................................................................
............................
......................................................................................................
............................

sesungguhnya
b.
ketentuan
yang
2013.
...................., .................
pernyataan,
...............................................
.

1. Sekola
h: :
2. N a m
a :
3. Jabata
n :
4. Telp/H
P:
5. E-mail
:
......................................................................................................
.............................
......................................................................................................
............................
......................................................................................................
............................
......................................................................................................
............................

sesungguhnya
b.
ketentuan
yang
2013.
...................., .................
pernyataan,
...............................................
.

1. Sekola
h: :
2. N a m
a :
3. Jabata
n :
4. Telp/H
P:
5. E-mail
:
......................................................................................................
.............................
......................................................................................................
............................
......................................................................................................
............................
......................................................................................................
............................

sesungguhnya
b.
ketentuan
yang
2013.
...................., .................
pernyataan,
...............................................
.

1. Sekola
h: :
2. N a m
a :
3. Jabata
n :
4. Telp/H
P:
5. E-mail
:
......................................................................................................
.............................
......................................................................................................
............................
......................................................................................................
............................
......................................................................................................
............................

sesungguhnya
b.
ketentuan
yang
2013.
...................., .................
pernyataan,
...............................................
.

1. Sekola
h: :
2. N a m
a :
3. Jabata
n :

......................................................................................................
............................
......................................................................................................
............................
4. Telp/H ......................................................................................................
P:
.............................
5. E-mail
:
......................................................................................................
............................

sesungguhnya
b.
ketentuan
yang
2013.
...................., .................
pernyataan,
...............................................
.

1. Sekola SMA Negeri 1 Tarakan .
h: :
2. N a m
a :
3. Jabata
n :
......................................................................................................
............................
......................................................................................................
............................
4. Telp/H
P:
5. E-mail
:
......................................................................................................
.............................
......................................................................................................
............................

sesungguhnya
b.
ketentuan
yang
2013.
...................., .................
pernyataan,
...............................................
.

1. Sekola
h: :
2. N a m
a :
3. Jabata
n :
SMA Negeri 2 Tarakan .
4. Telp/H
P:
5. E-mail
:
......................................................................................................
.............................
......................................................................................................
............................
......................................................................................................
............................
......................................................................................................
............................

sesungguhnya
b.
ketentuan
yang
2013.
...................., .................
pernyataan,
...............................................
.

1. Sekola
h: :
2. N a m
a :
3. Jabata
n :
SMA Negeri 3 Tarakan .
4. Telp/H
P:
5. E-mail
:
......................................................................................................
.............................
......................................................................................................
............................
......................................................................................................
............................
......................................................................................................
............................

sesungguhnya
b.
ketentuan
yang
2013.
...................., .................
pernyataan,
...............................................
.

1. Sekola
h: :
2. N a m
a :
3. Jabata
n :
SMK Negeri 1 Tarakan .
4. Telp/H
P:
5. E-mail
:
......................................................................................................
.............................
......................................................................................................
............................
......................................................................................................
............................
......................................................................................................
............................

sesungguhnya
b.
ketentuan
yang
2013.
...................., .................
pernyataan,
...............................................

1. Sekola
h: :
2. N a m
a :
3. Jabata
n :
SMK Negeri 2 Tarakan .
4. Telp/H
P:
5. E-mail
:
......................................................................................................
.............................
......................................................................................................
............................
......................................................................................................
............................
......................................................................................................
............................

sesungguhnya
b.
ketentuan
yang
2013.
...................., .................
pernyataan,
...............................................
.

1. Sekola
h: :
2. N a m
a :
3. Jabata
n :
4. Telp/H
P:
5. E-mail
:
......................................................................................................
.............................
......................................................................................................
............................
......................................................................................................
............................
......................................................................................................
............................

sesungguhnya
b.
ketentuan
yang
2013.
...................., .................
pernyataan,
...............................................
.

Surat Pernyataan Kebenaran Data

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Surat Pernyataan Kebenaran Data

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SURAT PERNYATAAN KEBENARAN DATA

Yang bertanda tangan di bawah ini:

SMP Negeri 1 Tarakan .

Menyatakan dengan sesungguhnya bahwa:

telah ditetapkan oleh Kesepakatan Team Panitia PPDB