1.
NAMA : ________________________________________
3. ALAMAT
:
________________________________________________________________________________________
________________________________________________________________________________________
________________________________________________________________________________________
4. JARAK TEMPAT TINGGAL DARI SEKOLAH : ___________km
5. PENGANGKUTAN KE SEKOLAH
: _______________________________
6. KEPUTUSAN PEPERIKSAAN
a)
b)
UPSR : ____________________
PMR : ____________________
__________________________________________
__________________________________________
______________________________
______________________________
______________________________
YA/TIDAK
( NAMA: