NAMA MURID
URING
J
A
N
TARIK
H
LAHIR
MYKID /
NO SIJIL
LAHIR
1009251307
38
/SK520249
1012051306
70
/SK549260
1009191301
25
/SK520054
1.
CHRISTY
LIAN
THOMAS
25.09.1
0
2.
05.12.1
0
3.
19.09.1
0
Disahkan Oleh:
Tandatangan :___________________________
:___________________________________
Jawatan
:___________________________
:___________________________________
Tarikh
:___________________________
NO. KAD
PENGENAL
AN
ALAMAT
BANG
SA
NAMA IBUBAPA
/
PENJAGA
KENYA
H
THOMAS LIAN
ANYI
8102051362
81
UMA
SAMBOP
KAYAN
MELINA AK.
BILONG
8507061361
39
KENYA
H
LEO NYIPA
6601121355
53
KLINIK
DESA UMA
SAMBOP
UMA
SAMBOP
Cop Sekolah:
KEWARG
ANEGARA
AN
MALAYSIA
AGAM
A
MALAYSIA
KRISTI
AN
MALAYSIA
KRISTI
AN
KRISTI
AN
Tandatangan
Nama
CATATAN