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YAYASAN PENDIDIKAN ISLAM AL – IMAN

PONDOK PESANTREN FATHU SA’ADAH


BANJAR AGUNG TULANG BAWANG
Jln. Lintas Timur Unit II Banjar agung Tulang Bawang Telp ( 0726 ) 750135 KP 34595

BIODATA SANTRI

I. SANTRI
1. Nama : .............................................................................................................
2. Jenis Kelamin : .............................................................................................................
3. TTL : .............................................................................................................
4. Anak Ke : .............................................................................................................
5. Jumlah Saudara Kandung
a. Kandung : .............................................................................................................
b. Tiri : .............................................................................................................
6. Alamat : .............................................................................................................
.............................................................................................................
II. ORANG TUA
1. Nama Orang Tua : .............................................................................................................
2. Pendidikan : .............................................................................................................
3. Pekerjaan : .............................................................................................................
4. No HP : .............................................................................................................
5. Alamat : .............................................................................................................
.............................................................................................................
III. MASUK PONDOK
1. Tanggal : .............................................................................................................
2. Lulusan dari : .............................................................................................................

Banjar Agung, .....................................

............................................................

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