LEMBAR BUKU INDUK SANTRI

NOMOR INDUK SANTRI ................

A. KETERANGAN IDENTITAS 30.Penghasilan per bulan : ......................................................................................................

1. Nama Lengkap : ............................................................................................... 31.No Telpon/ HP : ......................................................................................................
2. Tempat/ Tgl. Lahir : ................................................................................................ 32.Meninggal dunia : Tanggal...........................................di............................................
3. Jenis Kelamin : ................................................................................................ 33.Sebab meninggal : .......................................................................................................
4. Anak keberapa : ..................................... dari .............................................
5. Status Anak ( Yatim /Yatim piatu ) .............................................................................................. : E. KETERANGAN TENTANG WALI
6. Kewarganegaraan : ................................................................................................ 34.Nama Lengkap : ......................................................................................................
7. No Kartu Keluarga (KK) : ................................................................................................ 35.Tempat dan tanggal lahir : ......................................................................................................
8. Nomor Induk Kependudukan (NIK)............................................................................................... : 36.Nomor KTP/ NIK : .......................................................................................................
9. Agama : ............................................................................................... 37.Agama : ......................................................................................................
Pasfoto
3 cm x 4 cm 10.Bahasa sehari-hari dirumah : ............................................................................................... 38.Kewarganegaraan : ......................................................................................................
waktu masuk ke
dayah ini
39.Pendidikan Terakhir : ......................................................................................................
B. KETERANGAN ALAMAT 40.Pekerjaan : ......................................................................................................
11.Alamat 41.Penghasilan per bulan : ......................................................................................................
a. Jalan : ................................................................................................ 42.No Telpon/ HP : ......................................................................................................
b. Desa/ Kelurahan : ............................................................................................... 43.Alamat rumah : Jln..................................................................................................
c. Kecamatan : ............................................................................................... a. Desa/ Kelurahan : ......................................................................................................
d. Kabupaten /Kota : ............................................................................................... b. Kemukiman : .......................................................................................................
e. Propinsi : ................................................................................................ c. Kecamatan : ......................................................................................................
f. Kode Pos : ................................................................................................ d. Kabupaten : ......................................................................................................
e. Propinsi : .......................................................................................................
C. KETERANGAN TENTANG AYAH KANDUNG f. Kode POS : ......................................................................................................
12.Nama Lengkap : ............................................................................................... F. KEGEMARAN SANTRI
13.Tempat dan tanggal lahir : ............................................................................................... 44.Kesenian : ......................................................................................................
14.Nomor KTP/ NIK : ................................................................................................ 45.Olahraga : ......................................................................................................
Pasfoto
3 cm x 4 cm
15.Agama : ............................................................................................... 46.Kemasyarakatan/Organisasi : ......................................................................................................
waktu meninggalkan
dayah ini 16.Kewarganegaraan : ............................................................................................... 47.Lain-lain : ......................................................................................................
17.Pendidikan Terakhir : ............................................................................................... G. KETERANGAN PENDIDIKAN
18.Pekerjaan : ............................................................................................... 48.Meninggalkan Dayah
19.Penghasilan per bulan : ............................................................................................... 49.Tanggal meninggalkan dayah : ......................................................................................................
20.No Telpon/ HP : ............................................................................................... 50.Alasan : .......................................................................................................
21.Meninggal dunia : Tanggal...........................................di..................................... 51.Akhir Pendidikan : .......................................................................................................
22.Sebab meninggal : ....................................................................................................... 52.Tamat belajar : ......................................................................................................
53.STTB Nomor : ......................................................................................................
D. KETERANGAN TENTANG IBU KANDUNG H. KETERANGAN SETELAH SELESAI PENDIDIKAN
23.Nama Lengkap : ...................................................................................................... 54.Melanjutkan di : ......................................................................................................
24.Tempat dan tanggal lahir : ...................................................................................................... 55.Bekerja : ......................................................................................................
25.Nomor KTP/ NIK : ....................................................................................................... a. Tanggal mulai bekerja : ......................................................................................................
26.Agama : ...................................................................................................... b. Nama perusahaan/lembaga dan lain-lain.................................................................................... :
27.Kewarganegaraan : ...................................................................................................... c. Penghasilan : .......................................................................................................
28.Pendidikan Terakhir : ......................................................................................................
29.Pekerjaan : ......................................................................................................