PENDAFTARAN WISUDA
FOTO 4X6
Background warna
merah memakai
pangsi
Norekpus :.................................................................................................................
Nama :.................................................................................................................
Agama :.................................................................................................................
Pekerjaan :.................................................................................................................
Cabang/komda :.................................................................................................................
Tataran :.................................................................................................................
Alamat :.................................................................................................................
Nomer HP
:...........................................................................................................................
Mengetahui
Bojonegoro...../.........................../2018
Peserta Wisuda Ketua Ranting
(.........................................) (...................................................)
PEDOMAN SUCI
MARGALUYU 151 INDONESIA
Bismillahirrokhmanirrokhim