Anda di halaman 1dari 1

Yang kami hormati,

Kepala SD Islam Al-Kautsar


Di tempat

Dengan hormat,

Yang bertanda tangan dibawah ini :

Nama ................................................................................................................................

Pekerjaan ................................................................................................................................

Alamat ................................................................................................................................

Orang tua/wali *) dari siswa/i :

Nama ................................................................................................................................

NISN ................................................................................................................................

Kelas ................................................................................................................................

Tempat, tanggal lahir .......................................................................................................................

Dengan ini mengajukan permohonan pindah belajar untuk siswa tersebut diatas ke:

Nama Sekolah ................................................................................................................................

NPSN Sekolah ................................................................................................................................

Alamat Sekolah ................................................................................................................................

Alasan Pindah ................................................................................................................................

Atas perhatian dan kerjasamanya, kami ucapkan terima kasih.

Cimahi, ...................................

Hormat Kami,

(...............................................)

*) coret yang tidak perlu