Izin Pulang
Izin Pulang
TUKSONGO-NGLOROG-PRINGSURAT-TEMANGGUNG
PERIODE: 2 /2
Nama :_______________________________________________________________________Umur_____________tahun
Wali/Orang tua:______________________________________________________________________________________________________
Sekolah : SMP/MTS/M.A____________________________________________________________________Kelas:__________
Tmpt/Tgl.lahir:_______________________________________________________________________________________________________
Alamat Tujuan:_______________________________________________________________________________________________________
Keperluan :_______________________________________________________________________________________________________
Berlaku :______________________________________________________________________________________________________
dan dapat dipergunakan bilamana perlu untuk keterangan jalan bagi yang berdsangkutan.
Tuksongo,..............................20
____________________
Bapak Pengasuh
STAFF PENGASUHAN SANTRI
PONDOK PESANTREN HIDAYATULLAH
TUKSONGO-NGLOROG-PRINGSURAT-TEMANGGUNG
PERIODE: 2019/2020