Tanggal Lahir
Nomor Peserta
Tgl Bln Thn
A A A A A A A A A A A A A A A A A A A A
B B B B B B B B B B B B B B B B B B B B 0 0 0 0 0 0 0 0 0 0 0 0 0 0 0
C C C C C C C C C C C C C C C C C C C C 1 1 1 1 1 1 1 1 1 1 1 1 1 1 1
D D D D D D D D D D D D D D D D D D D D 2 2 2 2 2 2 2 2 2 2 2 2 2 2
E E E E E E E E E E E E E E E E E E E E 3 3 3 3 3 3 3 3 3 3 3 3 3 3
F F F F F F F F F F F F F F F F F F F F 4 4 4 4 4 4 4 4 4 4 4 4 4
G G G G G G G G G G G G G G G G G G G G 5 5 5 5 5 5 5 5 5 5 5 5 5
H H H H H H H H H H H H H H H H H H H H 6 6 6 6 6 6 6 6 6 6 6 6 6
I I I I I I I I I I I I I I I I I I I I 7 7 7 7 7 7 7 7 7 7 7 7 7
J J J J J J J J J J J J J J J J J J J J 8 8 8 8 8 8 8 8 8 8 8 8 8
K K K K K K K K K K K K K K K K K K K K 9 9 9 9 9 9 9 9 9 9 9 9 9
L L L L L L L L L L L L L L L L L L L L
Nama Mata Ujian (Silanglah salah satu)
M M M M M M M M M M M M M M M M M M M M
R R R R R R R R R R R R R R R R R R R R
S S S S S S S S S S S S S S S S S S S S Nama MI :
T T T T T T T T T T T T T T T T T T T T
Tanggal Ujian ..............................................................................
U U U U U U U U U U U U U U U U U U U U
Tanda Tangan Peserta
V V V V V V V V V V V V V V V V V V V V
W W W W W W W W W W W W W W W W W W W W
X X X X X X X X X X X X X X X X X X X X
Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y Y
Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z Z
JAWABAN
Berilah tanda (X) pada salah satu pilihan jawaban yang benar
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