Berita Acara SANGAT RAHASIA

Penyelidikan Dan Atau Penyidikan (BAP)

SMP PGRI 1 parung

Pada hari ...................... Tanggal ........... Bulan .............. Tahun ............... Pukul ................. WIB.Selaku
Penyidik : ...........................................................................................................................................

Jabatan : ..........................................................................................................................................

Telah melakukan penyelidikan atau penyidikan terhadap seorang yang beridentitas :

NIP/NIM : ...........................................................................................................
Nama : ...........................................................................................................
TTL/Umur : ...........................................................................................................
Ayah / Ibu : ............................................................................................... 3x4
Kelas : ...............................................................................................
No Telp. : ...............................................................................................
Alamat Lengkap: ...........................................................................................................................
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Hasil penyelidikan / penyidikan :
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Rekomendasi Hukuman Berdasarkan Tata Tertib dan Peraturan :

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Catatan Khusus :
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Demikian pernyataan ini saya buat dengan sebenar-benarnya, dan tanpa ada paksaan dan
penekanan dari pihak manapun.

Pembuat Pernyataan Penyidik Wali Kelas

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