KEMENTERIAN AGAMA

REPUBLIK INDONESIA
IJAZAH
MADRASAH ALIYAH
PROGRAM ILMU PENGETAHUAN ALAM
TAHUN PELAJARAN 2018/2019
Nomor : .~1.;/.~,J?:.!!:.f~i./..eP.:Q.1.J/~f(~~?.,
Yang bertanda tangan di bawah ini, Kepala Madrasah Aliyah ............................. .
PE~ANiltEN ,\L-AMIN
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nomor pokok sekolah•nasional : .. ~~,.1t~.~9. .........................................................
Kabupaten/Kota : ..M~~~~tt?. :-............................................... ••••••••
·:..}~w.~.:]i~Wf.'............ ............................................
menerangkan bahwa : ..
: .. ~f~!. .. A~f.t.~~N~.Y.~H ................................... .
tempat dan tanggal lahir . :~M~j~~~r.t.~.!..~f.~~~.:~! ............................... .
nama orang tua/wali :...~.~9!'~.~~~-.................................... .. ..... ............... ..
nomor induk siswa · .
. ·1:~,t2.;,s:l ~oo ~71 boo 18
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nomor induk siswa nasional . : .~ :l~F..?:'.~}~1_ .... ;............. .. ............................. ....

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nomor peserta ujian nasional : } .:.~9..:.~!..:-.l~~.~f.~1::·.~~{~~.........................
madrasah asal : .M~.. ~~~~~t~~ t .1.::A~!~.................................. . ..
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