DATA MASJID
1. Nama Masjid : ………………………………………………………………….
2. Alamat Masjid : ………………………………………………………………….
......................................HP .........................
3. Nama Pengurus : Ketua : .............................................................................
Sekretaris : .............................................................................
Bendahara : .............................................................................
4. Nomor SK Pengukuhan : ………………………………………………………………….
5. Nomor Rekening : ………………………………………………………………….
DATA MARBOT
1. Nama Marbot : ...............................................Nomor NIK :.
2. Alamat Marbot : ………………………………………………………………….
.....................................................HP............................................
DATA IMAM
1. Nama Imam : ................................................Nomor NIK : ...............................
2. Alamat Imam : ………………………………………………………………….
.....................................................................HP ...........................
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LAMPIRAN :