BIODATA ANGGOTA

PMR MADYA SMP MUHAMMADIYAH 2 JAKARTA

TAHUN 2022

A. UMUM
Anggota PMR : Madya *
Asal Sekolah : .................................................................................................
Kelas : .................................................................................................

B. DATA PRIBADI

Nama Lengkap : .................................................................................................

NIS / NISN : .................................................................................................
Jenis Kelamin : Laki – laki / Perempuan *
Tempat / Tanggal Lahir : .................................................................................................
Alamat Rumah : .................................................................................................
.................................................................................................
Nama Orang Tua :
Ayah : .................................................................................................
Ibu : .................................................................................................
No. Telp./ HP/ WA : .................................................................................................
(Anak / Orang Tua)*

NB : Diisi menggunakan huruf Kapital

Jakarta ,....................................2022
Pas Peserta,
Foto 3
x4

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