NAMA : ..................................................................
PANGKAT/CORPS : ..................................................................
NRP : ..................................................................
JABATAN : ..................................................................
AGAMA : ..................................................................
FOTO
(3X4CM)
NAMA & TTD
3
PANCASILA
3. PERSATUAN INDONESIA.
PELATIH/PENILAI,
23
DATA MENEMBAK PISTOL TW IV
WAKTU JARAK 20
NILAI TOTAL
METER
NO
2 TANGAN % NILAI
PELATIH/PENILAI,
25
DATA MENEMBAK SENAPAN SS-1/SS-2 TW II
WAKTU
MATERI NILAI TOTAL
NO
EV.
TTR TTM % NILAI
TTR
PELATIH/PENILAI,
27
DATA MENEMBAK SENAPAN SS-1/SS-2 TW IV
WAKTU
JARAK 100 METER NILAI TOTAL
NO
TIARAP DDUK BRDIRI % NILAI
PELATIH/PENILAI,
29
DATA KESEGARAN JASMANI SEMESTER II
GARJAS “B”
PELATIH/PENILAI,
CATATAN
31
PRESTASI.......................................................................................................
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