YAYASAN PENDIDIKAN ISLAM TSAFIUDDIN

PONDOK PESANTREN MUHAMMAD BASIUNI IMRAN SAMBAS

MADRASAH TSANAWIYAH
Alamat : Jalan Pembangunan No. 13 Desa Dalam Kaum, Kec. Sambas
e-mail : basiuniimran@ymail.com. ; Telp. ( 0562 ) 391 299
Terakreditasi B
NSM : 121261010006 NPSN : 30100505

BIODATA RINCI PESERTA DIDIK BARU

TAHUN PELAJARAN 2023/2024

A. DATA RINCI PESERTA DIDIK :

1. Nama : ............................................................................................
2. NIK : ............................................................................................
3. No. Peserta Ujian SD/MI : ............................................................................................
4. NISN : ............................................................................................
5. Tempat Lahir : ............................................................................................
6. Tanggal Lahir : ............................................................................................
7. Alamat 1 (Desa) : ............................................................................................
8. Alamat 2 (Kecamatan) : ............................................................................................
9. Asal Sekolah SD/MI : ............................................................................................
10. NPSN SD/MI : ............................................................................................
11. NSM (Khusus MI) : ............................................................................................
12. Hobi : ............................................................................................
13. Cita-Cita : ............................................................................................
14. Anak Ke- : ............................................................................................
15. Jumlah Saudara : ............................................................................................
16. Jarak Dari Rumah : ............................................................................................
17. Kendaraan Kesekolah : ............................................................................................
18. Nomor Seri Ijazah : ............................................................................................
19. Nomor Seri SKHU : ............................................................................................

B. DATA ORANG TUA :

1. Nomor Kartu Keluarga : ............................................................................................
2. Nama AYAH : ............................................................................................
a.NIK : ............................................................................................
b.Pendidikan : ............................................................................................
c.Pekerjaan : ............................................................................................
d.Penghasilan Rata2/bulan : ............................................................................................
3. Nama IBU : ............................................................................................
a.NIK : ............................................................................................
b.Pendidikan : ............................................................................................
c.Pekerjaan : ............................................................................................
d.Penghasilan Rata2/bulan : ............................................................................................
4. Alamat Orang Tua : ............................................................................................
5. Nomor HP : ............................................................................................

Note : Isilah data rinci dengan sebenar-benar nya.

(Mohon untuk di cek terlebih dahulu sebelum pengisian)