YAYASAN TASBIH NURUL AULIYA

JAMIYYAH TASBIH DAN SHOLAWAT KUBRO

KALIMANTAN

BIDODATA PESERTA SANTUNAN

ANAK YATIM / DHUAFA

DATA PRIBADI
Nama Lengkap : ....................................................................................................................
Nama Panggilan : ....................................................................................................................
Tempat Tanggal Lahir : ....................................................................................................................
Jenis Kelamin : Laki-laki Perempuan
Jumlah Saudara : .....................Anak ke- .................dari ...................................bersaudara
Alamat Lengkap
            Jalan :....................................................... RT : ................ RW : ..............
            Kelurahan : ....................................................................................................................
            Kecamatan : ....................................................................................................................
DATA PENDIDIKAN
Nama Sekolah : ....................................................................................................................
Alamat Sekolah : ....................................................................................................................
Kelas : ....................................................................................................................
DATA ORANG TUA / WALI
Nama Ayah : ................................................................................................................
Nama Ibu : .................................................................................................................
Pekerjaan : .................................................................................................................
Status perkawinan : Janda Wafat Menikah lagi
No. Telp / HP : .................................................................................................................
Nama Wali : .................................................................................................................
Hungunan dengan yatim : .................................................................................................................
Alamat : .................................................................................................................
No. Telp / Hp : .................................................................................................................
Demikian biodata ini dibuat dengan sebenar-benarnya. Apabila ada kekeliruan di masa yang
akan datang maka akan diperbaharui kembali.
……..……................ 2020

Yang mengisi
 YAYASAN TASBIH NURUL AULIYA
JAMIYYAH TASBIH DAN SHOLAWAT KUBRO
KALIMANTAN

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