Pada Hari ini .............. Tanggal .............................. Bulan ........................ Tahun Dua Ribu Dua
Puluh Tiga, bertempat di SMK …………………………………….
a. Telah dilaksanakan verifikasi Nilai ijazah Tahun Pelajaran 2022-2023 pada :
Nama SMK : ..................................................…
Alamat : ......................................................
Rekomendasi : sesuai/belum sesuai *)
untuk digunakan pada penulisan Ijazah Tahun Pelajaran 2022/2023.
b. Catatan hasil verifikasi
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Mengetahui Verifikator
Kepala SMK Daya Utama Pengawas Pembina