TTD
Proktor.......................................................................................
............................................................
NIP ............................................................ 1.
Pengawas..................................................................................
NIP ............................................................ 2. ............................................................
Kepala Sekolah..............................................................................
NIP ............................................................ 3. ............................................................
Catatan:
Dibuat rangkap 3 (tiga)
Ditanda tangani oleh Proktor, Pengawas dan Kepala sekolah
SMPN 1