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BIODATA SANTRI

Nama Lengkap : .........................................................................................

Nama Panggilan : ........................................................................................

Alamat Lengkap : .......................................................................................

Jenis Kelamin : ........................................................................................

Tempat & T. Lahir :.........................................................................................

Diterima di Lembaga :

a. Pada Tanggal............................................................................................
b. Jenjang/jilid.............................................................................................

Data Orang Tua

Ayah/ wali

Nama :.........................................................................................

Agama :.........................................................................................

Pekerjaan :.........................................................................................

Pendidikan :.........................................................................................

IBU

Nama :.........................................................................................

Agama :.........................................................................................

Pekerjaan :.........................................................................................

Pendidikan :.........................................................................................

Wali Santri, Kepala TPA “ Salamatuss’diyah”


FOTO

3x4

____________ Hj. Khusnul Khotimah

NB: DATA INI DI KUMPULKAN HARI : ...................................................................................

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