JML JML

No. INDUK KECAMATAN INDUK NAMA LEMBAGA ALAMAT KEPALA TPQ NO

SANTRI IMTAS
1 06.08.01.003 Pondok Kelapa 06.08.01.003 Ponpes Al Hasanah Jl. Raya Talang Pauh Nani Zahara, S.Pd 883 1
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 TEMPAT TANGGAL LAHIR MASUK TPQ
NAMA L/P WALI
LAHIR TTTT-BB-HH TTTT-BB-HH
M. Ajhi Pratama L Jon Effendi Lebong 2006/07/26 2021/07/15
Rizky Suprastio L Selo Prayitna Tanjung Ha 2006/05/11 2021/07/15
Falaq Fadhillah Raza Fetriansyah Manna 2006/10/04 2022/07/15
M. Nur Ilham Bintang Afriyanto Laiz 2007/07/14 2022/07/15
M. Nicky Fridyansah Ricky. H Banda Aceh 2008/01/30 2021/07/15
M. Hasbi Assidqi Maryadi Bengkulu 2008/05/09 2022/07/15
Fiki Juniardo Sujarman Bengkulu 2006/06/29 2021/07/15
Faiz Alfaruq Piruza Bengkulu 2006/01/13 2022/05/11
Ramah Fitrah Utama Endang Suryadi Seluma 2007/09/21 2022/07/15
M. Zharfan Dihaqo R Dikdik Sadikin Putri Hijau 2008/04/16 2022/07/15
Abdul Latif M. Sobri Bengkulu 2007/04/26 2022/07/15
Fajar Ilahi M. Murai Rahmat Bengkulu 2008/03/24 2022/07/15
Azhar Rahmansyah D Norman, St Bengkulu 2008/06/19 2022/07/15
Opick Adrian Zilullah Adi Susanto, M.Pd Bengkulu 2008/06/15 2022/07/15
Caesar Yudhistira Sambodo Joko Sambodo Padang 2008/01/30 2022/07/15
Fitratuk Adli Adnin Padang 2008/01/12 2022/07/15
2008/05/09 2022/07/15
2008/05/09 2022/07/15
2008/05/09 2022/07/15
2008/05/09 2022/07/15
2008/05/09 2022/07/15
2008/05/09 2022/07/15
2008/05/09 2022/07/15
2008/05/09 2022/07/15
2008/05/09 2022/07/15
 JML JML
No. INDUK KECAMATAN INDUK NAMA LEMBAGA ALAMAT KEPALA TPQ NO
SANTRI IMTAS
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 TEMPAT TANGGAL LAHIR MASUK TPQ
NAMA L/P WALI
LAHIR TTTT-BB-HH TTTT-BB-HH
CALISSA FIRAS NADIFA P EDI ANSORI BENGKULU 2008/12/29 2020/07/15
SALSABILA KHAIRUNNISA S P SHOLEHIN ARGA MAK 2006/07/14 2018/07/15
PIPACI NURSEPTA RASYAD P SUBARDIN BENGKULU 2006/09/03 2018/07/15
HELSA PRABETA SARI P HERI YADI BENTENG 2006/01/23 2018/07/15
ALYA JUWITA PUTRI P ALI AKBAR BENGKULU 2007/01/24 2021/07/15
YASMIN 'AAFIYAH P MUHAMAD SA'BANI BOYOLALI 2008/02/13 2020/07/15
NUHA KHOIRUNNISA P MUHAMAD SA'BANI BENGKULU 2009/03/25 2020/07/15
MUFIDAH NAFISAH SENA P AFENSENA CURUP 2005/01/28 2020/07/15
WINNI WAHYUNI MAYANG P SYAFIK MUARA TE 2005/05/05 2020/07/15
RAHMA NUR ADILA P DODI RAFLES BENGKULU 2007/12/14 2020/07/15
ZELFINA NIFARINDRA P BENDRA SUDARZEN BEKASI 2008/01/02 2020/07/15
ANISA MARITO P SOBARUDDIN SIREGARBENGKULU 2008/08/08 2020/07/15
ALIYYAH NUR SOLEHA P ABI DARMANSYAH CURUP 2007/11/02 2020/07/15
CHELSEA MONIKA NIRANTI P CHARLES HANIF NAPAL PUTI 2007/12/11 2020/07/15
SAFINA AYU SETYANINGSIH P SURANTO KOTA BANI 2007/08/27 2020/07/15
FAIZAH NUR ISTIQOMAH P IMAM SURAHMAD MARGA SAK 2006/01/14 2018/07/15
FAIZAH SOBIA RIZKIN P TORIKIN BENGKULU 2009/04/11 2020/07/15
NAZWA EKLY RAHMASUCI P EKO SETIYONO KARANG PU 2008/09/14 2020/07/15
FANNY AURELIA PUTRI P SUTIKNO BENGKULU 2008/01/06 2020/07/15
SALFINA RAHMADANIA KU P ARNALDO KURNIAWAN MANNA 2008/09/11 2020/07/15
LUTHFIA IZZATI JANNAH P JAMALUDIN BENGKULU 2008/08/16 2020/07/15
SOFIA ROYESTA P RONI TANJUNG BEKASI 2005/04/18 2020/07/15
SETRIYANI P ROSPENDI SEBLAT 2004/12/24 2020/07/15
NADIA CHINTIYA BELA P ANTON SUPRIYADI SELUMA 2005/09/23 2020/07/15
FEBY MAYA SARI P FAHMI ARGA MAK 2005/05/12 2020/07/15
ALYA NUR AZIZAH P AZWARANAS BENGKULU 2004/11/28 2020/07/15
DZAKIYA PUTRI BARIZA P SAWALUDIN BENGKULU 2006/01/06 2020/07/15
WIDYA AGUSTINA P MUGIWIDODO BENGKULU 2004/08/19 2020/07/15
NOLA FEBRINA P ALAIHI TUNGGANG 2005/02/20 2020/07/15
ZAZKIA KANA HAYA P BAMBANG KURNIAWAAIR BULUH 2008/02/18 2020/07/15
MARYANTI P SUTARMAN ARMA JAYA 2005/08/09 2020/07/15
NURUL FADILLAH SALSA BI P MASRUL BENGKULU 2008/11/27 2020/07/15
AZIIA MUTMAINNA P RESTON SELUMA 2008/06/30 2020/07/15
HAYA FATHINAH P ASEP IKHWANUL KAR BENGKULU 2008/11/02 2020/07/15
LESTA DARIA PUTRI P DEDE AHMAD SIBAK 2006/09/12 2019/07/15
SALWA KHORUNNISA P WALUYO BENGKULU 2008/06/02 2020/07/15
AISYAH SHAFIYYAH P SUPIYANDI ARGA MAK 2008/07/01 2020/07/15
MEUTIA HAFIDZAH ISNADI P LIKRAN ISNADI CURUP 2009/02/20 2020/07/15
KHUSNUL NUR FATHIMAH P H. MUNANDAR CURUP 2005/12/05 2020/07/15
SALWA ANDEA ZAHRA P ANSORI SUMBEREJ 2009/06/01 2020/07/15
ANISA DWI HASANAH P SYAMSUL MUARIF AIR BANAI 2008/04/17 2020/07/15
ANGEL UTAMA JUNIANTY P MARDIONO LAIS 2008/06/25 2019/07/15
FATIHA RIZQIYANI P RUSYDI BENGKULU 2008/06/15 2020/07/15
SYIFA FITRI AULIA P SISWANTO LEBONG 2007/10/19 2020/07/15
AURELIA PUTRI NABILA P SURYANTO CURUP 2008/01/01 2019/07/15
SALMA NURUL HIDAYAH P WASNO MEKAR MU 2006/07/01 2019/07/15
LINGGAR MANIK P WAKID SULISTIONO BENGKULU 2007/04/28 2019/07/15
NAFISHA AFID ARIYANI P DWI ARYANTO JAWA TENG 2007/11/17 2019/07/15
ADELSI TIRTA SUNDARI P PADIAL EFZON SELUMA 2005/06/08 2020/07/15
FANNY CANTIKA SETYA P HERI YADI PAGAR BAN 2007/09/03 2018/07/15
RHEVALIZA QISTY EDISON P EDISON AIR PUTIH 2006/09/20 2018/07/15
MONIKA CELSILIA UTAMI P ANZURI BENGKULU 2007/08/24 2019/07/15
IRMA NURAINI P AMENAN TANJUNG H 2006/01/10 2018/07/15
AMILIA SYAROH P ACHMADI KARYA MUL 2006/10/14 2018/07/15
NURHIDAYAH P SUBANDI SIABUN 2005/07/22 2017/07/15
LUTFIYAH MAHARANI P UNTUNG BOJONEGO 2008/04/03 2020/07/15
ZAFIRA DWI JOETI P JULUAN ARDI BENGKULU 2007/06/08 2019/07/15
CARISSA PRADIVA RAMADH P DETARIA SUNATA LAMPUNG 2009/09/11 2021/07/15
AYLA AZZAHRA P SUKIRMAN EFENDI BENGKULU 2008/05/30 2020/07/15
RIZKYTA AULIA SUANDI PU P DENI SUANDI PULAU BAR 2005/07/25 2017/07/15
DIAJENG ELVA TARA P SUBROTO ULOK KUPA 2004/08/19 2020/07/15
ENDELITA P SAHRI RAMLI PAGARDIN 2005/05/05 2020/07/15
SEPPIN ISLAMI PADILLAH P ZAINAL ABIDIN AIR RAMI 2005/09/27 2020/07/15
REZKY AMANDA P GUSTI WANTO ULOK KUPA 2005/01/25 2017/07/15
ANDINI RIZKI RACHMAWAT P MOCHAMAD SUCIANTBENGKULU 2005/02/05 2017/07/15
SYIFA AYU ANGGRAINI P GUNAWAN LEBONG 2006/01/30 2020/07/15
PUJI SURYA NING TYAS P RUS'AL DURIAN BU 2006/04/09 2020/07/15
NUR ASSYIFA HANIA PUTRI P HAMKA RETAK MUD 2009/07/19 2021/07/15
GITA PERMATA P WAJIRNO BENTENG 2008/09/26 2021/07/15
AFNI NURFADILLAH P SURATMIN SELUMA 2005/11/21 2018/07/15
FADILA APRILIA P AZIMAN SELUMA 2008/04/22 2020/07/15
RIZKI NUR INDAH SARI P SUPRIONO LINTANG 2005/05/26 2020/07/15
NANDA VERONITA P BAHDER BENGKULU 2005/06/26 2020/07/15
YULI SANTESA P TASWAN MANNA 2005/09/19 2020/07/15
BETHA AYU MUFIDAH P NUSROMADANI BENGKULU 2004/06/02 2020/07/15
GISPA ANANDA RAHMADANP NUSA BANDI BENGKULU 2004/10/26 2020/07/15
ZIVANNYA HAFIDZA PUTRI P AL HADI RETAK MUD 2009/07/17 2021/07/15
FAUZIAH RAHMAH P FAHMI ROZI LEBONG 2006/06/14 2018/07/15
SYIFA KHAIRUNNISA P DEDI ROHMANA ARGA MAK 2007/05/25 2019/07/15
RAHMADANIA P ANADI GEDUNG A 2004/10/15 2020/07/15
NAILAH RIHADATU AISYI N P ABDUSOMAD N BENGKULU 2009/07/06 2020/07/15
QHARIN JULIZA SAKTIANI P IWAN SAKTIAWAN LEBONG 2007/12/07 2020/07/15
NADHIFAH AMALIA GUTA P PUSERI BENGKULU 2007/12/07 2020/07/15
INDAH APRILIA P IZARTEMAN BENGKULU 2007/04/12 2020/07/15
JARINA SAPITRI P ALI JAROT LEBONG 2006/12/05 2020/07/15
M. Ajhi Pratama L Jon Effendi Lebong 2006/07/26 2021/07/15
Rizky Suprastio L Selo Prayitna Tanjung Ha 2006/05/11 2021/07/15
Falaq Fadhillah Raza L Fetriansyah Manna 2006/10/04 2022/07/15
M. Nur Ilham Bintang L Afriyanto Laiz 2007/07/14 2022/07/15
M. Nicky Fridyansah L Ricky. H Banda Aceh 2008/01/30 2021/07/15
M. Hasbi Assidqi L Maryadi Bengkulu 2008/05/09 2022/07/15
Fiki Juniardo L Sujarman Bengkulu 2006/06/29 2021/07/15
Faiz Alfaruq L Piruza Bengkulu 2006/01/13 2021/07/15
Ramah Fitrah Utama L Endang Suryadi Seluma 2007/09/21 2022/07/15
M. Zharfan Dihaga R L Dik dik Sodikin Putri hijau 2008/04/16 2022/07/15
Abdul Latif L M. Sobri Bengkulu 2007/04/26 2022/07/15
fajar Ilahi L M. Mura'I Rahmat Bengkulu 2008/03/24 2022/07/15
Azhar Rahmansyah D L Norman Bengkulu 2008/06/19 2022/07/15
Opick Adrian Z L Susanto Bengkulu 2008/01/15 2022/07/15
Caesar Yhudistira S L Sambodo Padang 2009/01/30 2022/07/15
Fitratul Adli L Adnin Padang 2006/01/12 2022/07/15
Ahmad Aziz Haziq A L Sudarsyah Penyangkak 2008/04/18 2022/07/15
M. Dahfi Okta L L Novi Leon Ipuh 2007/10/06 2022/07/15
Alzharif Raihan Daffa L Benny Bengkulu 2008/04/04 2022/07/15
M. Firgiansyah L Herlianda Ipuh 2006/11/24 2022/07/15
Robert Kueniawan L Dahiran Bengkulu 2007/11/21 2022/07/15
M. Rifqi Y L Mugianto Bengkulu 2007/08/19 2022/07/15
Mahrus Ali M L Mufid Ipuh 2007/04/26 2022/07/15
M. Bilal Hasan A L Purwono Bengkulu 2006/11/13 2022/07/12
M. Alif Alfatir L Irawan Bengkulu 2008/07/18 2022/07/15
Dzakwan Fikriy L Hamzah Bengkulu 2007/12/10 2022/05/17
Faishal M L Ilmahri Seluma 2008/02/13 2022/07/15
M.Fatih A L Riswan Lebong 2008/04/30 2022/07/15
Abizar S L Nizam Bengkulu 2008/07/18 2022/07/15
Arief Ali R L Muzar Putri hijau 2006/10/12 2022/07/15
Dwi Prasetyo L Parimon Kondoran 2006/09/13 2020/07/15
M. Reflih H L Elvis Bengkulu 200/01/25 2020/07/15
M.Arifin L Saafrudin Seluma 2007/07/13 2020/07/15
M. Faiz Nur A L Untung Seluma 2010/05/09 2020/07/15
Ahmad Haddy F L Maykar Bengkulu 2008/05/16 2020/07/15
Rafif Rais L Sudarmadi Bengkulu 2008/12/13 2020/07/15
M. Zaki Diqah P L Gunaidi Lubuklingg 2008/05/20 2020/07/15
Febrian Hanif W L Yudha Klaten 2009/02/09 2020/07/15
Rayhan Arifandi L Andrizal Arma 2007/11/04 2020/07/15
M. Rayhan A L Mariono Bengkulu 2009/06/10 2020/07/15
Imam Iksan L Syahrul Seluma 2006/03/11 2022/07/15
Romi Abdullah L Rahman padang jay 2006/06/16 202/08/04
Alfatih M Y L Tantawi Sekayun 2005/09/16 2021/07/15
Ibrah Mumtaz L Suryadi Lais 2008/10/09 2022/07/15
C.Raka L Asep Lebong 2009/01/10 2020/07/15
Rafi Abdul Hamid Pane L Edi Bengkulu 2006/08/04 2022/07/15
Tatang A L Deni Benteng 2008/05/13 2022/07/15
Rofid Aqil S L Sholehin Bengkulu 2008/12/07 2022/07/15
Ahmad Faishal L Hendri Lebong 2004/04/09 2020/07/30
M. Fahry A L Ridwan Bengkulu 2008/10/11 2020/07/15
Charles Q L Reski G Benteng 2009/04/12 2020/07/15
Abim bintang A L Rizky Hamdani Lebong 2005/25/05 2020/07/15
M. Nabil A L Aprin Kaur 2005/05/15 2020/07/15
M. Hanafi L Jasril Bengkulu 2004/10/07 2020/07/15
Nufail Fahry L Lisman Padang Jay 2007/12/23 2020/07/15
Ilham R L Sasuliadi Sluma 2005/12/14 2020/07/15
M. Sholahuddin L Abdul Haris Airrami 2004/09/01 2019/07/15
Geary Andrean Syaputra L Guntur Sunardi Arga Makmu 2005/10/24 2019/07/15
 FORMULIR PRA IMTIHAN AKHIR SANTRI TPQ METODE QIRAATI
PERIODE RAJAB 1444 H

Nomor Ijazah : (Diisi Oleh Panitia) Nomor Tashih :

Nama Lengkap Peserta : M. A J H I P R A T A MA

L/P : L
Nama Ayah Kandung : J O N E F F E N D I
Tempat Lahir Peserta : L E B O N G
Tgl. Lahir Peserta : Tahun 2 0 0 6 Bulan 0 7 Tanggal 2 6
Tgl. Masuk TPQ : Tahun 2 0 2 1 Bulan 0 7 Tanggal 1 5
No Induk TPQ : 0 6 . 0 8 . 0 1 . 0 0 3 .
Nama TPQ : P O N P E S A L H A S A N A H
Nama Kepala TPQ : N A N I Z A H A R A , S . P D
Alamat TPQ : J L . R A Y A T A L A N G P A U H
Kecamatan : P O N D O K K E L A P A

Dengan ini mendaftarkan sebagai peserta Tashih Akhir Santri TPQ Metode Qiraati Koordinator Cabang
Bengkulu dan bersedia melengkapi persyaratan serta tata tertib tashih yang dibuat oleh panitia. Bersama ini
kami sertakan: pas foto 3 lembar ukuran 3 x 4 tanpa bingkai dan biaya pendaftaran sebesar Rp. 20.000,-/
peserta.
Peremajaan, ……………………….. H
…………………………
Mengetahui Kepala TPQ
Wali Santri

JON EFFENDI NANI ZAHARA, S.PD

Tanda tangan & Stempel Lembaga

Keterangan :
¨ Formulir diperbanyak sesuai kebutuhan
¨ Pengisian data yang jelas, lengkap dan tidak direkayasa
¨ Penempelan foto pada formulir tidak terlalu rekat, dan Foto harus tanpa bingkai
¨ Pembenahan ijazah akibat kesalahan pengisian formulir dikenakan biaya sebesar Rp 50.000,-

Khatam Jilid/Persiapam Khatam Dasar/Lulus Khatam al-Qur’an

Juz
Pra I II III IV V 27 VI Al-Q Ghrb Tjwd Ke-1 Ke-2
Tgl
 Foto 3x4
Warna

(tempel sedikit
bagian tengah
disini)
QIRAATI
1

or Cabang
a. Bersama ini
p. 20.000,-/

……………….. H
………………….. M

AHARA, S.PD
n & Stempel Lembaga

hatam al-Qur’an
Ke-3