Nama : ...............................................
NISN : ...............................................
Kelas : ...............................................
Asal Sekolah : ...............................................
1. Seragam
2. Sepatu
3. Buku
4. ……………….
5. ……………….
6. ……………….
7. ……………….
8. ……………….
9. ……………….
10. ……………….
DST