Anda di halaman 1dari 2

R A N P RI BADI AN

A PO A K
L
KBM
KELOMPOK BELAJAR MANDIRI

NAMA :................................................

NO.INDUK :...............................................
BIODATA ANAK DIDIK
1. Nama :........................................................................

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

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

2. Tempat, Tanggal Lahir :........................................................................

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

4. Agama :........................................................................

5. Alamat :........................................................................

6. Orang Tua/Wali :........................................................................

a. Nama Ayah :........................................................................

b. Nama Ibu :........................................................................

c. Nama Wali :........................................................................

d. Pekerjaan :........................................................................

e. Alamat :........................................................................

7. Diterima di KBM :........................................................................

Jakarta, ........................., 20.......


Kepala KBM An-Nahl

Anda mungkin juga menyukai