NAMA
NAMA PENDETA/ SASARAN MATERI
NO HARI/TGL KETERANGAN MENGETAHUI
GEREJA/SEKOLAH GURU/ PEMBINAAN PEMBINAAN
PETUGAS LAIN
1 2 3 4 5 6 7 8
Kepala ...................................
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NIP.
Kepala ...................................
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NIP.
Kepala ...................................
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NIP.
Kepala ...................................
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NIP.