BUKU INDUK

Pas Fhoto
3X4

I.SISWA
: NOMOR INDUK :..................................................................
1. Nama
: ....................................................................................................
2. Jenis Kelamain
: ....................................................................................................
3. Tempat dan Tanggal Lahir : ...................................................................................................
4. Anak Ke
: ....................................................................................................
5. Jumlah Saudara
: Kandung : ....................................Orang
Tiri
: ..................................... Orang
6. Alamat
: ....................................................................................................
....................................................................................................
II. ORANG TUA WALI
7. Nama Orang Tua
: Ayah................................................Ibu.......................................
8. Pendidikan Orang Tua
: Ayah................................................Ibu.......................................
9. Pekerjaan Orang Tua
: Ayah................................................Ibu.......................................
10. Agama
: Ayah................................................Ibu.......................................
11. Alamat Orang Tua
: ....................................................................................................
12. Nama Wali
: ....................................................................................................
13. Pendidikan Wali
: ....................................................................................................
14. Agama
: ....................................................................................................
15. Alamat
: ....................................................................................................
16. Masuk di MI Tahun
:
Pas Fhoto

BUKU INDUK

3X4

I.SISWA
: NOMOR INDUK :..................................................................
1. Nama
: ....................................................................................................
2. Jenis Kelamain
: ....................................................................................................
3. Tempat dan Tanggal Lahir : ...................................................................................................
4. Anak Ke
: ....................................................................................................
5. Jumlah Saudara
: Kandung : ....................................Orang
Tiri
: ..................................... Orang
6. Alamat
: ....................................................................................................
....................................................................................................
II. ORANG TUA WALI
7. Nama Orang Tua
: Ayah................................................Ibu.......................................
8. Pendidikan Orang Tua
: Ayah................................................Ibu.......................................
9. Pekerjaan Orang Tua
: Ayah................................................Ibu.......................................
10. Agama
: Ayah................................................Ibu.......................................
11. Alamat Orang Tua
: ....................................................................................................
12. Nama Wali
: ....................................................................................................
13. Pendidikan Wali
: ....................................................................................................
14. Agama
: ....................................................................................................
15. Alamat
: ....................................................................................................
16. Masuk di MI Tahun

MADRASAH IBTIDAIYAH NAHDLATUL

WATHAN KEKALE DESA SENGKOL
KECAMATAN PUJUT KABUPATEN
LOMBOK TENGAH

PROVINSI
NUSA TENGGARA BARAT

BUKU INDUK SISWA

TAHUN 2005