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STUDENTS IDENTITY

1. Students Name (full)

____________________________________________________
2. Registration Number : ____________________________________________________
3. Sex

____________________________________________________
4. Place & Date of Birth : ____________________________________________________
5. Phone

: __________________________ mobile

____________________
6. Religion

: ____________________________________________________

7. Son/Daughter of

____________________________________________________
8. Status in Familiy

____________________________________________________
9. Address

: ____________________________________________________

10. Accepted at School


a. at class

____________________________________________________
b. on

: ____________________________________________________

11. Origin School


a. school name

: ____________________________________________________

b. address

____________________________________________________
12. Certificate of Graduated
a. year

: ____________________________________________________

b. number

____________________________________________________
13. Parents Name
a. Father

: ____________________________________________________

b. Mother

: ____________________________________________________

14. Parents Address

____________________________________________________
____________________________________________________
a. Phone

: ___________________________ mobile

___________________
15. Parents Occupation
a. Father

: ____________________________________________________

b. Mother

: ____________________________________________________

16. House of Parent Name

____________________________________________________
17. Address

: ____________________________________________________

18. House of Parents Job

____________________________________________________
Jakarta, _____________________
2013
3x4
_____________________
( ________________________ )

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