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PEMERINTAH PROVINSI DAERAH KHUSUS IBUKOTA JAKARTA

DINAS PENDIDIKAN
SDN PULOGEBANG 04
Jl. Rawa Bebek RT.02/01 Kelurahan Pulogebang KecamatanCakung Jakarta Timur
Telp. (021) 88957170 e-mail: sdn.pulogebang.4@gmail.com

BIODATA
A. SISWA

Nama (Sesuai akte kelahiran) :……………………………………………………………………………………………………………...

Jenis Kelamin :……………………………………………………………………………………………………………...

Tempat,Tgl lahir :……………………………………………………………………………………………………………..

Agama :……………………………………………………………………………………………………………..

Anak no :………………………………………………………………………………………………………………

Jumlah Saudara : ……………………………………………………………………………………………………………..

Berat Badan :………………………………………………………………………………………………………………

Tinggi Badan :……………………………………………………………………………………………………………..

Hobbi :……………………………………………………………………………………………………………..

Alamat :……………………………………………………………………………………………………………..

……………………………………………………………………………………………………………..
B. ORANGTUA

Nama (ayah) :……………………………………………………………………………………………………………..

Umur :……………………………………………………………………………………………………………..

Pendidikan Tertinggi :……………………………………………………………………………………………………………..

Pekerjaan :……………………………………………………………………………………………………………..

Agama :……………………………………………………………………………………………………………..

Alamat :……………………………………………………………………………………………………………..

……………………………………………………………………………………………………………..

Nama (Ibu) :……………………………………………………………………………………………………………..

Umur :……………………………………………………………………………………………………………..

Pendidikan Tertinggi :……………………………………………………………………………………………………………..

Pekerjaan :……………………………………………………………………………………………………………..

Agama :……………………………………………………………………………………………………………..

Alamat :……………………………………………………………………………………………………………..

………………………………………………………………………………………………………………

Jakarta, 2021
Hormat kami,

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