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NO.

FORMULIR DATA PESERTA KSN

l DATA DIRI
1 NAMA Ibnu Amal
2 AGAMA Islam
3 NO. HP 085215635854
4 EMAIL Ibnussst22@gmail.com
5 ALAMAT Mario
6 DATA PRESTASI -

ll DATA ORANG TUA


1 NAMA Rusliati
NO. HP 085219574366
ALAMAT Mario
KARTU INDONESIA PINTAR -

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