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NAILUL AUTHAR MODERN ISLAMIC BOARDING SCHOOL

STUDENT GUIDANCE SECTION


Street Negara Danau Usung, District Murung Regency Murung Raya Middle Borneo Potal Code 73911 Telp. 0821 5006 4059

License Sheet
Number : 18/Liburan Umum/2UY/XII/2022

With this license sheet we as Student Guidance Staff of Nailul Authar Islamic Modern Boarding
School, we give permission to :

Name : Ahmad Wijaya


Class : 2 ‘Ulya
Id Number :
Necessity : Liburan Mingguan
Destination : Benao Hulu
Parent : Syahrani
Room : Darul Faidzin
Homeroom Teacher : Ustz. Siti Ummi Lathifah
Apply : 27 Desember 2022 s/d 04 Januari 2023 M

Thus, we have made this licene sheet so that you are aware of it. And can be used properly.

Danau Usung, December 26th 2022 M

Chief of OSNA Security Section Treasure of OSNA

Danang Riadi M. Misfhulani Uswatun Hasanah

Knowling,
Parent Student Guidance

Syahrani Mr. Achmad Farij Alal M., S.Pd.

Keterangan :
 Surat izin ini supaya tidak rusak dan hilang
 Surat izin ini supaya dibawa kembali saat kembali tiba ke Pondok
 Supaya tetap menjaga nama baik Pondok saat liburan berlangsung
 Kembali ke Pondok sebelum pukul 16.30 WIB
 Jika ada keterlambatan kembali ke Pondok harap konfirmasi kepada Ust/zh Bagian Pengasuhan
Santri

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