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    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
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    9 views1 page

    Blanko Piket

    Uploaded by

    Arif Khoirudin Zuhri

    Copyright:

    © All Rights Reserved
    Download as XLSX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    YAYASAN PEMBINAAN DAN PEMBERDAYAAN YAYASAN PEMBINAAN DAN PEMBERDAYAAN

    INSANI HUD INSANI HUD


    SMP BUDI LUHUR SAMARINDA SMP BUDI LUHUR SAMARINDA
    JL BUGIS RT 02 NO 02 MUGIREJO SUNGAI PINANG JL BUGIS RT 02 NO 02 MUGIREJO SUNGAI PINANG
    SURAT IZIN KELUAR / MASUK SURAT IZIN KELUAR / MASUK
    DIBERIKAN IZIN KEPADA DIBERIKAN IZIN KEPADA

    NAMA : ….............................................................. NAMA : …..............................................................


    KELAS : ….............................................................. KELAS : …..............................................................
    WAKTU : ….............................................................. WAKTU : …..............................................................
    KELUAR PUKUL : ….............................................................. KELUAR PUKUL : …..............................................................
    MASUK PUKUL : ….............................................................. MASUK PUKUL : …..............................................................
    ALASAN : ….............................................................. ALASAN : …..............................................................
    SAMARINDA, …............ 202.. SAMARINDA, …............ 202..
    GURU PIKET GURU PIKET

    (….............................) (….............................)

    YAYASAN PEMBINAAN DAN PEMBERDAYAAN YAYASAN PEMBINAAN DAN PEMBERDAYAAN


    INSANI HUD INSANI HUD
    SMP BUDI LUHUR SAMARINDA SMP BUDI LUHUR SAMARINDA
    JL BUGIS RT 02 NO 02 MUGIREJO SUNGAI PINANG JL BUGIS RT 02 NO 02 MUGIREJO SUNGAI PINANG
    SURAT IZIN KELUAR / MASUK SURAT IZIN KELUAR / MASUK
    DIBERIKAN IZIN KEPADA DIBERIKAN IZIN KEPADA

    NAMA : ….............................................................. NAMA : …..............................................................


    KELAS : ….............................................................. KELAS : …..............................................................
    WAKTU : ….............................................................. WAKTU : …..............................................................
    KELUAR PUKUL : ….............................................................. KELUAR PUKUL : …..............................................................
    MASUK PUKUL : ….............................................................. MASUK PUKUL : …..............................................................
    ALASAN : ….............................................................. ALASAN : …..............................................................
    SAMARINDA, …............ 202.. SAMARINDA, …............ 202..
    GURU PIKET GURU PIKET

    (….............................) (….............................)

    YAYASAN PEMBINAAN DAN PEMBERDAYAAN YAYASAN PEMBINAAN DAN PEMBERDAYAAN


    INSANI HUD INSANI HUD
    SMP BUDI LUHUR SAMARINDA SMP BUDI LUHUR SAMARINDA
    JL BUGIS RT 02 NO 02 MUGIREJO SUNGAI PINANG JL BUGIS RT 02 NO 02 MUGIREJO SUNGAI PINANG
    SURAT IZIN KELUAR / MASUK SURAT IZIN KELUAR / MASUK
    DIBERIKAN IZIN KEPADA DIBERIKAN IZIN KEPADA

    NAMA : ….............................................................. NAMA : …..............................................................


    KELAS : ….............................................................. KELAS : …..............................................................
    WAKTU : ….............................................................. WAKTU : …..............................................................
    KELUAR PUKUL : ….............................................................. KELUAR PUKUL : …..............................................................
    MASUK PUKUL : ….............................................................. MASUK PUKUL : …..............................................................
    ALASAN : ….............................................................. ALASAN : …..............................................................
    SAMARINDA, …............ 202.. SAMARINDA, …............ 202..
    GURU PIKET GURU PIKET

    (….............................) (….............................)

    YAYASAN PEMBINAAN DAN PEMBERDAYAAN YAYASAN PEMBINAAN DAN PEMBERDAYAAN


    INSANI HUD INSANI HUD
    SMP BUDI LUHUR SAMARINDA SMP BUDI LUHUR SAMARINDA
    JL BUGIS RT 02 NO 02 MUGIREJO SUNGAI PINANG JL BUGIS RT 02 NO 02 MUGIREJO SUNGAI PINANG
    SURAT IZIN KELUAR / MASUK SURAT IZIN KELUAR / MASUK
    DIBERIKAN IZIN KEPADA DIBERIKAN IZIN KEPADA

    NAMA : ….............................................................. NAMA : …..............................................................


    KELAS : ….............................................................. KELAS : …..............................................................
    WAKTU : ….............................................................. WAKTU : …..............................................................
    KELUAR PUKUL : ….............................................................. KELUAR PUKUL : …..............................................................
    MASUK PUKUL : ….............................................................. MASUK PUKUL : …..............................................................
    ALASAN : ….............................................................. ALASAN : …..............................................................
    SAMARINDA, …............ 202.. SAMARINDA, …............ 202..
    GURU PIKET GURU PIKET

    (….............................) (….............................)

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