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BUKU IURAN

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					                                             BUKU IURAN
NAMA : .............................................................................................................................

                                      TANGGAL
        BULAN                                                            JUMLAH                              PARAF
                                       BAYAR
    JANUARI
    FEBRUARI
    MARET
    APRIL
    MEI
    JUNI
    JULI
    AGUSTUS
    SEPTEMBER
    OKTOBER
    NOPEMBER
    DESEMBER

Catatan :

-    Tunaikan kewajiban semata-mata karena Allah SWT selambat-lambatnya

     tanggal 15 tiap-tiap bulan

-    Kartu ini sebagai bukti amanah yang dibebankan kepadamu

-    Infak uang kartu Rp. 1.000,-
                         IDENTITAS SANTRI / SANTRIWATI



1. Nama santri/santriwati                   : ........................................................................

2. Nomor Induk                              : ........................................................................

3. Tempat Tanggal Lahir                     : ........................................................................

4. Jenis Kelamin                            : ........................................................................

5. Alamat Santri/santriwati : .........................................................................

6. Nama orang tua

    a. Ayah                                 : .........................................................................

    b. Ibu                                  : ........................................................................

7. Pekerjaan Orang tua

    a. Ayah                                 : .........................................................................

    b. Ibu                                  : .........................................................................

8. Alamat orang tua

    a. Ayah                                 : ........................................................................

                                              ........................................................................

    b. Ibu                                  : ........................................................................

                                              ........................................................................

    c. Nama Wali                            : ........................................................................

    d. Pekerjaan Wali                       : ........................................................................

    e. Alamat wali                          : ........................................................................


                                                         Langsa, ..............................................
                                                                   Kepala Sekolah
                                                               TPA Asy-Syakirin




                                                                        MILA KARMILA
                                 TPA ASY-SYAKIRIN
                  JLN. DURIAN RAYA PERUMNAS- DESA PB. SEULEMAK KEC. LANGSA BARO




                                FORMULIR PENDAFTARAN



NO PENDAFTARAN                            : ...........................................................................

NAMA SANTRI/SANTRIWATI : ...........................................................................

TEMPAT / TANGGAL LAHIR                    : ...........................................................................



NAMA ORANG TUA

A. AYAH                                   : ...........................................................................

B. IBU                                    : ...........................................................................

PEKERJAAN ORANG TUA

A. AYAH                                   : ...........................................................................

B. IBU                                    : ...........................................................................

ALAMAT                                    : ...........................................................................



                                                       LANGSA, 01 JANUARI 2011
                                                           WALI SANTRI,




                                                  ............................................................

				
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