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FORMULIR PENDAFTARAN SMPN 1 CIPEUCANG TAHUN PELAJARAN 2019/ 2020
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NO PENDAFTARAN
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NAMA LENGKAP
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NISN
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JENIS KELAMIN
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LAKI-LAKI
PEREMPUAN
TEMPAT LAHIR
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TANGGAL LAHIR
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MM
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DD
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YYYY
SEKOLAH ASAL
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ALAMAT JALAN
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NAMA DUSUN/ KAMPUNG
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RT/RW
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NAMA KELURAHAN/ DESA
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KECAMATAN
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NIK CALON PESERTA DIDIK
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NO REGISTRASI AKTA LAHIR
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AGAMA
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ISLAM
KRISTEN/ PROTESTAN
LAINNYA
KEWARGANEGARAAN
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WNI
WNA
KODE POS
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TEMPAT TINGGAL
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BERSAMA ORANG TUA
WALI
LAINNYA
MODE TRANSPORTASI
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NO KARTU KELUARGA SEJAHTERA (APABILA MENERIMA)
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ANAK KEBERAPA
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NOM KPS/ PKH (APABILA MENERIMA)
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NO KIP (APABILA MENERIMA)
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NAMA YANG TERTERA DI KIP
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NAMA AYAH KANDUNG
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NIK AYAH KANDUNG
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TAHUN LAHIR AYAH KANDUNG
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PENDIDIKAN TERAKHIR AYAH KANDUNG
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PEKERJAAN AYAH KANDUNG
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PENGHASILAN BULANAN AYAH KANDUNG
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NAMA IBU KANDUNG
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NIK IBU KANDUNG
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TAHUN LAHIR IBU KANDUNG
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PENDIDIKAN TERAKHIR IBU KANDUNG
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PEKERJAAN IBU KANDUNG
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PENGHASILAN BULANAN IBU KANDUNG
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NAMA WALI
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NIK WALI
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TAHUN LAHIR WALI
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PENDIDIKAN WALI
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PEKERJAAN WALI
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PENGHASILAN WALI
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NOMOR TELEPON RUMAH/ HP
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JENIS EKSTRA KURIKULER YANG DIMINATI
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