M M M

ub M da
ya ub M ay ub
IS
t IS tu t ad IS at ta
d H
ad H H ul
M iin * i
M iin * id lM iin * id M
M ay ub M ay ub
ub
t IS a ta IS

.6 _ _
ta IS at ad tu d H
di H ul H l M iin * id
in * id M iin * id M
M ay ub M ay ub
IS
ay
at
IS at ta IS at ta u
H ul di H ul di H l
iin * id M in * id M in * id
a

2. NIS
M M a ub M

b. Ibu
b. Ibu
3. NISN
ay ub ya IS ya

6. Agama
t IS ta

a. Ayah
a. Ayah
IS tu

8. Anak ke
at ad tu H l
H ul H di
M

a. Di kelas
* id M iin * id lM in * id
a
M

11. Sekolah Asal

M M ub

5. Jenis Kelamin
ay ub ay ub ya

Pekerjaan Wali
b. Pada tanggal
IS at ta IS at ta IS tu ta
d

13. Nama Orang Tua

H l di

16. Nama Wali Siswa

H ul i

14. Alamat Orang Tua

H ul di M

Alamat Wali Siswa

M iin * id
1. Nama Peserta Didik
* M in * id

15. Pekerjaan Orang Tua

id M

9. Alamat Peserta Didik

M ay ub
4. Tempat Tanggal Lahir

7. Status dalam Keluarga

M ay

12. Diterima di sekolah ini

ay ub ub
t IS at ta IS at ta
IS at ad H ul di H ul d

3x4
H

10. Nomor Telepon Rumah/HP

ul M

Foto
iin
id M iin * id M in * id
ay ub M ay ub M ay ub
at ta IS at ta IS at ta
d H

:
:
:
:
:
u H ul ul di
di M in

:-
:I
M *
:2
iin id
id lM in * id M a
ay ub M ay ub ya ub
: Islam

IS at ta IS tu ta
ta d

: Sukarti
at H l
H ul di
: Laki-laki

ul di
M * M iin *

: A. Slamet
M in * id in id M
M M

: 18 Juli 2016
: 3092740107

ay

: Desa Pragen
: Desa Pragen
ub ay ub ub
ta IS at ta IS
: Anak Kandung

IS at d

: Petani/Peternak
: Petani/Peternak
ta H
: 6288232841936
di H ul di H ul
M iin * i
M in * id M in * id
a M
M ay ub M ya ub
: 111233170020160001

ub IS ta IS
IS at ta tu

Kepala Madrasah
ta
H ul di H l d H
di
M in * id M iin * id
: Rembang, 12 Oktober 2009

in * id M M ay

Ashiful Faizin, S.Pd.I

M

Rembang, 18 Juli 2016

ay ub ay ub
IS a
IS at ta tu
: TK Hidayatul Mubtadiin Pragen

IS at ta d H l
Jl. Ngemplakrejo KM.05 Desa Pragen

H ul

NIP. 197807162007101003
H ul di
M *
IDENTITAS PESERTA DIDIK

iin
: ACHMAD MUJIBURROCHMAN

in * M in * id id
M
id
ay ub M a ya ub M a ya
IS a ta IS tu ta IS tu
tu d H
MIS HIDAYATUL MUBTADIIN

H l
Kecamatan Pamotan, Kabupaten Rembang - Jawa Tengah

H di
M iin * id lM
KEMENTERIAN AGAMA REPUBLIK INDONESIA

* id lM in * id M
M ay ub M ay ub
IS
ay
a
ub
ta
IS at ta IS at ta tu
H ul H ul d H l di
M
di
in * id M iin * id M in
* id M M a ub
M ay ub ay ub
IS ya ta
IS a tu ta IS at ta
d H
tu di
H di H ul
M iin * id lM in
id lM in * id M
ay ub M ay ub
IS
ay
a
ub
ta
at ta IS at ta tu d
ul H ul d H l *
di
M * M iin

Halaman 1
iin id
id M in * id M a
ay ub M ay ub
IS ya ub
ta
at ta IS at ta tu d
ul di H ul di
i H lM iin *
i
 M M M
ub M da
ya ub M ay ub
IS
t IS tu t ad IS at ta
d H
ad H H ul
M iin * i
M iin * id lM iin * id M
M ay ub M ay ub
ub
t IS a ta IS

.6 _ _
ta IS at ad tu d H
di H ul H l M iin * id
in * id M iin * id M
M ay ub M ay ub
IS
ay
at
IS at ta IS at ta u
H ul di H ul di H l
iin * id M in * id M in * id
a

2. NIS
M M a ub M

b. Ibu
b. Ibu
3. NISN
ay ub ya IS ya

6. Agama
t IS ta

a. Ayah
a. Ayah
IS tu

8. Anak ke
at ad tu H l
H ul H di
M

a. Di kelas
* id M iin * id lM in * id
a
M

11. Sekolah Asal

M M ub

5. Jenis Kelamin
ay ub ay ub ya

Pekerjaan Wali
b. Pada tanggal
IS at ta IS at ta IS tu ta
d

13. Nama Orang Tua

H l di

16. Nama Wali Siswa

H ul i

14. Alamat Orang Tua

H ul di M

Alamat Wali Siswa

M iin * id
1. Nama Peserta Didik
* M in * id

15. Pekerjaan Orang Tua

id M

9. Alamat Peserta Didik

M ay ub
4. Tempat Tanggal Lahir

7. Status dalam Keluarga

M ay

12. Diterima di sekolah ini

ay ub ub
t IS at ta IS at ta
IS at ad H ul di H ul d

3x4
H

10. Nomor Telepon Rumah/HP

ul M

Foto
iin
id M iin * id M in * id
ay ub M ay ub M ay ub
at ta IS at ta IS at ta
d H

:
:
:
:
:
u H ul ul di
di M in

:-
:I
M *
:2
iin id
id lM in * id M a
ay ub M ay ub ya ub
: Islam

IS at ta IS tu ta
at ta H d

: Fitriyah
H ul di l
: Laki-laki

ul di M iin *

: Nur Sa`di
M in * id M in * id M
M M

: 18 Juli 2016
: 3102991732

ay

: Desa Pragen
: Desa Pragen
ub ay ub ub
ta IS at ta IS
: Anak Kandung

IS at d

: Petani/Peternak
: Petani/Peternak
ta H
: 6281225566319
H ul
: AHMAD NAJIB

di H ul
M
di
in * id M iin * i
M in * id M a M
M ay ub ya ub
: 111233170020160002

ub IS ta IS
IS at ta tu

Kepala Madrasah
ta
H ul di H l d H
di
* M in * id M iin * id
: Rembang, 21 Februari 2010

in id M M ay

Ashiful Faizin, S.Pd.I

M

Rembang, 18 Juli 2016

ay ub ay ub
IS a
IS at ta tu
: TK Hidayatul Mubtadiin Pragen

IS at ta d H l
Jl. Ngemplakrejo KM.05 Desa Pragen

H ul

NIP. 197807162007101003
H ul di
M *
IDENTITAS PESERTA DIDIK

iin id
in * id M in * id
a M a
M ay ub M ya ub
IS ya
IS a tu ta IS tu ta
d H
tu
MIS HIDAYATUL MUBTADIIN

H l
Kecamatan Pamotan, Kabupaten Rembang - Jawa Tengah

H di
M iin * id lM
KEMENTERIAN AGAMA REPUBLIK INDONESIA

* id lM in * id M
M ay ub M ay ub
IS
ay
a
ub
ta
IS at ta IS at ta tu
H ul H ul d H l di
M
di
in * id M iin * id M in
* id M M a ub
M ay ub ay ub
IS ya ta
IS a tu ta IS at ta
d H
tu di
H di H ul
M iin * id lM in
id lM in * id M
ay ub M ay ub
IS
ay
a
ub
ta
at ta IS at ta tu d
ul H ul d H l *
di
M * M iin

Halaman 2
iin id
id M in * id M a
ay ub M ay ub
IS ya ub
ta
at ta IS at ta tu d
ul di H ul di
i H lM iin *
i
 M M M
ub M da
ya ub M ay ub
IS
t IS tu t ad IS at ta
d H
ad H H ul
M iin * i
M iin * id lM iin * id M
M ay ub M ay ub
ub
t IS a ta IS

.6 _ _
ta IS at ad tu d H
di H ul H l M iin * id
in * id M iin * id M
M ay ub M ay ub
IS
ay
at
IS at ta IS at ta u
H ul di H ul di H l
iin * id M in * id M in * id
a

2. NIS
M M a ub M

b. Ibu
b. Ibu
3. NISN
ay ub ya IS ya

6. Agama
t IS ta

a. Ayah
a. Ayah
IS tu

8. Anak ke
at ad tu H l
H ul H di
M

a. Di kelas
* id M iin * id lM in * id
a
M

11. Sekolah Asal

M M ub

5. Jenis Kelamin
ay ub ay ub ya

Pekerjaan Wali
b. Pada tanggal
IS at ta IS at ta IS tu ta
d

13. Nama Orang Tua

H l di

16. Nama Wali Siswa

H ul i

14. Alamat Orang Tua

H ul di M

Alamat Wali Siswa

M iin * id
1. Nama Peserta Didik
* M in * id

15. Pekerjaan Orang Tua

id M

9. Alamat Peserta Didik

M ay ub
4. Tempat Tanggal Lahir

7. Status dalam Keluarga

M ay

12. Diterima di sekolah ini

ay ub ub
t IS at ta IS at ta
IS at ad H ul di H ul d

3x4
H

10. Nomor Telepon Rumah/HP

ul M

Foto
iin
id M iin * id M in * id
ay ub M ay ub M ay ub
at ta IS at ta IS at ta
d H

:
:
:
:
:
u H ul ul di
di M in

:-
:I
M *
:1
iin id
id lM in * id M a
ay ub M ay ub ya ub
: Islam

IS at ta IS tu ta
at ta
H ul di H l d
: Laki-laki

ul di
M in * id M iin *

: Mukhlisin
M in * id M M
M

: 18 Juli 2016
: 3109767343

ay

: Desa Pragen
: Desa Pragen
ub ay ub ub
ta IS at ta IS
: Anak Kandung

IS at d

: Petani/Peternak
: Petani/Peternak
ta H

: Siti Nur Akidah

: 6282324878167
di H ul di H ul
M iin * i
M in * id M in * id
a M
M ay ub M ya ub
: 111233170020160003

ub IS ta IS
IS at ta tu

Kepala Madrasah
ta d H
: Rembang, 15 April 2010

di H ul di H l M iin * id
in * id M in * id M
M ay

Ashiful Faizin, S.Pd.I

M

Rembang, 18 Juli 2016

ay ub ay ub
IS a
: AHMAD AKHSINUL IQYAN

IS at ta tu
: TK Hidayatul Mubtadiin Pragen

IS at ta d H l
Jl. Ngemplakrejo KM.05 Desa Pragen

H ul

NIP. 197807162007101003
H ul di
M *
IDENTITAS PESERTA DIDIK

iin id
in * id M in * id
a M a
M ay ub M ya ub
IS ya
IS a tu ta IS tu ta
d H
tu
MIS HIDAYATUL MUBTADIIN

H l
Kecamatan Pamotan, Kabupaten Rembang - Jawa Tengah

H di
M iin * id lM
KEMENTERIAN AGAMA REPUBLIK INDONESIA

* id lM in * id M
M ay ub M ay ub
IS
ay
a
ub
ta
IS at ta IS at ta tu
H ul H ul d H l di
M
di
in * id M iin * id M in
* id M M a ub
M ay ub ay ub
IS ya ta
IS a tu ta IS at ta
d H
tu di
H di H ul
M iin * id lM in
id lM in * id M
ay ub M ay ub
IS
ay
a
ub
ta
at ta IS at ta tu d
ul H ul d H l *
di
M * M iin

Halaman 3
iin id
id M in * id M a
ay ub M ay ub
IS ya ub
ta
at ta IS at ta tu d
ul di H ul di
i H lM iin *
i
 M M M
ub M da
ya ub M ay ub
IS
t IS tu t ad IS at ta
d H
ad H H ul
M iin * i
M iin * id lM iin * id M
M ay ub M ay ub
ub
t IS a ta IS

.6 _ _
ta IS at ad tu d H
di H ul H l M iin * id
in * id M iin * id M
M ay ub M ay ub
IS
ay
at
IS at ta IS at ta u
H ul di H ul di H l
iin * id M in * id M in * id
a

2. NIS
M M a ub M

b. Ibu
b. Ibu
3. NISN
ay ub ya IS ya

6. Agama
t IS ta

a. Ayah
a. Ayah
IS tu

8. Anak ke
at ad tu H l
H ul H di
M

a. Di kelas
* id M iin * id lM in * id
a
M

11. Sekolah Asal

M M ub

5. Jenis Kelamin
ay ub ay ub ya

Pekerjaan Wali
b. Pada tanggal
IS at ta IS at ta IS tu ta
d

13. Nama Orang Tua

H l di

16. Nama Wali Siswa

H ul i

14. Alamat Orang Tua

H ul di M

Alamat Wali Siswa

M iin * id
1. Nama Peserta Didik
* M in * id

15. Pekerjaan Orang Tua

id M

9. Alamat Peserta Didik

M ay ub
4. Tempat Tanggal Lahir

7. Status dalam Keluarga

M ay

12. Diterima di sekolah ini

ay ub ub
t IS at ta IS at ta
IS at ad H ul di H ul d

3x4
H

10. Nomor Telepon Rumah/HP

ul M

Foto
iin
id M iin * id M in * id
ay ub M ay ub M ay ub
at ta IS at ta IS at ta
d H

:
:
:
:
:
u H ul ul di
di M in

:-
:I
M *
:1
iin id
id lM in * id M a
ay ub M ay ub ya ub
: Islam

IS at ta IS tu ta
at ta H l d

: Rasdani
H ul di
: Laki-laki

ul
M
di
in * id M in * id M iin *
M M M

: 18 Juli 2016
: 3097385429

ay

: Desa Pragen
: Desa Pragen
ub ay ub ub
ta IS at ta IS
: Anak Kandung

IS at d

: Petani/Peternak
: Petani/Peternak
ta H
: 6282324077087
di H ul di H ul
M iin * i
M in * id M in * id
a M
M ay ub M ya ub
: 111233170020160004

ub IS

: Henny Sulistyaningsih
IS at ta IS tu ta

Kepala Madrasah
ta
H ul di H l d H
di
in * id M in * id M iin * id
M M ay

Ashiful Faizin, S.Pd.I

M

Rembang, 18 Juli 2016

ay ub
: Rembang, 13 September 2009

ay ub
IS at ta IS a tu
: TK Hidayatul Mubtadiin Pragen

IS at ta d H l
Jl. Ngemplakrejo KM.05 Desa Pragen

H ul

NIP. 197807162007101003
H ul di
M *
IDENTITAS PESERTA DIDIK

iin id
in * id M in * id
a M a
M M ub
: AHMAD HAYDAR JAMALULLAIL

ay ub ya IS ya
IS a tu ta IS tu ta
d H
tu
MIS HIDAYATUL MUBTADIIN

H l
Kecamatan Pamotan, Kabupaten Rembang - Jawa Tengah

H di
M iin * id lM
KEMENTERIAN AGAMA REPUBLIK INDONESIA

* id lM in * id M
M ay ub M ay ub
IS
ay
a
ub
ta
IS at ta IS at ta tu
H ul H ul d H l di
M
di
in * id M iin * id M in
* id M M a ub
M ay ub ay ub
IS ya ta
IS a tu ta IS at ta
d H
tu di
H di H ul
M iin * id lM in
id lM in * id M
ay ub M ay ub
IS
ay
a
ub
ta
at ta IS at ta tu d
ul H ul d H l *
di
M * M iin

Halaman 4
iin id
id M in * id M a
ay ub M ay ub
IS ya ub
ta
at ta IS at ta tu d
ul di H ul di
i H lM iin *
i
 M M M
ub M da
ya ub M ay ub
IS
t IS tu t ad IS at ta
d H
ad H H ul
M iin * i
M iin * id lM iin * id M
M ay ub M ay ub
ub
t IS a ta IS

.6 _ _
ta IS at ad tu d H
di H ul H l M iin * id
in * id M iin * id M
M ay ub M ay ub
IS
ay
at
IS at ta IS at ta u
H ul di H ul di H l
iin * id M in * id M in * id
a

2. NIS
M M a ub M

b. Ibu
b. Ibu
3. NISN
ay ub ya IS ya

6. Agama
t IS ta

a. Ayah
a. Ayah
IS tu

8. Anak ke
at ad tu H l
H ul H di
M

a. Di kelas
* id M iin * id lM in * id
a
M

11. Sekolah Asal

M M ub

5. Jenis Kelamin
ay ub ay ub ya

Pekerjaan Wali
b. Pada tanggal
IS at ta IS at ta IS tu ta
d

13. Nama Orang Tua

H l di

16. Nama Wali Siswa

H ul i

14. Alamat Orang Tua

H ul di M

Alamat Wali Siswa

M iin * id
1. Nama Peserta Didik
* M in * id

15. Pekerjaan Orang Tua

id M

9. Alamat Peserta Didik

M ay ub
4. Tempat Tanggal Lahir

7. Status dalam Keluarga

M ay

12. Diterima di sekolah ini

ay ub ub
t IS at ta IS at ta
IS at ad H ul di H ul d

3x4
H

10. Nomor Telepon Rumah/HP

ul M

Foto
iin
id M iin * id M in * id
ay ub M ay ub M ay ub
at ta IS at ta IS at ta
d H

:
:
:
:
:
u H ul ul di
di M in

:-
:I
M *
:2
iin id
id lM in * id M a
ay ub M ay ub ya ub
: Islam

IS at ta IS tu ta
at ta
H ul di H l d
: Laki-laki

ul
M
di
in * id M in * id M iin *
M

: Siti Qoniah
M M

: 18 Juli 2016
: 3103322651

ay

: Desa Pragen
: Desa Pragen
ub ay ub ub
IS ta IS

: Rozikin (Alm)
ta at
: Anak Kandung

IS at d

: Petani/Peternak
: Petani/Peternak
ta H
: 6285291758298
di H ul di H ul
M iin * i
M in * id M in * id
a M
M ay ub M ya ub
: 111233170020160005

ub IS ta IS
: Rembang, 12 Juni 2010

IS at ta tu

Kepala Madrasah
ta
H ul di H l d H
di
in * id M in * id M iin * id
M
: AHMAD KHARIRI AQILA

M ay

Ashiful Faizin, S.Pd.I

M

Rembang, 18 Juli 2016

ay ub ay ub
IS a
IS at ta tu
: TK Hidayatul Mubtadiin Pragen

IS at ta d H l
Jl. Ngemplakrejo KM.05 Desa Pragen

H ul

NIP. 197807162007101003
H ul di
M *
IDENTITAS PESERTA DIDIK

iin id
in * id M in * id
a M a
M ay ub M ya ub
IS ya
IS a tu ta IS tu ta
d H
tu
MIS HIDAYATUL MUBTADIIN

H l
Kecamatan Pamotan, Kabupaten Rembang - Jawa Tengah

H di
M iin * id lM
KEMENTERIAN AGAMA REPUBLIK INDONESIA

* id lM in * id M
M ay ub M ay ub
IS
ay
a
ub
ta
IS at ta IS at ta tu
H ul H ul d H l di
M
di
in * id M iin * id M in
* id M M a ub
M ay ub ay ub
IS ya ta
IS a tu ta IS at ta
d H
tu di
H di H ul
M iin * id lM in
id lM in * id M
ay ub M ay ub
IS
ay
a
ub
ta
at ta IS at ta tu d
ul H ul d H l *
di
M * M iin

Halaman 5
iin id
id M in * id M a
ay ub M ay ub
IS ya ub
ta
at ta IS at ta tu d
ul di H ul di
i H lM iin *
i
 M M M
ub M da
ya ub M ay ub
IS
t IS tu t ad IS at ta
d H
ad H H ul
M iin * i
M iin * id lM iin * id M
M ay ub M ay ub
ub
t IS a ta IS

.6 _ _
ta IS at ad tu d H
di H ul H l M iin * id
in * id M iin * id M
M ay ub M ay ub
IS
ay
at
IS at ta IS at ta u
H ul di H ul di H l
iin * id M in * id M in * id
a

2. NIS
M M a ub M

b. Ibu
b. Ibu
3. NISN
ay ub ya IS ya

6. Agama
t IS ta

a. Ayah
a. Ayah
IS tu

8. Anak ke
at ad tu H l
H ul H di
M

a. Di kelas
* id M iin * id lM in * id
a
M

11. Sekolah Asal

M M ub

5. Jenis Kelamin
ay ub ay ub ya

Pekerjaan Wali
b. Pada tanggal
IS at ta IS at ta IS tu ta
d

13. Nama Orang Tua

H l di

16. Nama Wali Siswa

H ul i

14. Alamat Orang Tua

H ul di M

Alamat Wali Siswa

M iin * id
1. Nama Peserta Didik
* M in * id

15. Pekerjaan Orang Tua

id M

9. Alamat Peserta Didik

M ay ub
4. Tempat Tanggal Lahir

7. Status dalam Keluarga

M ay

12. Diterima di sekolah ini

ay ub ub
t IS at ta IS at ta
IS at ad H ul di H ul d

3x4
H

10. Nomor Telepon Rumah/HP

ul M

Foto
iin
id M iin * id M in * id
ay ub M ay ub M ay ub
at ta IS at ta IS at ta
d H

:
:
:
:
:
u H ul ul di
di M in

:-
:I
M *
:1
iin id
id lM in * id M a
ay ub M ay ub ya ub
: Islam

IS at ta IS tu ta
at ta
H ul di H l d
: Laki-laki

ul
M
di
in * id M in * id M iin *
M M M

: 18 Juli 2016

: Nur Chakim
: 3102875649

ay

: Desa Pragen
: Desa Pragen
ub

: Rahmawatik
ub ay ub IS
ta IS at ta
: Anak Kandung

IS at d

: Petani/Peternak
: Petani/Peternak
ta H
: 6281325944548
di H ul di H ul
M iin * i
M in * id M in * id M
: AHMAD MAARIF

M ay ub M a ya ub
: 111233170020160006

ub IS ta IS
IS at ta tu

Kepala Madrasah
ta
H ul di H l d H
di M iin *
: Rembang, 11 Januari 2010

in * id M in * id id
M M ay

Ashiful Faizin, S.Pd.I

M

Rembang, 18 Juli 2016

ay ub ay ub
IS a
IS at ta tu
: TK Hidayatul Mubtadiin Pragen

IS at ta d H l
Jl. Ngemplakrejo KM.05 Desa Pragen

H ul

NIP. 197807162007101003
H ul di
M *
IDENTITAS PESERTA DIDIK

iin id
in * id M in * id
a M a
M ay ub M ya ub
IS ya
IS a tu ta IS tu ta
d H
tu
MIS HIDAYATUL MUBTADIIN

H l
Kecamatan Pamotan, Kabupaten Rembang - Jawa Tengah

H di
M iin * id lM
KEMENTERIAN AGAMA REPUBLIK INDONESIA

* id lM in * id M
M ay ub M ay ub
IS
ay
a
ub
ta
IS at ta IS at ta tu
H ul H ul d H l di
M
di
in * id M iin * id M in
* id M M a ub
M ay ub ay ub
IS ya ta
IS a tu ta IS at ta
d H
tu di
H di H ul
M iin * id lM in
id lM in * id M
ay ub M ay ub
IS
ay
a
ub
ta
at ta IS at ta tu d
ul H ul d H l *
di
M * M iin

Halaman 6
iin id
id M in * id M a
ay ub M ay ub
IS ya ub
ta
at ta IS at ta tu d
ul di H ul di
i H lM iin *
i
 M M M
ub M da
ya ub M ay ub
IS
t IS tu t ad IS at ta
d H
ad H H ul
M iin * i
M iin * id lM iin * id M
M ay ub M ay ub
ub
t IS a ta IS

.6 _ _
ta IS at ad tu d H
di H ul H l M iin * id
in * id M iin * id M
M ay ub M ay ub
IS
ay
at
IS at ta IS at ta u
H ul di H ul di H l
iin * id M in * id M in * id
a

2. NIS
M M a ub M

b. Ibu
b. Ibu
3. NISN
ay ub ya IS ya

6. Agama
t IS ta

a. Ayah
a. Ayah
IS tu

8. Anak ke
at ad tu H l
H ul H di
M

a. Di kelas
* id M iin * id lM in * id
a
M

11. Sekolah Asal

M M ub

5. Jenis Kelamin
ay ub ay ub ya

Pekerjaan Wali
b. Pada tanggal
IS at ta IS at ta IS tu ta
d

13. Nama Orang Tua

H l di

16. Nama Wali Siswa

H ul i

14. Alamat Orang Tua

H ul di M

Alamat Wali Siswa

M iin * id
1. Nama Peserta Didik
* M in * id

15. Pekerjaan Orang Tua

id M

9. Alamat Peserta Didik

M ay ub
4. Tempat Tanggal Lahir

7. Status dalam Keluarga

M ay

12. Diterima di sekolah ini

ay ub ub
t IS at ta IS at ta
IS at ad H ul di H ul d

3x4
H

10. Nomor Telepon Rumah/HP

ul M

Foto
iin
id M iin * id M in * id
ay ub M ay ub M ay ub
at ta IS at ta IS at ta
d H

:
:
:
:
:
u H ul ul di
di M in

:-
:I
M *
:1
iin id
id lM in * id M a
ay ub M ay ub ya ub
: Islam

IS at ta IS tu ta
at ta
H ul di H l d
: Laki-laki

ul
M
di
in * id M in * id M iin *
M M M

: 18 Juli 2016
: 3098807906

ay

: Desa Pragen
: Desa Pragen
ub

: Ali Shodikin
ub ay ub IS
ta IS at ta
: Anak Kandung

IS at d

: Petani/Peternak
: Petani/Peternak
ta H
: 6281215687438
di H ul di H ul
M iin * i
M in * id M in * id
a M
M ay ub M ub

: Maghfurotun Nihayah
ya
: 111233170020160007

ub IS ta IS
IS at ta tu

Kepala Madrasah
ta
H ul di H l d H
di
M in * id M iin * id
: Rembang, 04 Oktober 2009

in * id M M ay

Ashiful Faizin, S.Pd.I

M

Rembang, 18 Juli 2016

ay ub ay ub
IS a
IS at ta tu
: TK Hidayatul Mubtadiin Pragen

IS at ta d H l
Jl. Ngemplakrejo KM.05 Desa Pragen

H ul

NIP. 197807162007101003
H ul di
M *
IDENTITAS PESERTA DIDIK

iin id
in * id M in * id
a M a
M ay ub M ya ub
IS ya
IS a tu ta IS tu ta
d H
tu
MIS HIDAYATUL MUBTADIIN

H
: AHMAD NABHAN ABIQ ATHOILLAH

l
Kecamatan Pamotan, Kabupaten Rembang - Jawa Tengah

H di
M iin * id lM
KEMENTERIAN AGAMA REPUBLIK INDONESIA

* id lM in * id M
M ay ub M ay ub
IS
ay
a
ub
ta
IS at ta IS at ta tu
H ul H ul d H l di
M
di
in * id M iin * id M in
* id M M a ub
M ay ub ay ub
IS ya ta
IS a tu ta IS at ta
d H
tu di
H di H ul
M iin * id lM in
id lM in * id M
ay ub M ay ub
IS
ay
a
ub
ta
at ta IS at ta tu d
ul H ul d H l *
di
M * M iin

Halaman 7
iin id
id M in * id M a
ay ub M ay ub
IS ya ub
ta
at ta IS at ta tu d
ul di H ul di
i H lM iin *
i
 M M M
ub M da
ya ub M ay ub
IS
t IS tu t ad IS at ta
d H
ad H H ul
M iin * i
M iin * id lM iin * id M
M ay ub M ay ub
ub
t IS a ta IS

.6 _ _
ta IS at ad tu d H
di H ul H l M iin * id
in * id M iin * id M
M ay ub M ay ub
IS
ay
at
IS at ta IS at ta u
H ul di H ul di H l
iin * id M in * id M in * id
a

2. NIS
M M a ub M

b. Ibu
b. Ibu
3. NISN
ay ub ya IS ya

6. Agama
t IS ta

a. Ayah
a. Ayah
IS tu

8. Anak ke
at ad tu H l
H ul H di
M

a. Di kelas
* id M iin * id lM in * id
a
M

11. Sekolah Asal

M M ub

5. Jenis Kelamin
ay ub ay ub ya

Pekerjaan Wali
b. Pada tanggal
IS at ta IS at ta IS tu ta
d

13. Nama Orang Tua

H l di

16. Nama Wali Siswa

H ul i

14. Alamat Orang Tua

H ul di M

Alamat Wali Siswa

M iin * id
1. Nama Peserta Didik
* M in * id

15. Pekerjaan Orang Tua

id M

9. Alamat Peserta Didik

M ay ub
4. Tempat Tanggal Lahir

7. Status dalam Keluarga

M ay

12. Diterima di sekolah ini

ay ub ub
t IS at ta IS at ta
IS at ad H ul di H ul d

3x4
H

10. Nomor Telepon Rumah/HP

ul M

Foto
iin
id M iin * id M in * id
ay ub M ay ub M ay ub
at ta IS at ta IS at ta
d H

:
:
:
:
:
u H ul ul di
di M in

:-
:I
M *
:1
iin id
id lM in * id M a
ay ub M ay ub ya ub
: Islam

IS at ta IS tu ta
at ta
H ul di H l d
ul
M
di
* M in * id M iin *

: Setiantono
in id M
: Perempuan

M M

: 18 Juli 2016

: Siti Kulasoh
: 3095325204

ay

: Desa Pragen
: Desa Pragen
ub ay ub ub
ta IS at ta IS
: Anak Kandung

IS at d

: Petani/Peternak
: Petani/Peternak
ta H
: 6288221813875
di H ul di H ul
M iin * i
M in * id M in * id
a M
M ay ub M ya ub
: 111233170020160008

ub IS ta IS
IS at ta tu

Kepala Madrasah
ta d
: ALYA NUR FADHILA

H ul di H l H
di
in * id M in * id M iin * id
M M ay

Ashiful Faizin, S.Pd.I

M
: Rembang, 05 Desember 2009

Rembang, 18 Juli 2016

ay ub ay ub
IS a
IS at ta tu
: TK Hidayatul Mubtadiin Pragen

IS at ta d H l
Jl. Ngemplakrejo KM.05 Desa Pragen

H ul

NIP. 197807162007101003
H ul di
M *
IDENTITAS PESERTA DIDIK

iin id
in * id M in * id
a M a
M ay ub M ya ub
IS ya
IS a tu ta IS tu ta
d H
tu
MIS HIDAYATUL MUBTADIIN

H l
Kecamatan Pamotan, Kabupaten Rembang - Jawa Tengah

H di
M iin * id lM
KEMENTERIAN AGAMA REPUBLIK INDONESIA

* id lM in * id M
M ay ub M ay ub
IS
ay
a
ub
ta
IS at ta IS at ta tu
H ul H ul d H l di
M
di
in * id M iin * id M in
* id M M a ub
M ay ub ay ub
IS ya ta
IS a tu ta IS at ta
d H
tu di
H di H ul
M iin * id lM in
id lM in * id M
ay ub M ay ub
IS
ay
a
ub
ta
at ta IS at ta tu d
ul H ul d H l *
di
M * M iin

Halaman 8
iin id
id M in * id M a
ay ub M ay ub
IS ya ub
ta
at ta IS at ta tu d
ul di H ul di
i H lM iin *
i
 M M M
ub M da
ya ub M ay ub
IS
t IS tu t ad IS at ta
d H
ad H H ul
M iin * i
M iin * id lM iin * id M
M ay ub M ay ub
ub
t IS a ta IS

.6 _ _
ta IS at ad tu d H
di H ul H l M iin * id
in * id M iin * id M
M ay ub M ay ub
IS
ay
at
IS at ta IS at ta u
H ul di H ul di H l
iin * id M in * id M in * id
a

2. NIS
M M a ub M

b. Ibu
b. Ibu
3. NISN
ay ub ya IS ya

6. Agama
t IS ta

a. Ayah
a. Ayah
IS tu

8. Anak ke
at ad tu H l
H ul H di
M

a. Di kelas
* id M iin * id lM in * id
a
M

11. Sekolah Asal

M M ub

5. Jenis Kelamin
ay ub ay ub ya

Pekerjaan Wali
b. Pada tanggal
IS at ta IS at ta IS tu ta
d

13. Nama Orang Tua

H l di

16. Nama Wali Siswa

H ul i

14. Alamat Orang Tua

H ul di M

Alamat Wali Siswa

M iin * id
1. Nama Peserta Didik
* M in * id

15. Pekerjaan Orang Tua

id M

9. Alamat Peserta Didik

M ay ub
4. Tempat Tanggal Lahir

7. Status dalam Keluarga

M ay

12. Diterima di sekolah ini

ay ub ub
t IS at ta IS at ta
IS at ad H ul di H ul d

3x4
H

10. Nomor Telepon Rumah/HP

ul M

Foto
iin
id M iin * id M in * id
ay ub M ay ub M ay ub
at ta IS at ta IS at ta
d H

:
:
:
:
:
u H ul ul di
di M in

:-
:I
M *
:1
iin id
id lM in * id M a
ay ub M ay ub ya ub
: Islam

IS at ta IS tu ta
ta d

: Mukoli
at H l
ul di H ul
M
di
in * id M iin *
M in * id M
: Perempuan

M M

: 18 Juli 2016
: 3097017194

ay

: Desa Pragen
: Desa Pragen
ub ay ub ub
ta IS at ta IS
: Anak Kandung

IS at d

: Petani/Peternak
: Petani/Peternak
ta H
: 6285655208824
H ul

: Khoirun Nikmah
di H ul
M
di
in * id M iin * i
M in * id M a M
M ay ub ya ub
: 111233170020160009

ub IS ta IS
IS at ta tu

Kepala Madrasah
ta
H ul di H l d H
di
M in * id M iin * id
: FITRI REZA SALSABILA

in * id M M ay

Ashiful Faizin, S.Pd.I

M

Rembang, 18 Juli 2016

ay ub
: Rembang, 03 September 2009

ay ub
IS at ta IS a tu
: TK Hidayatul Mubtadiin Pragen

IS at ta d H l
Jl. Ngemplakrejo KM.05 Desa Pragen

H ul

NIP. 197807162007101003
H ul di
M *
IDENTITAS PESERTA DIDIK

iin id
in * id M in * id
a M a
M ay ub M ya ub
IS ya
IS a tu ta IS tu ta
d H
tu
MIS HIDAYATUL MUBTADIIN

H l
Kecamatan Pamotan, Kabupaten Rembang - Jawa Tengah

H di
M iin * id lM
KEMENTERIAN AGAMA REPUBLIK INDONESIA

* id lM in * id M
M ay ub M ay ub
IS
ay
a
ub
ta
IS at ta IS at ta tu
H ul H ul d H l di
M
di
in * id M iin * id M in
* id M M a ub
M ay ub ay ub
IS ya ta
IS a tu ta IS at ta
d H
tu di
H di H ul
M iin * id lM in
id lM in * id M
ay ub M ay ub
IS
ay
a
ub
ta
at ta IS at ta tu d
ul H ul d H l *
di
M * M iin

Halaman 9
iin id
id M in * id M a
ay ub M ay ub
IS ya ub
ta
at ta IS at ta tu d
ul di H ul di
i H lM iin *
i
 M M M
ub M da
ya ub M ay ub
IS
t IS tu t ad IS at ta
d H
ad H H ul
M iin * i
M iin * id lM iin * id M
M ay ub M ay ub
ub
t IS a ta IS

.6 _ _
ta IS at ad tu d H
di H ul H l M iin * id
in * id M iin * id M
M ay ub M ay ub
IS
ay
at
IS at ta IS at ta u
H ul di H ul di H l
iin * id M in * id M in * id
a

2. NIS
M M a ub M

b. Ibu
b. Ibu
3. NISN
ay ub ya IS ya

6. Agama
t IS ta

a. Ayah
a. Ayah
IS tu

8. Anak ke
at ad tu H l
H ul H di
M

a. Di kelas
* id M iin * id lM in * id
a
M

11. Sekolah Asal

M M ub

5. Jenis Kelamin
ay ub ay ub ya

Pekerjaan Wali
b. Pada tanggal
IS at ta IS at ta IS tu ta
d

13. Nama Orang Tua

H l di

16. Nama Wali Siswa

H ul i

14. Alamat Orang Tua

H ul di M

Alamat Wali Siswa

M iin * id
1. Nama Peserta Didik
* M in * id

15. Pekerjaan Orang Tua

id M

9. Alamat Peserta Didik

M ay ub
4. Tempat Tanggal Lahir

7. Status dalam Keluarga

M ay

12. Diterima di sekolah ini

ay ub ub
t IS at ta IS at ta
IS at ad H ul di H ul d

3x4
H

10. Nomor Telepon Rumah/HP

ul M

Foto
iin
id M iin * id M in * id
ay ub M ay ub M ay ub
at ta IS at ta IS at ta
d H

:
:
:
:
:
u H ul ul di
di M in

:-
:I
M *
:2
iin id
id lM in * id M a
ay ub M ay ub ya ub
: Islam

IS at ta IS tu ta
at ta
H ul di H l d

: Sholihati
ul
M
di
in * id M in * id M iin *
M
: Perempuan

M M

: 18 Juli 2016
: 3107267236

ay

: Desa Pragen
: Desa Pragen
ub ay ub ub
ta IS at ta IS
: Anak Kandung

IS at d

: Petani/Peternak
: Petani/Peternak
ta H
: 6281228596441
H ul

: Mohamag Yasak
di H ul
M
di
in * id M iin * i
M in * id M a M
M ay ub ya ub
: 111233170020160010

ub IS ta IS
IS at ta tu

Kepala Madrasah
ta
H ul di H l d H
di
M in * id M iin * id
: JIHAN NOOR FAJRIYAH

*
: Rembang, 15 Februari 2010

in id M M ay

Ashiful Faizin, S.Pd.I

M

Rembang, 18 Juli 2016

ay ub ay ub
IS a
IS at ta tu
: TK Hidayatul Mubtadiin Pragen

IS at ta d H l
Jl. Ngemplakrejo KM.05 Desa Pragen

H ul

NIP. 197807162007101003
H ul di
M *
IDENTITAS PESERTA DIDIK

iin id
in * id M in * id
a M a
M ay ub M ya ub
IS ya
IS a tu ta IS tu ta
d H
tu
MIS HIDAYATUL MUBTADIIN

H l
Kecamatan Pamotan, Kabupaten Rembang - Jawa Tengah

H di
M iin * id lM
KEMENTERIAN AGAMA REPUBLIK INDONESIA

* id lM in * id M
M ay ub M ay ub
IS
ay
a
ub
ta
IS at ta IS at ta tu
H ul H ul d H l di
M
di
in * id M iin * id M in
* id M M a ub
M ay ub ay ub
IS ya ta
IS a tu ta IS at ta
d H
tu di
H di H ul
M iin * id lM in
id lM in * id M
ay ub M ay ub
IS
ay
a
ub
ta
at ta IS at ta tu d
ul H ul d H l *
di
M * M iin

Halaman 10
iin id
id M in * id M a
ay ub M ay ub
IS ya ub
ta
at ta IS at ta tu d
ul di H ul di
i H lM iin *
i
 M M M
ub M da
ya ub M ay ub
IS
t IS tu t ad IS at ta
d H
ad H H ul
M iin * i
M iin * id lM iin * id M
M ay ub M ay ub
ub
t IS a ta IS

.6 _ _
ta IS at ad tu d H
di H ul H l M iin * id
in * id M iin * id M
M ay ub M ay ub
IS
ay
at
IS at ta IS at ta u
H ul di H ul di H l
iin * id M in * id M in * id
a

2. NIS
M M a ub M

b. Ibu
b. Ibu
3. NISN
ay ub ya IS ya

6. Agama
t IS ta

a. Ayah
a. Ayah
IS tu

8. Anak ke
at ad tu H l
H ul H di
M

a. Di kelas
* id M iin * id lM in * id
a
M

11. Sekolah Asal

M M ub

5. Jenis Kelamin
ay ub ay ub ya

Pekerjaan Wali
b. Pada tanggal
IS at ta IS at ta IS tu ta
d

13. Nama Orang Tua

H l di

16. Nama Wali Siswa

H ul i

14. Alamat Orang Tua

H ul di M

Alamat Wali Siswa

M iin * id
1. Nama Peserta Didik
* M in * id

15. Pekerjaan Orang Tua

id M

9. Alamat Peserta Didik

M ay ub
4. Tempat Tanggal Lahir

7. Status dalam Keluarga

M ay

12. Diterima di sekolah ini

ay ub ub
t IS at ta IS at ta
IS at ad H ul di H ul d

3x4
H

10. Nomor Telepon Rumah/HP

ul M

Foto
iin
id M iin * id M in * id
ay ub M ay ub M ay ub
at ta IS at ta IS at ta
d H

:
:
:
:
:
u H ul ul di
di M in

:-
:I
M *
:3
iin id
id lM in * id M a
ay ub M ay ub ya ub
: Islam

IS at ta IS tu ta
at ta d

: Untatik
ul di H ul di H l M iin *

: Khoribun
M in * id M in * id M
: Perempuan

M M

: 18 Juli 2016
: 3108240017

ay

: Desa Pragen
: Desa Pragen
ub ay ub ub
ta IS at ta IS
: Anak Kandung

IS at d

: Petani/Peternak
: Petani/Peternak
ta H
: 6282325268014
di H ul di H ul
M iin * i
M in * id M in * id
a M
M ay ub M ya ub
: NAFIATUL AZIZAH
: 111233170020160011

ub IS ta IS
IS at ta tu

Kepala Madrasah
ta
H ul di H l d H
di
* M in * id M iin * id
: Rembang, 13 Februari 2010

in id M M ay

Ashiful Faizin, S.Pd.I

M

Rembang, 18 Juli 2016

ay ub ay ub
IS a
IS at ta tu
: TK Hidayatul Mubtadiin Pragen

IS at ta d H l
Jl. Ngemplakrejo KM.05 Desa Pragen

H ul

NIP. 197807162007101003
H ul di
M *
IDENTITAS PESERTA DIDIK

iin id
in * id M in * id
a M a
M ay ub M ya ub
IS ya
IS a tu ta IS tu ta
d H
tu
MIS HIDAYATUL MUBTADIIN

H l
Kecamatan Pamotan, Kabupaten Rembang - Jawa Tengah

H di
M iin * id lM
KEMENTERIAN AGAMA REPUBLIK INDONESIA

* id lM in * id M
M ay ub M ay ub
IS
ay
a
ub
ta
IS at ta IS at ta tu
H ul H ul d H l di
M
di
in * id M iin * id M in
* id M M a ub
M ay ub ay ub
IS ya ta
IS a tu ta IS at ta
d H
tu di
H di H ul
M iin * id lM in
id lM in * id M
ay ub M ay ub
IS
ay
a
ub
ta
at ta IS at ta tu d
ul H ul d H l *
di
M * M iin

Halaman 11
iin id
id M in * id M a
ay ub M ay ub
IS ya ub
ta
at ta IS at ta tu d
ul di H ul di
i H lM iin *
i
 M M M
ub M da
ya ub M ay ub
IS
t IS tu t ad IS at ta
d H
ad H H ul
M iin * i
M iin * id lM iin * id M
M ay ub M ay ub
ub
t IS a ta IS

.6 _ _
ta IS at ad tu d H
di H ul H l M iin * id
in * id M iin * id M
M ay ub M ay ub
IS
ay
at
IS at ta IS at ta u
H ul di H ul di H l
iin * id M in * id M in * id
a

2. NIS
M M a ub M

b. Ibu
b. Ibu
3. NISN
ay ub ya IS ya

6. Agama
t IS ta

a. Ayah
a. Ayah
IS tu

8. Anak ke
at ad tu H l
H ul H di
M

a. Di kelas
* id M iin * id lM in * id
a
M

11. Sekolah Asal

M M ub

5. Jenis Kelamin
ay ub ay ub ya

Pekerjaan Wali
b. Pada tanggal
IS at ta IS at ta IS tu ta
d

13. Nama Orang Tua

H l di

16. Nama Wali Siswa

H ul i

14. Alamat Orang Tua

H ul di M

Alamat Wali Siswa

M iin * id
1. Nama Peserta Didik
* M in * id

15. Pekerjaan Orang Tua

id M

9. Alamat Peserta Didik

M ay ub
4. Tempat Tanggal Lahir

7. Status dalam Keluarga

M ay

12. Diterima di sekolah ini

ay ub ub
t IS at ta IS at ta
IS at ad H ul di H ul d

3x4
H

10. Nomor Telepon Rumah/HP

ul M

Foto
iin
id M iin * id M in * id
ay ub M ay ub M ay ub
at ta IS at ta IS at ta
d H

:
:
:
:
:
u H ul ul di
di M in

:-
:I
M *
:1
iin id
id lM in * id M a
ay ub M ay ub ya ub
: Islam

IS at ta IS tu ta
at ta
H ul di H l d
ul
M
di
in * id M in * id M iin *
M
: Perempuan

M M

: 18 Juli 2016
: 3090947160

ay

: Desa Pragen
: Desa Pragen
ay ub ub

: Santi Afrianti
ub IS

: Alim Setiyana
ta IS at ta
: Anak Kandung

IS at d

: Petani/Peternak
: Petani/Peternak
ta H
: 6283840972415
di H ul di H ul
M iin * i
M in * id M in * id
a M
M ay ub M ya ub
: 111233170020160012

ub IS ta IS
IS at ta tu

Kepala Madrasah
ta
H ul di H l d H
di
in * id M in * id M iin * id
M M ay

Ashiful Faizin, S.Pd.I

M
: Rembang, 09 Desember 2009

Rembang, 18 Juli 2016

ay ub ay ub a
: SALWA LUTFIATUL ULYA

IS at ta IS tu
: TK Hidayatul Mubtadiin Pragen

IS at ta d H l
Jl. Ngemplakrejo KM.05 Desa Pragen

H ul

NIP. 197807162007101003
H ul di
M *
IDENTITAS PESERTA DIDIK

iin id
in * id M in * id
a M a
M ay ub M ya ub
IS ya
IS a tu ta IS tu ta
d H
tu
MIS HIDAYATUL MUBTADIIN

H l
Kecamatan Pamotan, Kabupaten Rembang - Jawa Tengah

H di
M iin * id lM
KEMENTERIAN AGAMA REPUBLIK INDONESIA

* id lM in * id M
M ay ub M ay ub
IS
ay
a
ub
ta
IS at ta IS at ta tu
H ul H ul d H l di
M
di
in * id M iin * id M in
* id M M a ub
M ay ub ay ub
IS ya ta
IS a tu ta IS at ta
d H
tu di
H di H ul
M iin * id lM in
id lM in * id M
ay ub M ay ub
IS
ay
a
ub
ta
at ta IS at ta tu d
ul H ul d H l *
di
M * M iin

Halaman 12
iin id
id M in * id M a
ay ub M ay ub
IS ya ub
ta
at ta IS at ta tu d
ul di H ul di
i H lM iin *
i
 M M M
ub M da
ya ub M ay ub
IS
t IS tu t ad IS at ta
d H
ad H H ul
M iin * i
M iin * id lM iin * id M
M ay ub M ay ub
ub
t IS a ta IS

.6 _ _
ta IS at ad tu d H
di H ul H l M iin * id
in * id M iin * id M
M ay ub M ay ub
IS
ay
at
IS at ta IS at ta u
H ul di H ul di H l
iin * id M in * id M in * id
a

2. NIS
M M a ub M

b. Ibu
b. Ibu
3. NISN
ay ub ya IS ya

6. Agama
t IS ta

a. Ayah
a. Ayah
IS tu

8. Anak ke
at ad tu H l
H ul H di
M

a. Di kelas
* id M iin * id lM in * id
a
M

11. Sekolah Asal

M M ub

5. Jenis Kelamin
ay ub ay ub ya

Pekerjaan Wali
b. Pada tanggal
IS at ta IS at ta IS tu ta
d

13. Nama Orang Tua

H l di

16. Nama Wali Siswa

H ul i

14. Alamat Orang Tua

H ul di M

Alamat Wali Siswa

M iin * id
1. Nama Peserta Didik
* M in * id

15. Pekerjaan Orang Tua

id M

9. Alamat Peserta Didik

M ay ub
4. Tempat Tanggal Lahir

7. Status dalam Keluarga

M ay

12. Diterima di sekolah ini

ay ub ub
t IS at ta IS at ta
IS at ad H ul di H ul d

3x4
H

10. Nomor Telepon Rumah/HP

ul M

Foto
iin
id M iin * id M in * id
ay ub M ay ub M ay ub
at ta IS at ta IS at ta
d H

:
:
:
:
:
u H ul ul di
di M in

:-
:I
M *
:1
iin id
id lM in * id M a
ay ub M ay ub ya ub
: Islam

IS at ta IS tu ta
at ta H l d

: Dariono
ul di H ul
M
di
in * id M iin *
M in * id M
: Perempuan

M M

: 18 Juli 2016
: 3097499795

ay

: Desa Pragen
: Desa Pragen
ub ay ub ub
ta IS at ta IS
: Anak Kandung

IS at d

: Petani/Peternak
: Petani/Peternak
ta H

: Tutik Hidiantho
: 6282300126835
di H ul di H ul
M iin * i
M in * id M in * id
a M
M ay ub M ya ub
: 111233170020160013

ub IS ta IS
IS at ta tu

Kepala Madrasah
ta
H ul di H l d H
di
M in * id M iin * id
: Rembang, 09 Agustus 2009

in * id M M ay

Ashiful Faizin, S.Pd.I

M

Rembang, 18 Juli 2016

: SYAFIRA ANINDIA PUTRI

ay ub ay ub
IS a
IS at ta tu
: TK Hidayatul Mubtadiin Pragen

IS at ta d H l
Jl. Ngemplakrejo KM.05 Desa Pragen

H ul

NIP. 197807162007101003
H ul di
M *
IDENTITAS PESERTA DIDIK

iin id
in * id M in * id
a M a
M ay ub M ya ub
IS ya
IS a tu ta IS tu ta
d H
tu
MIS HIDAYATUL MUBTADIIN

H l
Kecamatan Pamotan, Kabupaten Rembang - Jawa Tengah

H di
M iin * id lM
KEMENTERIAN AGAMA REPUBLIK INDONESIA

* id lM in * id M
M ay ub M ay ub
IS
ay
a
ub
ta
IS at ta IS at ta tu
H ul H ul d H l di
M
di
in * id M iin * id M in
* id M M a ub
M ay ub ay ub
IS ya ta
IS a tu ta IS at ta
d H
tu di
H di H ul
M iin * id lM in
id lM in * id M
ay ub M ay ub
IS
ay
a
ub
ta
at ta IS at ta tu d
ul H ul d H l *
di
M * M iin

Halaman 13
iin id
id M in * id M a
ay ub M ay ub
IS ya ub
ta
at ta IS at ta tu d
ul di H ul di
i H lM iin *
i
 M M M
ub M da
ya ub M ay ub
IS
t IS tu t ad IS at ta
d H
ad H H ul
M iin * i
M iin * id lM iin * id M
M ay ub M ay ub
ub
t IS a ta IS

.6 _ _
ta IS at ad tu d H
di H ul H l M iin * id
in * id M iin * id M
M ay ub M ay ub
IS
ay
at
IS at ta IS at ta u
H ul di H ul di H l
iin * id M in * id M in * id
a

2. NIS
M M a ub M

b. Ibu
b. Ibu
3. NISN
ay ub ya IS ya

6. Agama
t IS ta

a. Ayah
a. Ayah
IS tu

8. Anak ke
at ad tu H l
H ul H di
M

a. Di kelas
* id M iin * id lM in * id
a
M

11. Sekolah Asal

M M ub

5. Jenis Kelamin
ay ub ay ub ya

Pekerjaan Wali
b. Pada tanggal
IS at ta IS at ta IS tu ta
d

13. Nama Orang Tua

H l di

16. Nama Wali Siswa

H ul i

14. Alamat Orang Tua

H ul di M

Alamat Wali Siswa

M iin * id
1. Nama Peserta Didik
* M in * id

15. Pekerjaan Orang Tua

id M

9. Alamat Peserta Didik

M ay ub
4. Tempat Tanggal Lahir

7. Status dalam Keluarga

M ay

12. Diterima di sekolah ini

ay ub ub
t IS at ta IS at ta
IS at ad H ul di H ul d

3x4
H

10. Nomor Telepon Rumah/HP

ul M

Foto
iin
id M iin * id M in * id
ay ub M ay ub M ay ub
at ta IS at ta IS at ta
d H

:
:
:
:
:
u H ul ul di
di M in

:-
:I
M *
:3
iin id
id lM in * id M a
ay ub M ay ub ya ub
: Islam

ta IS ta

: Sukari
at ta IS at tu d
H ul di H l

: Musidah
ul
M
di
in * id M in * id M iin *
M
: Perempuan

M M

: 18 Juli 2016
: 3106743461

ay

: Desa Pragen
: Desa Pragen
ub ay ub ub
ta IS at ta IS
: Anak Kandung

IS at d

: Petani/Peternak
: Petani/Peternak
ta H
: 6283869144069
di H ul di H ul
M iin * i
M in * id M in * id M
: TRI SUCI ANDINI

M ay ub M a ya ub
: 111233170020160014

ub IS ta IS
: Rembang, 29 Juni 2010

IS at ta tu

Kepala Madrasah
ta
H ul di H l d H
di
in * id M in * id M iin * id
M M ay

Ashiful Faizin, S.Pd.I

M

Rembang, 18 Juli 2016

ay ub ay ub
IS a
IS at ta tu
: TK Hidayatul Mubtadiin Pragen

IS at ta d H l
Jl. Ngemplakrejo KM.05 Desa Pragen

H ul

NIP. 197807162007101003
H ul di
M *
IDENTITAS PESERTA DIDIK

iin id
in * id M in * id
a M a
M ay ub M ya ub
IS ya
IS a tu ta IS tu ta
d H
tu
MIS HIDAYATUL MUBTADIIN

H l
Kecamatan Pamotan, Kabupaten Rembang - Jawa Tengah

H di
M iin * id lM
KEMENTERIAN AGAMA REPUBLIK INDONESIA

* id lM in * id M
M ay ub M ay ub
IS
ay
a
ub
ta
IS at ta IS at ta tu
H ul H ul d H l di
M
di
in * id M iin * id M in
* id M M a ub
M ay ub ay ub
IS ya ta
IS a tu ta IS at ta
d H
tu di
H di H ul
M iin * id lM in
id lM in * id M
ay ub M ay ub
IS
ay
a
ub
ta
at ta IS at ta tu d
ul H ul d H l *
di
M * M iin

Halaman 14
iin id
id M in * id M a
ay ub M ay ub
IS ya ub
ta
at ta IS at ta tu d
ul di H ul di
i H lM iin *
i