Formulir Pendaftaran PPDB 2023 SMPN 1 Patrol

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\langfe1057 \langfenp1057 \alang1025 \tab }{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \
\langfe1057 \langfenp1057 \alang1025 \uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \
?\uc1
\u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \
u8230 ?\uc1 \u8230 ?.}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \
langfe1057 \langfenp1057 \alang1025 \cf1 Agama}{\rtlch \fcs1 \af0 \afs22 \ltrch \
langnp1057 \langfe1057 \langfenp1057 \alang1025 \cf1 \tab }{\rtlch \fcs1 \af0 \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \cf1 :}{\rtlch \fcs1 \af0
\afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \dbch \af4 \hich \af4 \loch \
f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \cf1 \tab }{\rtlch \
langnp1057 \langfe1057 \langfenp1057 \alang1025 \cf1 Sekolah Asal/Lulus Tahun}{\
\cf1 :}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \
alang1025 \cf1 \tab }{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025
\ltrch \dbch \af4 \hich \af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \
langfenp1057 \alang1025 \cf1 \uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\
\cf1 Alamat Sekolah}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \
?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?}{\rtlch \fcs1 \
loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 .}{\rtlch \fcs1
li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \
lin0 \rin0 \tql \tx426 \tql \tx709 \tql \tx4395 \tql \tx4820 \itap0 \rtlch \fcs1 \
af4 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \loch \af4 \hich \af4 \
dbch \af4 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 {\rtlch \
pard \plain \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
adjustright \lin0 \rin0 \tql \tx426 \tql \tx709 \tql \tx4395 \tql \tx4820 \itap0 \
rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \loch \af4 \
hich \af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 B.}
hich \af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \tab
}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \dbch \af4 \
IDENTITAS ORANG TUA}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \
langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \li0 \ri0 \lisb0 \lisa0 \
sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \tql \tx426 \
tql \tx709 \tql \tx4395 \tql \tx4820 \itap0 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \
langnp1057 \langfe1057 \langfenp1057 \alang1025 \tab }{\rtlch \fcs1 \af0 \afs22 \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 1.}{\rtlch \fcs1 \af0 \
loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 Nama }{\rtlch \
adjustright \lin0 \rin0 \tql \tx426 \tql \tx709 \tql \tx993 \tql \tx4395 \tql \
tx4820 \itap0 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \
\langfe1057 \langfenp1057 \alang1025 a.}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \
\langfe1057 \langfenp1057 \alang1025 Ayah}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \
fs22 \rtlch \alang1025 \ltrch \dbch \af4
\hich \af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 :}
hich \af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \uc1
plain \li0 \ri0 \lisb0 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \
\langfe1057 \langfenp1057 \alang1025 b.}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \
\langfe1057 \langfenp1057 \alang1025 Ibu}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \
\langfe1057 \langfenp1057 \alang1025 :}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22
\rtlch \alang1025 \ltrch \dbch \af4 \hich \af4 \loch \f0 \lang1057 \langnp1057 \
?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1
\u8230 ?\uc1 \u8230 ?.}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \
tql \tx709 \tql \tx993 \tql \tx4395 \tql \tx4820 \itap0 \rtlch \fcs1 \af4 \afs24 \
ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \loch \af4 \hich \af4 \dbch \af4 \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 {\rtlch \fcs1 \af0 \afs22
loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 2.}{\rtlch \
af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \tab }{\
Pekerjaan}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \
alang1025 \par }\pard \plain \li0 \ri0 \lisb0 \lisa0 \sl276 \slmult1 \widctlpar \
tql \tx4395 \tql \tx4820 \itap0 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \fs24 \
langfe1057 \langfenp1057 \alang1025 {\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \
loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \tab }{\rtlch \
af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 b.}{\rtlch
\fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \dbch \af4 \hich \af4
\loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \tab }{\
hich \af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 Ibu}
hich \af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 :}{\
?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?.\uc1 \u8230 ?}{\rtlch \fcs1 \
\langfe1057 \langfenp1057 \alang1025 3.}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \
\langfe1057 \langfenp1057 \alang1025 Alamat}{\rtlch \fcs1 \af0 \afs22 \ltrch \
ltrch \fcs0 \fs22 \rtlch \alang1025
langfenp1057 \alang1025 :}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \
\langfe1057 \langfenp1057 \alang1025 Telepon / HP}{\rtlch \fcs1 \af0 \afs22 \
loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 :}{\rtlch \fcs1
\f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \tab }{\rtlch \
af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \uc1 \
\u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?.}{\rtlch \fcs1 \af0 \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \li0 \
ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \
rin0 \tql \tx426 \tql \tx709 \tql \tx993 \tql \tx4395 \tql \tx4820 \itap0 \rtlch \
af4 \dbch \af4 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 {\rtlch \
langfe1057 \langfenp1057 \alang1025 C.}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22
\langfe1057 \langfenp1057 \alang1025 IDENTITAS WALI}{\rtlch \fcs1 \af0 \afs22 \
rin0 \tql \tx426 \tql \tx709 \tql \tx4395 \tql \tx4820 \itap0 \rtlch \fcs1 \af4 \
hich \af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 Nama
\langfe1057 \langfenp1057 \alang1025 Pekerjaan}{\rtlch \fcs1 \af0 \afs22 \ltrch \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 :}{\rtlch \fcs1 \af0 \
loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \uc1 \u8230 ?\
uc1 \u8230 ?\uc1 \u8230
?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\
u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \
Alamat}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \
hich \af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 5. }
Hubungan wali dengan calon siswa}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \
Demikian data diatas adalah data sebenarnya dan dapat dipertanggung jawabkan. Jika
data tersebut tidak sesuai dengan yang sebenarnya, kami siap menerima sanksi sesuai
ketentuan peraturan perundang-undangan.}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \
\langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \qj \li426 \ri0 \lisb0
\lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin426 \rin0 \tql \tx426 \tql \
tx709 \tql \tx993 \tql \tx4395 \tql \tx4820 \itap0 \rtlch \fcs1 \af4 \afs24 \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \qj \
li426 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin426 \rin0 \
tql \tx426 \tql \tx709 \tql \tx993 \tql \tx4395 \tql \tx4820 \itap0 \rtlch \fcs1 \
af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 Diketahui}
Patrol, .......................... 2023}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \
\langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \qj \li426 \ri0 \lisb0 \
lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin426 \rin0 \tql \tx426 \tql \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 Orang Tua / Wali}{\
Calon peserta didik,}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025
langfenp1057 \alang1025 \par }\pard \plain \qj \li426 \ri0 \lisb0 \lisa0 \widctlpar
\aspalpha \aspnum \adjustright \lin426 \rin0 \tql \tx426 \tql \tx709 \tql \tx993 \
langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \qj \li426 \ri0 \lisb0 \
li426 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin426 \rin0 \
tql \tx426 \tql \tx709 \tql \tx993 \tql \tx4395 \tql \tx4820 \itap0 \rtlch \fcs1 \
pard \plain \qj \li426 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \
aspnum \adjustright \lin426 \rin0 \tql \tx426 \tql \tx709 \tql \tx993 \tql \
tx4395 \tql \tx4820 \itap0 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \fs24 \rtlch \
\langfenp1057 \alang1025 {\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \
langfe1057 \langfenp1057 \alang1025 \uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \
?\uc1 \u8230 ?..}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \
u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?..}{\
}\pard \plain \qj \li426 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \
langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \qc \li0 \ri0 \lisb0 \
lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \rtlch \fcs1 \
af4 \loch \f0 \lang1057 \langnp1057 \langfe1057
\langfenp1057 \alang1025 \par }\pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \widctlpar
\aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \rtlch \fcs1 \af4 \afs24 \ltrch \
langnp1057 \langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \qc \li0 \ri0 \
lisb0 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \rtlch \
langfe1057 \langfenp1057 \alang1025 FORMULIR PENDAFTARAN SISWA BARU KELAS VII}{\
langfe1057 \langfenp1057 \alang1025 UPTD SMP NEGERI 1 PATROL}{\rtlch \fcs1 \af0 \
f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \
alang1025 TAHUN AJARAN 2023/2024}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \
af5 \loch \f5 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 Jalan Raya
Patrol Telp. (0234) }{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025
langfenp1057 \alang1025 610096 Kec. Patrol \uc1 \u8211 ? }{\rtlch \fcs1 \af5 \afs21
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 Indramayu 45258}{\rtlch \
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hich \af4 \dbch \af4 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025
langnp1057 \langfe1057 \langfenp1057 \alang1025 BIODATA CALON PESERTA DIDIK BARU}{\
langfe1057 \langfenp1057 \alang1025 JALUR PERPINDAHAN/MUTASI}{\rtlch \fcs1 \af0 \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 }{\rtlch \fcs1 \af0 \
aspnum \adjustright \lin0 \rin0 \tql \tx426 \tql \tx709 \itap0 \rtlch \fcs1 \af4 \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 A.}{\rtlch \fcs1 \af0 \
loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 IDENTITAS CALON
PESERTA DIDIK}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch
widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \tql \tx426 \tql \tx709 \tql
\tx4395 \tql \tx4820 \itap0 \ls2 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \fs24 \rtlch
Nomor Pendaftaran (}{\rtlch \fcs1 \af0 \afs18 \ltrch \fcs0 \fs18 \rtlch \
langfe1057 \langfenp1057 \alang1025 diisi oleh petugas}{\rtlch \fcs1 \af0 \afs22 \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 )}{\rtlch \fcs1 \af0 \
\u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?.}{\rtlch \fcs1 \af0 \afs22 \ltrch \
langnp1057 \langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \fi-360 \li720 \
ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720
\rin0 \tql \tx426 \tql \tx709 \tql \tx4395 \tql \tx4820 \itap0 \ls2 \rtlch \fcs1 \
dbch \af4 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 {\listtext \
pard \plain \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \
langfe1057 \langfenp1057 \alang1025 Nama Lengkap Calon}{\rtlch \fcs1 \af0 \afs22 \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \fi-
360 \li720 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
adjustright \lin720 \rin0 \tql \tx426 \tql \tx709 \tql \tx4395 \tql \tx4820 \
itap0 \ls2 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \
langnp1057 \langfe1057 \langfenp1057 \alang1025 N I S N}{\rtlch \fcs1 \af0 \afs22 \
langnp1057 \langfe1057 \langfenp1057 \alang1025 Tempat dan tanggal lahir}{\rtlch \
rtlch \fcs1 \af0 \afs22
?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?.}{\rtlch \fcs1 \af0 \afs22 \
langnp1057 \langfe1057 \langfenp1057 \alang1025 Tempat tinggal calon}{\rtlch \
langfe1057 \langfenp1057 \alang1025 .\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \
\u8230 ?\uc1 \u8230 ?}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \
langfe1057 \langfenp1057 \alang1025 Agama}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \
langfe1057 \langfenp1057 \alang1025 Sekolah Asal/Lulus Tahun}{\rtlch \fcs1 \af0 \
langnp1057 \langfe1057 \langfenp1057 \alang1025 Alamat Sekolah}{\rtlch \fcs1 \af0 \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 B.}{\rtlch \fcs1 \af0 \
loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 IDENTITAS ORANG
TUA}{\rtlch \fcs1 \af0 \afs22
tql \tx4820 \itap0 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \
af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 b.}{\rtlch
hich \af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 Ibu}
langnp1057 \langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \li0 \ri0 \lisb0
\lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \tql \
tx426 \tql \tx709 \tql \tx993 \tql \tx4395 \tql \tx4820 \itap0 \rtlch \fcs1 \af4 \
af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 a.}{\rtlch
Ayah}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \dbch \
:}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \dbch \
\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\
u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?.}{\rtlch \
fs22 \rtlch \alang1025 \ltrch \dbch
\af4 \hich \af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \
alang1025 b.}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \
langfe1057 \langfenp1057 \alang1025 Ibu}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \
\u8230 ?.\uc1 \u8230 ?}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \
af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 C.}{\rtlch
IDENTITAS WALI}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \
langfenp1057 \alang1025 \par }\pard \plain \li0 \ri0 \lisb0 \lisa0 \sl360 \
slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \tql \tx426 \tql \
tx709 \tql \tx4395 \tql \tx4820 \itap0 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 1.}{\rtlch \fcs1 \af0 \
loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 Nama }{\rtlch \
}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch
\alang1025 \ltrch \dbch \af4 \hich \af4 \loch \f0 \lang1057 \langnp1057 \
\rtlch \alang1025 \ltrch \dbch \af4 \hich \af4 \loch
\f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \tab }{\rtlch \fcs1
\f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \uc1 \u8230 ?\uc1 \
\u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?.}{\rtlch \fcs1 \af0 \afs22 \ltrch \
tx426 \tql \tx709 \tql \tx993 \tql \tx4395 \tql \tx4820 \itap0 \rtlch \fcs1 \af4 \
\langfe1057 \langfenp1057 \alang1025 Demikian data diatas adalah data sebenarnya
dan dapat dipertanggung jawabkan. Jika data tersebut tidak sesuai dengan yang
sebenarnya, kami siap menerima sanksi sesuai ketentuan peraturan perundang-
undangan.}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \
alang1025 \par }\pard \plain \qj \li426 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 Diketahui}{\rtlch \fcs1 \
li426 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
langfe1057 \langfenp1057
\alang1025 \par }\pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \
lisb0 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \rtlch \
langfe1057 \langfenp1057 \alang1025 FORMULIR PENDAFTARAN SISWA BARU KELAS VII}{\
langfe1057 \langfenp1057 \alang1025 UPTD SMP NEGERI 1 PATROL}{\rtlch \fcs1 \af0 \
alang1025 TAHUN AJARAN 2023/2024}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \
af5 \loch \f5 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 Jalan Raya
Patrol Telp. (0234) }{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025
langfenp1057 \alang1025 610096 Kec. Patrol \uc1 \u8211 ? }{\rtlch \fcs1 \af5 \afs21
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 Indramayu 45258}{\rtlch \
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00000000000000000000000000000000000000040000002d010000040000002d0100000400000002010
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00000000000000000000000000000000040000002d010100040000002d010100040000002d010100050
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000000000000040000002d01040007000000fc020000ffffff000000040000002d01050004000000270
1ffff040000002d010000040000002d010000030000000000}}}{\rtlch \fcs1 \af0 \afs21 \
langnp1057 \langfe1057 \langfenp1057 \alang1025 BIODATA CALON PESERTA DIDIK}{\rtlch
\loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \par }\pard \
plain \qc \li0 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \
rin0 \itap0 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \
alang1025 {\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \b1 \fs22 \rtlch \alang1025 \ltrch
alang1025 JALUR PRESTASI}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \b1 \fs22 \rtlch \
fcs1 \af0 \afs22 \ltrch \fcs0 \b1 \fs22 \rtlch \alang1025 \ltrch \dbch \af4 \hich \
pard \plain \li0 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin0
\rin0 \itap0 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \
aspalpha \aspnum \adjustright \lin0 \rin0 \tql \tx426 \tql \tx709 \itap0 \rtlch \
af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 A.}{\rtlch
IDENTITAS CALON PESERTA DIDIK}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \
langfe1057 \langfenp1057 \alang1025 \cf1 Nomor Pendaftaran (}{\rtlch \fcs1 \af0 \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \cf1 diisi oleh petugas}
)}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \dbch \
\cf1 Nama Lengkap Calon}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \
plain \fi-360 \li720 \ri0 \lisb0 \lisa0 \sl276
\slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \tql \tx426 \
tql \tx709 \tql \tx4395 \tql \tx4820 \itap0 \ls3 \rtlch \fcs1 \af4 \afs24 \ltrch \
\cf1 N I S N}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \
langfe1057 \langfenp1057 \alang1025 \cf1 :}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \
\langfe1057 \langfenp1057 \alang1025 \cf1 \tab }{\rtlch \fcs1 \af0 \afs22 \ltrch \
langnp1057 \langfe1057 \langfenp1057 \alang1025 \cf1 \uc1 \u8230 ?\uc1 \u8230 ?\uc1
?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?.}{\rtlch \fcs1 \af4 \afs22 \ltrch \fcs0 \
\langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \fi-360 \li720 \ri0 \
lisb0 \lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \
rin0 \tql \tx426 \tql \tx709 \tql \tx4395 \tql \tx4820 \itap0 \ls3 \rtlch \fcs1 \
langfe1057 \langfenp1057 \alang1025 \cf1 Tempat dan tanggal lahir}{\rtlch \fcs1 \
loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \cf1 \tab }{\
alang1025 \cf1 \uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\
?.}{\rtlch \fcs1 \af4 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \dbch \af4
\hich \af4 \loch \f4 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \
par }\pard \plain \fi-360 \li720 \ri0 \lisb0 \lisa0 \sl276 \slmult1 \widctlpar \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \cf1 Tempat tinggal
calon}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \dbch \
tql \tx709 \tql \tx4395 \tql \tx4820 \itap0 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \
langnp1057 \langfe1057 \langfenp1057 \alang1025 \cf1 Agama}{\rtlch \fcs1 \af0 \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \cf1 Sekolah Asal/Lulus
Tahun}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \dbch \
ltrch \dbch \af4 \hich \af4 \loch \f0 \lang1057 \langnp1057
\langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \fi-360 \li720 \ri0 \
rin0 \tql \tx426 \tql \tx709 \tql \tx4395 \tql \tx4820 \itap0 \ls3 \rtlch \fcs1 \
langfe1057 \langfenp1057 \alang1025 \cf1 Alamat Sekolah}{\rtlch \fcs1 \af0 \afs22 \
alang1025 B.}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \
langfe1057 \langfenp1057 \alang1025 IDENTITAS ORANG TUA}{\rtlch \fcs1 \af0 \afs22 \
\langfe1057 \langfenp1057 \alang1025 Ayah /Wali}{\rtlch \fcs1 \af0 \afs22 \ltrch \
hich \af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 b.}
Ibu / Wali}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \
rtlch \fcs1 \af0
\afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \dbch \af4 \hich \af4 \loch \f0
\lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 Pekerjaan}{\rtlch \
\langfe1057 \langfenp1057 \alang1025 Ayah /Wali}{\rtlch \fcs1 \af0 \afs22 \ltrch \
hich \af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 b.}
Ibu / Wali}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \
\u8230 ?.\uc1 \u8230 ?}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \
loch \f0 \lang1057 \langnp1057 \langfe1057
\langfenp1057 \alang1025 :}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 C.}{\rtlch \fcs1 \af0 \
loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 PRESTASI YANG
DIPEROLEH}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \
alang1025 \par }\trowd \trql \trgaph0 \trleft-108 \trbrdrt \brdrs \brdrw20 \brdrcf1
\trbrdrb \brdrs \brdrw20 \brdrcf1 \trbrdrl \brdrs \brdrw20 \brdrcf1 \trbrdrr \brdrs
\brdrw20 \brdrcf1 \trbrdrh \brdrs \brdrw20 \brdrcf1 \trbrdrv \brdrs \brdrw20 \
brdrcf1 \trhdr \trkeep \trwWidth9576 \trftsWidth3 \trftsWidthB3 \trftsWidthA3 \
trpaddl100 \trpaddt100 \trpaddb100 \trpaddr100 \trpaddfl3 \trpaddft3 \trpaddfb3 \
trpaddfr3 \clvertalc \clbrdrl \brdrs \brdrw20 \brdrcf1 \clbrdrr \brdrs \brdrw20 \
brdrcf1 \clbrdrt \brdrs \brdrw20 \brdrcf1 \clbrdrb \brdrs \brdrw20 \brdrcf1 \
cltxlrtb \clpadt108 \clpadr108 \clpadfl3 \clpadfb3 \clpadft3 \clpadfr3 \clwWidth558
\clftsWidth3 \cellx450 \clvertalc \clbrdrl \brdrs \brdrw20 \brdrcf1 \clbrdrr \brdrs
\brdrw20 \brdrcf1 \clbrdrt \brdrs \brdrw20 \brdrcf1 \clbrdrb \brdrs \brdrw20 \
brdrcf1 \cltxlrtb \clpadt108 \clpadr108 \clpadfl3 \clpadfb3 \clpadft3 \clpadfr3 \
clwWidth3272 \clftsWidth3 \cellx3722 \clvertalc \clbrdrl \brdrs \brdrw20 \brdrcf1 \
clbrdrr \brdrs \brdrw20 \brdrcf1 \clbrdrt \brdrs \brdrw20 \brdrcf1 \clbrdrb \
brdrs \brdrw20 \brdrcf1 \cltxlrtb \clpadt108 \clpadr108 \clpadfl3 \clpadfb3 \
clpadft3 \clpadfr3 \clwWidth1915 \clftsWidth3 \cellx5637 \clvertalc \clbrdrl \brdrs
\brdrw20 \brdrcf1 \clbrdrr \brdrs \brdrw20 \brdrcf1 \clbrdrt \brdrs \brdrw20 \
brdrcf1 \clbrdrb \brdrs \brdrw20 \brdrcf1 \cltxlrtb \clpadt108 \clpadr108 \clpadfl3
\clpadfb3 \clpadft3 \clpadfr3 \clwWidth1915 \clftsWidth3 \cellx7552 \clvertalc \
clbrdrl \brdrs \brdrw20 \brdrcf1 \clbrdrr \brdrs \brdrw20 \brdrcf1 \clbrdrt \
brdrs \brdrw20 \brdrcf1 \clbrdrb \brdrs \brdrw20 \brdrcf1 \cltxlrtb \clpadt108 \
clpadr108 \clpadfl3 \clpadfb3 \clpadft3 \clpadfr3 \clwWidth1916 \clftsWidth3 \
cellx9468 \pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \
adjustright \lin0 \rin0 \tql \tx426 \tql \tx709 \tql \tx4395 \tql \tx4820 \intbl \
alang1025 No}{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \b1 \fs21 \rtlch \alang1025 \
langfenp1057 \alang1025 \cell }\pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \
widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \tql \tx426 \tql \tx709 \tql \
tx4395 \tql \tx4820 \intbl \itap1 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \fs24 \
langfe1057 \langfenp1057 \alang1025 {\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \b1 \
\langfe1057 \langfenp1057 \alang1025 Bidang Prestasi}{\rtlch \fcs1 \af0 \afs21 \
ltrch \fcs0 \b1 \fs21 \rtlch \alang1025 \ltrch \dbch \af4 \hich \af4 \loch \f0 \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \cell }\pard \plain \qc \
li0 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \tql \
tx426 \tql \tx709 \tql \tx4395 \tql \tx4820 \intbl \itap1 \rtlch \fcs1 \af4 \
f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 Peringkat Kejuaraan}
{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \b1 \fs21 \rtlch \alang1025 \ltrch \dbch \
\cell }\pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \
alang1025 Tingkat}{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \b1 \fs21 \rtlch \
langfe1057 \langfenp1057 \alang1025 \cell }\pard \plain \qc \li0 \ri0 \lisb0 \lisa0
\widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \tql \tx426 \tql \tx709 \
tql \tx4395 \tql \tx4820 \intbl \itap1 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \
fcs0 \b1 \fs21 \rtlch \alang1025 \ltrch \dbch \af4 \hich \af4 \loch \f0 \lang1057 \
langnp1057 \langfe1057 \langfenp1057 \alang1025 Penyelenggara}{\rtlch \fcs1 \af0 \
f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \cell }\pard \plain \
li0 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \intbl
\itap1 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \loch \
alang1025 {\trowd \trql \trgaph0 \trleft-108 \trbrdrt \brdrs \brdrw20 \brdrcf1 \
trbrdrb \brdrs \brdrw20 \brdrcf1 \trbrdrl \brdrs \brdrw20 \brdrcf1 \trbrdrr \
brdrs \brdrw20 \brdrcf1 \trbrdrh \brdrs \brdrw20 \brdrcf1 \trbrdrv \brdrs \
brdrw20 \brdrcf1 \trhdr \trkeep \trwWidth9576 \trftsWidth3 \trftsWidthB3 \
trftsWidthA3 \trpaddl100 \trpaddt100 \trpaddb100 \trpaddr100 \trpaddfl3 \
trpaddft3 \trpaddfb3 \trpaddfr3 \clvertalc \clbrdrl \brdrs \brdrw20 \brdrcf1 \
clpadft3 \clpadfr3 \clwWidth558 \clftsWidth3 \cellx450 \clvertalc \clbrdrl \brdrs \
brdrw20 \brdrcf1 \clbrdrr \brdrs \brdrw20 \brdrcf1 \clbrdrt \brdrs \brdrw20 \
cellx5637 \clvertalc \clbrdrl \brdrs \brdrw20 \brdrcf1 \clbrdrr \brdrs \brdrw20 \
cltxlrtb \clpadt108 \clpadr108 \clpadfl3 \clpadfb3 \clpadft3 \clpadfr3 \
clpadft3 \clpadfr3 \clwWidth1916 \clftsWidth3 \cellx9468 \row }\pard \plain \qc \
li0 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \tql \
tx426 \tql \tx709 \tql \tx4395 \tql \tx4820 \intbl \itap1 \rtlch \fcs1 \af4 \
f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 1}{\rtlch \fcs1 \
af0 \afs21 \ltrch \fcs0 \b1 \fs21 \rtlch \alang1025 \ltrch \dbch \af4 \hich \af4 \
loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \cell }\pard \
rin0 \tql \tx426 \tql \tx709 \tql \tx4395 \tql \tx4820 \intbl \itap1 \rtlch \fcs1 \
af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025
alang1025 \cell }\pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \
intbl \itap1 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \
alang1025 \cell }\pard \plain \li0 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \
aspnum \adjustright \lin0 \rin0 \intbl \itap1 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0
\fs24 \rtlch \alang1025 \ltrch \loch \af4 \hich \af4 \dbch \af4 \lang1057 \
langnp1057 \langfe1057 \langfenp1057 \alang1025 {\trowd \trql \trgaph0 \trleft-
108 \trbrdrt \brdrs \brdrw20 \brdrcf1 \trbrdrb \brdrs \brdrw20 \brdrcf1 \trbrdrl \
brdrs \brdrw20 \brdrcf1 \trbrdrr \brdrs \brdrw20 \brdrcf1 \trbrdrh \brdrs \
brdrw20 \brdrcf1 \trbrdrv \brdrs \brdrw20 \brdrcf1 \trhdr \trkeep \trwWidth9576 \
trftsWidth3 \trftsWidthB3 \trftsWidthA3 \trpaddl100 \trpaddt100 \trpaddb100 \
trpaddr100 \trpaddfl3 \trpaddft3 \trpaddfb3 \trpaddfr3 \clvertalc \clbrdrl \brdrs \
\clpadfb3 \clpadft3 \clpadfr3 \clwWidth1916 \clftsWidth3 \cellx9468 \row }\pard \
af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 2}{\
rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \b1 \fs21 \rtlch \alang1025 \ltrch \dbch \
loch \af4
\hich \af4 \dbch \af4 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025
{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \b1 \fs21 \rtlch \alang1025 \ltrch \dbch \
\langfe1057 \langfenp1057 \alang1025 Demikian data diatas adalah data sebenarnya
dan dapat dipertanggungjawabkan. Jika data tersebut tidak sesuai dengan yang
sebenarnya, kami siap menerima sanksi sesuai ketentuan yang berlaku.}{\rtlch \
alang1025
}{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \fs21 \rtlch \alang1025 \ltrch \
alang1025 \par }\pard \plain \li0 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \
langfe1057 \langfenp1057 \alang1025 }{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0
langnp1057 \langfe1057 \langfenp1057 \alang1025 Diketahui}{\rtlch \fcs1 \af0 \afs22
ltrch \loch \af4 \hich \af4 \dbch \af4 \lang1057 \langnp1057
\langfe1057 \langfenp1057 \alang1025 {\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \
af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 FORMULIR
PENDAFTARAN SISWA BARU KELAS VII}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \
af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 UPTD SMP
NEGERI 1 PATROL}{\rtlch \fcs1 \af0 \afs28 \ltrch \fcs0 \b1 \fs28 \rtlch \
af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 TAHUN
AJARAN 2023/2024}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \
langfenp1057 \alang1025 \par }\pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \widctlpar \
aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \rtlch \fcs1 \af4 \afs24 \ltrch \
langnp1057 \langfe1057 \langfenp1057 \alang1025 Jalan Raya Patrol Telp. (0234) }{\
610096 Kec. Patrol \uc1 \u8211 ? }{\rtlch \fcs1 \af5 \afs21 \ltrch \fcs0 \fs21 \
langfe1057 \langfenp1057 \alang1025 Indramayu 45258}{\rtlch \fcs1 \af5 \afs21 \
e-mail :}{\rtlch \fcs1 \af5 \afs18 \ltrch \fcs0 \fs18 \rtlch \alang1025 \ltrch \
alang1025 }{\field \fldedit {\*\fldinst {\rtlch \fcs1 \af5 \afs18 \ltrch \fcs0 \
fs18 \rtlch \alang1025 \ltrch \dbch \af4 \hich \af5 \loch \af5 \lang1057 \
langnp1057 \langfe1057 \langfenp1057 \alang1025 }{\rtlch \fcs1 \af5 \afs18 \ltrch \
langnp1057 \langfe1057 \langfenp1057 \alang1025 HYPERLINK
"mailto:uptdsmpn1patrol@gmail.com" }}{\fldrslt {\rtlch \fcs1 \af5 \afs18 \ltrch \
fcs0 \fs18 \rtlch \alang1025 \ltrch \dbch \af4 \hich \af5 \loch \af5 \lang1057 \
langnp1057 \langfe1057 \langfenp1057 \alang1025 }{\rtlch \fcs1 \af5 \afs18 \ltrch \
fcs0 \cs15 \fs18 \rtlch \ltrch \dbch \af2 \hich \af5 \loch \f5 \cf13 \ul1
uptdsmpn1patrol@gmail.com}}}{\rtlch \fcs1 \af5 \afs18 \ltrch \fcs0 \cs15 \fs18 \
rtlch \ltrch \dbch \af2 \hich \af5 \loch \af5 \cf13 \ul1 }{\rtlch \fcs1 \af5 \afs18
hich \af4 \loch \af4 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 {\
*\shppict {\pict {\*\picprop \shplid0 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}
{\sv 0}}{\sp {\sn fFlipV}{\sv 0}}{\sp {\sn fLockAspectRatio}{\sv 1}}{\sp {\sn
WrapText}{\sv 0}}{\sp {\sn fLineOK}{\sv 1}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn
fillColor}{\sv 10526880}}{\sp {\sn fFilled}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp
{\sn fLine}{\sv 0}}{\sp {\sn wzName}{\sv Picture 4}}{\sp {\sn posrelh}{\sv 1}}{\sp
{\sn posrelv}{\sv 1}}{\sp {\sn alignHR}{\sv 1}}{\sp {\sn dxHeightHR}{\sv 30}}{\sp
{\sn fHorizRule}{\sv 1}}{\sp {\sn fStandardHR}{\sv 1}}{\sp {\sn fLayoutInCell}{\sv
1}}}\piccropl0 \piccropr0 \piccropt0 \piccropb0 \picscalex100 \picscaley29 \
picw298627 \pich137344053 \picwgoal3583532 \pichgoal1648128588 \wmetafile8 {\*\
blipuid
001a04574d4643010000000000010046230000000001000000f803000000000000f8030000010000006
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0000e000080120000000c00000001000000520000007001000001000000a4ffffff0000000000000000
00000000900100000000000004400022430061006c00690062007200690000000000000000000000000
00000000000000000000000000000000000000000000000000000000000000000000000000000000017
0000000005802000025000000372e90010000020f0502020204030204ff0200e0ffac00400100000000
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80000
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01000000180000000c00000000000002540000005400000000000000000000003500000037000000010
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003800000050000000200035003600000046000000280000001c000000474449430200000000000000f
fffffff3d0f000039000000000000002100000008000000620000000c00000001000000240000002400
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000000000a0a0a00000000000250000000c00000002000000250000000c000000080000805600000030
00000000000000ffffffff3c0f000039000000050000000000f9ff0000c201e079c201e079f9ff0000f
9ff250000000c00000007000080250000000c0000000000008024000000240000000000004100000000
0000000000000041000000000000000002000000220000000c000000ffffffff4600000014000000080
000004744494303000000250000000c0000000e000080250000000c0000000e0000800e000000140000
000000000010000000140000000400000003010800050000000b0200000000050000000c020700d4010
40000002e0118001c000000fb020200010000000000bc02000000000102022253797374656d00000000
00000000000000000000000000000000000000000000040000002d010000040000002d0100000400000
0020101001c000000fb02f5ff0000000000009001000000000440002243616c69627269000000000000
00000000000000000000000000000000000000040000002d010100040000002d010100040000002d010
100050000000902000000020d000000320a0a0000000100040000000000d30107002000060003000000
1e0007000000fc020000a0a0a0000000040000002d01020008000000fa02050000000000ffffff00040
000002d0103000e000000240305000000000000000700d3010700d30100000000000008000000fa0200
000000000000000000040000002d01040007000000fc020000ffffff000000040000002d01050004000
0002701ffff040000002d010000040000002d010000030000000000}}}{\rtlch \fcs1 \af0 \afs21
langnp1057 \langfe1057 \langfenp1057 \alang1025 BIODATA CALON PESERTA DIDIK}{\rtlch
\loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \par }\pard \
alang1025 JALUR AFIRMASI }{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \b1 \fs22 \rtlch \
li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \
lin0 \rin0 \tql \tx426 \tql \tx709 \itap0 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \
langnp1057 \langfe1057 \langfenp1057 \alang1025 A.}{\rtlch \fcs1 \af0 \afs22 \ltrch
\fcs0 \fs22 \rtlch \alang1025 \ltrch \dbch \af4 \hich \af4 \loch \f0 \lang1057 \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 IDENTITAS CALON PESERTA
DIDIK}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \dbch \
\par }\pard \plain \fi-360 \li720 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \cf1 Nomor Pendaftaran (}
diisi oleh petugas}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \
langfenp1057 \alang1025 \cf1 )}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \
langnp1057 \langfe1057 \langfenp1057 \alang1025 \cf1 Nama Lengkap Calon}{\rtlch \
\cf1 N I S N}{\rtlch \fcs1 \af0
\lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \cf1 \tab }{\rtlch \fcs1
\f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \cf1 :}{\rtlch \fcs1
\f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \cf1 \tab }{\rtlch \
langnp1057 \langfe1057 \langfenp1057 \alang1025 \cf1 Tempat dan tanggal lahir}{\
\cf1 Tempat tinggal calon}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \
adjustright \lin0 \rin0 \tql \tx426 \tql \tx709 \tql \tx4395 \tql \tx4820 \itap0 \
langnp1057 \langfe1057 \langfenp1057 \alang1025 \cf1 Agama}{\rtlch \fcs1 \af0 \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \cf1 Sekolah Asal/Lulus
Tahun}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \dbch \
lisa0 \sl276 \slmult1
\widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \tql \tx426 \tql \tx709 \
tql \tx4395 \tql \tx4820 \itap0 \ls4 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \fs24 \
Alamat Sekolah}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \
langfe1057 \langfenp1057 \alang1025 \cf1 :}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 B.}{\rtlch \fcs1 \af0 \
loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 IDENTITAS ORANG
TUA}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \dbch \
\par }\pard \plain \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \
langfenp1057 \alang1025 1.}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \
\langfe1057 \langfenp1057 \alang1025 Nama }{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \
\langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \li0 \ri0 \lisb0 \lisa0 \
af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 a.}{\rtlch
hich \af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 Ayah
/Wali}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \dbch \
\langfe1057 \langfenp1057 \alang1025 Ibu / Wali}{\rtlch \fcs1 \af0 \afs22 \ltrch \
hich \af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 2.}
tql \tx4395 \tql \tx4820 \itap0 \rtlch \fcs1
\af4 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \loch \af4 \hich \af4 \
hich \af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 a.}
hich \af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 Ayah
/Wali}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \dbch \
\langfe1057 \langfenp1057 \alang1025 Ibu / Wali}{\rtlch \fcs1 \af0 \afs22 \ltrch \
?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?.\uc1 \u8230 ?}{\rtlch \fcs1 \af0 \afs22 \
?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230
?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?.}
langfe1057 \langfenp1057 \alang1025 C.}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22
\langfe1057 \langfenp1057 \alang1025 IDENTITAS WALI}{\rtlch \fcs1 \af0 \afs22 \
?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?}{\rtlch \fcs1 \af0 \afs22 \
fs22 \rtlch \alang1025
langfe1057 \langfenp1057 \alang1025 Telepon / HP}{\rtlch \fcs1 \af0 \afs22 \ltrch \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 D.}{\rtlch \fcs1 \af0 \
loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 DOKUMEN
FISIK }{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \
widctlpar \aspalpha \aspnum \adjustright \lin1150 \rin0 \tql \tx426 \tql \tx709 \
tql \tx993 \tql \tx4395 \tql \tx4820 \itap0 \ls5 \rtlch \fcs1 \af4 \afs24 \ltrch \
KIP/PKH/LAINNYA}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \
langfe1057 \langfenp1057 \alang1025 :}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \cf1 \par }\pard \plain \
qj \li426 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
langfe1057 \langfenp1057 \alang1025 Demikian data diatas adalah data sebenarnya dan
dapat dipertanggungjawabkan. Jika data tersebut tidak sesuai dengan yang
sebenarnya, kami siap menerima sanksi sesuai ketentuan yang berlaku.}{\rtlch \
alang1025 }{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \
langfenp1057 \alang1025 \par }\pard \plain \li0 \ri0 \lisb0 \lisa0 \widctlpar \
langnp1057 \langfe1057 \langfenp1057 \alang1025 Diketahui}{\rtlch \fcs1 \af0
f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \tab }{\rtlch \fcs1 \
hich \af4 \loch
\f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \tab }{\rtlch \fcs1
\f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025
langfe1057 \langfenp1057 \alang1025 }{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \b1 \
ri0 \sb240 \lisb0 \sa240 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \
alang1025 \par }\pard \plain \li0 \ri0 \sb240 \lisb0 \sa240 \lisa0 \widctlpar \
langnp1057 \langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \li0 \ri0 \sb240
\lisb0 \sa240 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \
}\pard \plain \li0 \ri0 \sb240 \lisb0 \sa240 \lisa0 \widctlpar \aspalpha \aspnum \
langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \li0 \ri0 \sb240 \lisb0 \
pard \plain \li0 \ri0 \sb240 \lisb0 \sa240 \lisa0 \widctlpar \aspalpha \aspnum \
langfe1057 \langfenp1057 \alang1025 Contoh Formulir (Keterangan Anak Guru)}{\
langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \qc \li0 \ri0 \sb240 \
lisb0 \sa240 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \
KOP SEKOLAH}{\rtlch \fcs1 \af0 \afs28 \ltrch \fcs0 \b1 \fs28 \rtlch \alang1025 \
ltrch \dbch
alang1025 \par }\pard \plain \qc \li0 \ri0 \sb240 \lisb0 \sa240 \lisa0 \widctlpar \
fcs0 \fs22 \rtlch \alang1025 \ltrch \dbch \af4 \hich \af4 \loch \af4 \lang1057 \
langnp1057 \langfe1057 \langfenp1057 \alang1025 {\*\shppict {\pict {\*\picprop \
shplid0 {\sp {\sn shapeType}{\sv 1}}{\sp {\sn fFlipH}{\sv 0}}{\sp {\sn fFlipV}{\sv
0}}{\sp {\sn fLockAspectRatio}{\sv 1}}{\sp {\sn WrapText}{\sv 0}}{\sp {\sn fLineOK}
{\sv 1}}{\sp {\sn fShadowOK}{\sv 1}}{\sp {\sn fillColor}{\sv 10526880}}{\sp {\sn
fFilled}{\sv 1}}{\sp {\sn lineStyle}{\sv 0}}{\sp {\sn fLine}{\sv 0}}{\sp {\sn
wzName}{\sv Picture 5}}{\sp {\sn posrelh}{\sv 1}}{\sp {\sn posrelv}{\sv 1}}{\sp {\
sn alignHR}{\sv 1}}{\sp {\sn dxHeightHR}{\sv 30}}{\sp {\sn fHorizRule}{\sv 1}}{\sp
{\sn fStandardHR}{\sv 1}}{\sp {\sn fLayoutInCell}{\sv 1}}}\piccropl0 \piccropr0 \
piccropt0 \piccropb0 \picscalex100 \picscaley29 \picw298627 \pich137344053 \
picwgoal3583532 \pichgoal1648128588 \wmetafile8 {\*\blipuid
001a04574d4643010000000000010046230000000001000000f803000000000000f8030000010000006
0100f80300001d00000003000000000000000000000000000000c0120000aa1a0000cb0000002101000
0000000000000000000000000c0190300c7680400160000000c000000180000000a0000001000000000
0000000000000009000000100000003c0f000039000000250000000c0000000e000080250000000c000
0000e000080120000000c00000001000000520000007001000001000000a4ffffff0000000000000000
00000000900100000000000004400022430061006c00690062007200690000000000000000000000000
00000000000000000000000000000000000000000000000000000000000000000000000000000000017
0000000005802000025000000372e90010000020f0502020204030204ff0200e0ffac00400100000000
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1c3888006476000800000000250000000c00000001000000250000000c00000001000000250000000c0
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000100000055558740637b87400000000057000000010000004c0000000400000000000000000000003
c0f00003800000050000000200035003600000046000000280000001c00000047444943020000000000
0000ffffffff3d0f000039000000000000002100000008000000620000000c000000010000002400000
0240000000000003e00000000000000000000003e000000000000000002000000270000001800000002
00000000000000a0a0a00000000000250000000c00000002000000250000000c0000000800008056000
0000f9ff250000000c00000007000080250000000c00000000000080240000002400000000000041000
000000000000000000041000000000000000002000000220000000c000000ffffffff46000000140000
00080000004744494303000000250000000c0000000e000080250000000c0000000e0000800e0000001
40000000000000010000000140000000400000003010800050000000b0200000000050000000c020700
d401040000002e0118001c000000fb020200010000000000bc02000000000102022253797374656d000
0000000000000000000000000000000000000000000000000040000002d010000040000002d01000004
000000020101001c000000fb02f5ff0000000000009001000000000440002243616c696272690000000
0000000000000000000000000000000000000000000040000002d010100040000002d01010004000000
2d010100050000000902000000020d000000320a0a0000000100040000000000d301070020000600030
00040000002d0103000e000000240305000000000000000700d3010700d30100000000000008000000f
a0200000000000000000000040000002d01040007000000fc020000ffffff000000040000002d010500
f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 }{\rtlch \fcs1 \
af0 \afs22 \ltrch \fcs0 \b1 \fs22 \rtlch \alang1025 \ltrch \dbch \af4 \hich \af4 \
plain \qc \li0 \ri0 \sb240 \lisb0 \sa240 \lisa0 \widctlpar \aspalpha \aspnum \
langfe1057 \langfenp1057 \alang1025 }{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \
\langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \qc \li0 \ri0 \sb240 \lisb0
\lisa0 \sl276 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0
SURAT KETERANGAN}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \b1 \fs24 \rtlch \alang1025
langfenp1057 \alang1025 \par }\pard \plain \qc \li0 \ri0 \sb240 \lisb0 \lisa0 \
sl276 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \
Nomor : \uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \
?.}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \dbch \af4
\hich \af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \
par }\pard \plain \qc \li0 \ri0 \sb240 \lisb0 \sa240 \lisa0 \widctlpar \aspalpha \
langnp1057 \langfe1057 \langfenp1057 \alang1025 }{\rtlch \fcs1 \af0 \afs22 \
li0 \ri0 \sb240 \lisb0 \sa240 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \
\langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \li0 \ri0 \sb240 \lisb0 \
af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 Yang
bertandatangan di bawah ini, kepala }{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \i1 \
\langfe1057 \langfenp1057 \alang1025 SD/MI\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\
uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?.....
Kecamatan \uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?..
Kabupaten \uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \
u8230 ?\uc1 \u8230 ?, Provinsi\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\
uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?.,}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \
\langfe1057 \langfenp1057 \alang1025 Menerangkan bahwa :}{\rtlch \fcs1 \af0 \afs22
\langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \li0 \ri0 \sb240 \lisb0 \
sa240 \lisa0 \widctlpar \aspalpha \aspnum
\adjustright \lin0 \rin0 \itap0 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \fs24 \rtlch
langfe1057 \langfenp1057 \alang1025 Nama Siswa }{\rtlch \fcs1 \af0 \
langfe1057 \langfenp1057 \alang1025 Tempat, Tanggal lahir }{\rtlch \fcs1 \af0 \
langfe1057 \langfenp1057 \alang1025 Asal Sekolah }{\rtlch \fcs1 \af0 \
langfe1057 \langfenp1057 \alang1025 No Ujian }{\rtlch \fcs1 \af0 \afs22 \ltrch
\fcs0 \fs22 \rtlch \alang1025 \ltrch \dbch \af4 \hich \af4 \loch \f0 \lang1057 \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 }{\rtlch \fcs1 \
af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 :}{\
}\pard \plain \qc \li0 \ri0 \sb240 \lisb0 \sa240 \lisa0 \widctlpar \aspalpha \
langnp1057 \langfe1057 \langfenp1057 \alang1025 }{\rtlch \fcs1 \af0 \afs22 \
ri0 \sb240 \lisb0 \sa240 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \
alang1025 Anak tersebut adalah benar merupakan putra / putri guru yaitu :}{\rtlch \
pard \plain \li0 \ri0 \sb240 \lisb0 \sa240 \lisa0 \widctlpar \aspalpha \aspnum \
langfe1057 \langfenp1057 \alang1025 Nama Bapak/Ibu }{\rtlch \fcs1 \af0 \afs22 \
langfe1057 \langfenp1057 \alang1025 NIP }{\rtlch \fcs1 \
af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 :}{\
langfe1057 \langfenp1057 \alang1025 Unit Kerja }{\rtlch \fcs1 \af0 \
langfe1057 \langfenp1057 \alang1025 Lama Mengajar }{\rtlch \fcs1 \af0 \afs22 \
qc \li0 \ri0 \sb240 \lisb0 \sa240 \lisa0 \widctlpar \aspalpha \aspnum \
\langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \qc \li0 \ri0 \sb240 \lisb0
\sa240 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \rtlch \
fcs1 \af4
\afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \loch \af4 \hich \af4 \dbch \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 Demikian surat keterangan
ini kami buat, untuk dapat digunakan sebagaimana mestinya.}{\rtlch \fcs1 \af0 \
\langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \fi720 \li4320 \ri-900 \
rin-900 \itap0 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch
\loch \af4 \hich \af4 \dbch \af4 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \
alang1025 Patrol, \uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \
u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ? 2023}{\
}\pard \plain \fi720 \li4320 \ri0 \lisb0 \lisa0 \sl276 \slmult1 \widctlpar \
aspalpha \aspnum \adjustright \lin4320 \rin0 \itap0 \rtlch \fcs1 \af4 \afs24 \ltrch
\fcs0 \fs24 \rtlch \alang1025 \ltrch \loch \af4 \hich \af4 \dbch \af4 \lang1057 \
langnp1057 \langfe1057 \langfenp1057 \alang1025 Kepala SD/MI \uc1 \u8230 ?\uc1 \
?\uc1 \u8230 ?}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \
langfenp1057 \alang1025 \par }\pard \plain \qc \li0 \ri0 \sb240 \lisb0 \sa240 \
af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 }{\
}\pard \plain \qc \li0 \ri0 \sb240 \lisb0 \sa240 \lisa0 \widctlpar \aspalpha \
langnp1057 \langfe1057 \langfenp1057 \alang1025
Bermaterai 10.000}{\rtlch \fcs1 \af0 \afs16 \ltrch \fcs0 \fs16 \rtlch \alang1025 \
langfenp1057 \alang1025 \par }\pard \plain \qc \li5760 \ri0 \lisb0 \lisa0 \sl276 \
slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin5760 \rin0 \itap0 \rtlch \
af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 }{\
}\pard \plain \fi720 \li4320 \ri0 \lisb0 \lisa0 \sl276 \slmult1 \widctlpar \
langnp1057 \langfe1057 \langfenp1057 \alang1025 \uc1 \u8230 ?\uc1 \u8230 ?\uc1 \
\u8230 ?}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \
alang1025 \par }\pard \plain \fi720 \li4320 \ri0 \lisb0 \lisa0 \sl276 \slmult1 \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 NIP.}{\rtlch \fcs1 \af0 \
fcs1 \af0
\lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \qc \
af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 Lampiran
1}{\rtlch \fcs1 \af0 \afs21 \ltrch \fcs0 \fs21 \rtlch \alang1025 \ltrch \dbch \
\par }\pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha
\aspnum \adjustright \lin0 \rin0 \itap0 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \fs24
\rtlch \alang1025 \ltrch \loch \af4 \hich \af4 \dbch \af4 \lang1057 \langnp1057 \
alang1025 \par }\pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar
langnp1057 \langfe1057 \langfenp1057 \alang1025 SURAT PERNYATAAN}{\rtlch \fcs1 \af0
\afs24 \ltrch \fcs0 \b1 \fs24 \rtlch \alang1025 \ltrch \dbch \af4 \hich \af4 \
plain \qc \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
langfe1057 \langfenp1057 \alang1025 TANGGUNG JAWAB MUTLAK ORANG TUA/WALI}{\rtlch \
hich \af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 Yang
bertandatangan dibawah ini}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \
Lengkap}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \dbch
\langfe1057 \langfenp1057 \alang1025 : \uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\
langnp1057 \langfe1057 \langfenp1057 \alang1025 Nama Calon Siswa}{\rtlch \fcs1 \af0
f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \tab }{\rtlch \fcs1 \
hich \af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 : \
\u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?.}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \
Alamat Rumah}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \
uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230
?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\
u8230 ?.}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \
langnp1057 \langfe1057 \langfenp1057 \alang1025 No. HP/Email}{\rtlch \fcs1 \af0 \
langnp1057 \langfe1057 \langfenp1057 \alang1025 MENYATAKAN}{\rtlch \fcs1 \af0 \
alang1025 \par }\pard \plain \qj \fi-360 \li720 \ri0 \lisb0 \lisa0 \sl360 \
slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \ls6 \
listtext \pard \plain \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025
\ltrch \loch \af4 \hich \af4 \dbch \af4 \lang1057 \langnp1057 \langfe1057 \
langfenp1057 \alang1025 \f0 1.\tab }{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \
langfe1057 \langfenp1057 \alang1025 \cf1 Bahwa seluruh data/informasi yang
diberikan dalam dokumen-dokumen persyaratan PPDB ini adalah benar.}{\rtlch \fcs1 \
plain \qj \li720 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
adjustright \lin720 \rin0 \itap0 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \fs24 \rtlch
langfe1057 \langfenp1057 \alang1025 \cf1 \par }\pard \plain \qj \fi-360 \li720 \ri0
\lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin720 \
rin0 \itap0 \ls6 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \
langfenp1057 \alang1025 {\listtext \pard \plain \rtlch \fcs1 \af4 \afs24 \ltrch \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \cf1 Bahwa saya tidak
akan melakukan suap menyuap dan/atau perbuatan yang melawan hukum dalam
pelaksanaan PPDB ini.}{\rtlch \fcs1 \af4 \afs22 \ltrch \fcs0 \fs22 \rtlch \
qj \fi-360 \li720 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
adjustright \lin720 \rin0 \itap0 \ls6 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \fs24 \
Apabila dikemudian hari ternyata apa yang saya nyatakan tersebut tidak benar, maka
saya bersedia dikenakan sanksi/hukuman sesuai ketentuan peraturan perundang-
undangan.}{\rtlch \fcs1 \af4 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \
alang1025 \par }\pard \plain \li720 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \fs24 \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \cf1 Demikian surat
pernyataan ini saya buat dalam keadaan sadar tanpa paksaan, dan dibuat dengan
sebenarnya.}{\rtlch \fcs1 \af4 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \
alang1025 \par }\pard \plain \li720 \ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum
\adjustright \lin720 \rin0 \itap0 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \fs24 \
langfe1057 \langfenp1057 \alang1025 \cf1 \par }\pard \plain \qj \li0 \ri0 \lisb0 \
alang1025 \cf1 \par }\pard \plain \qj \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \
afs22 \ltrch \fcs0 \fs22 \rtlch
\alang1025 \ltrch \dbch \af4 \hich \af4 \loch \f0 \lang1057 \langnp1057 \
langfe1057 \langfenp1057 \alang1025 \cf1 \par }\pard \plain \qj \li0 \ri0 \lisb0 \
alang1025 \cf1 \par }\pard \plain \qj \li5040 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 Indramayu, \uc1 \u8230 ?\
u8230 ?\uc1 \u8230 ?\uc1 \u8230 ? 2023}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22
langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \qj \fi720 \li5040 \ri0 \
alang1025 Yang membuat pernyataan}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \
\langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \qj \li0 \ri0 \lisb0 \lisa0
\sl360 \slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \rtlch
\fcs1 \af4 \afs24 \ltrch \fcs0 \fs24 \rtlch \alang1025 \ltrch \loch \af4 \hich \af4
\dbch \af4 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 {\rtlch \fcs1
hich \af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 Ttd}
Bermaterai 10.000}{\rtlch \fcs1 \af0 \afs18 \ltrch \fcs0 \fs18 \rtlch \alang1025 \
langfenp1057 \alang1025 \par }\pard \plain \qj \li0 \ri0 \lisb0 \lisa0 \sl360 \
slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \rtlch \fcs1 \
langnp1057 \langfe1057 \langfenp1057 \alang1025
u8230 ?\uc1 \u8230 ?}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025
langfenp1057 \alang1025 \par }\pard \plain \li0 \ri0 \lisb0 \lisa0 \widctlpar \
langnp1057 \langfe1057 \langfenp1057 \alang1025 \page }{\rtlch \fcs1 \af0 \afs22 \
ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \
langfe1057 \langfenp1057 \alang1025 Lampiran 2}{\rtlch \fcs1 \af0 \afs21 \ltrch \
alang1025 \par }\pard \plain \qc \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar
langnp1057 \langfe1057 \langfenp1057 \alang1025 SURAT PERNYATAAN}{\rtlch \fcs1 \af0
\afs24 \ltrch \fcs0 \b1 \fs24 \rtlch \alang1025 \ltrch \dbch \af4 \hich \af4 \
plain \qc \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
langfe1057 \langfenp1057 \alang1025 TANGGUNG JAWAB MUTLAK PEJABAT
ORGANISASI/INSTANSI}{\rtlch \fcs1 \af0 \afs24 \ltrch \fcs0 \b1 \fs24 \rtlch \
\par }\pard \plain \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \
langnp1057 \langfe1057 \langfenp1057 \alang1025 Yang bertandatangan dibawah ini}{\
langnp1057 \langfe1057 \langfenp1057 \alang1025 Nama Lengkap}{\rtlch \fcs1 \af0 \
Jabatan}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \dbch
langnp1057 \langfe1057 \langfenp1057 \alang1025 Organisasi/Instansi}{\rtlch \fcs1 \
}{\rtlch \fcs1 \af0
\lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 : \uc1 \u8230 ?\uc1 \
u8230 ?\uc1 \u8230 ?.}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \
Alamat Kantor}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch
hich \af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 No.
HP/Email}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \
alang1025 MENYATAKAN}{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025
langfenp1057 \alang1025 \par }\pard \plain \li0 \ri0 \lisb0 \lisa0 \sl360 \
slmult1 \widctlpar \aspalpha \aspnum \adjustright \lin0 \rin0 \itap0 \rtlch \fcs1 \
pard \plain \qj \fi-360 \li720 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \
aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \ls7 \rtlch \fcs1 \af4 \afs24 \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 {\listtext \pard \plain \
hich \af4 \dbch \af4 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \f0
1.\tab }{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \ltrch \dbch
alang1025 \cf1 Bahwa seluruh data/informasi yang diberikan tentang keterangan
prestasi atas nama\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \
u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?.. adalah benar.}{\rtlch \fcs1 \af4 \
adjustright \lin720 \rin0 \itap0 \rtlch \fcs1 \af4 \afs24 \ltrch \fcs0 \fs24 \rtlch
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \cf1 Apabila dikemudian
hari ternyata apa yang saya nyatakan tersebut tidak benar, maka saya bersedia
dikenakan sanksi/hukuman sesuai ketentuan peraturan perundang-undangan.}{\rtlch \
fcs1 \af4 \afs22 \ltrch \fcs0 \fs22
qj \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
langfe1057 \langfenp1057 \alang1025 Demikian surat pernyataan ini saya buat dalam
keadaan sadar tanpa paksaan, dan dibuat dengan sebenarnya.}{\rtlch \fcs1 \af0 \
lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \li720
\ri0 \lisb0 \lisa0 \widctlpar \aspalpha \aspnum \adjustright \lin720 \rin0 \itap0 \
langnp1057 \langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \qj \li0 \ri0 \
alang1025 \par }\pard \plain \qj \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar
langnp1057 \langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \qj \li5040 \ri0
alang1025 Indramayu, \uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \
u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ?\uc1 \u8230 ? 2023}{\
}\pard \plain \qj \fi720 \li5040 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \
langnp1057 \langfe1057 \langfenp1057 \alang1025 Yang membuat pernyataan}{\rtlch \
pard \plain \qj \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \
hich \af4 \loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 Ttd}
hich \af4 \loch \f0 \lang1057 \langnp1057
\langfe1057 \langfenp1057 \alang1025 \tab }{\rtlch \fcs1 \af0 \afs18 \ltrch \
langnp1057 \langfe1057 \langfenp1057 \alang1025 Bermaterai 10.000}{\rtlch \fcs1 \
plain \qj \li0 \ri0 \lisb0 \lisa0 \sl360 \slmult1 \widctlpar \aspalpha \aspnum \
\langfe1057 \langfenp1057 \alang1025 }{\rtlch \fcs1 \af0 \afs22 \ltrch \
langnp1057 \langfe1057 \langfenp1057 \alang1025 \par }\pard \plain \qj \li0 \ri0 \
alang1025 }{\rtlch \fcs1 \af0 \afs22 \ltrch \fcs0 \fs22 \rtlch \alang1025 \
\langfe1057 \langfenp1057 \alang1025 \uc1 \u8230 ?\uc1 \u8230 ?\uc1 \
loch \f0 \lang1057 \langnp1057 \langfe1057 \langfenp1057 \alang1025 \par }}

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deflangfe1033 {\fonttbl {\f0 \froman \fcharset0 \fprq2 {\*\panose

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