8/16/2019 Form Mutasi Siswa

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SURAT KETERANGAN MUTASI SISWA

 Nomor : xxxxxxxxxxxxxxxxxxxxxxxxxxxxxxx

1. Nama : ..............................................................................................

2. Jenis Kelamin : ..............................................................................................3. NIS/NISN : ..............................................................................................

4. NPSN : ..............................................................................................5. Kelas : ..............................................................................................6. Agama : ..............................................................................................

7. Telah Tera!"ar #$ian : ..............................................................................................

%. Tem&a"' Tgl. (ahir : ..............................................................................................

). Nama *rang T+a : ..............................................................................................1,. Alama" : ..............................................................................................

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

11. -+lai mas+ seolah :a. Tanggal : ..............................................................................................

 . 0i "erima i elas : ..............................................................................................

. erasal ari Seolah : ..............................................................................................12. Tanggal &inah seolah : ..............................................................................................

13. Alasan &inah seolah : ..............................................................................................

14. Seolah ang i"+$+ :

a. Nama Seolah : .............................................................................................. . Alama" : ..............................................................................................

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

. NPSN : ..............................................................................................15. Ke"erangan :

a. Nama ang menangg+ng : ..............................................................................................

 . Peer$aan : ..............................................................................................

16. a"a"an :a. S+ra" Ke"erangan ini ilam&iri engan ++ a&or".

 . Se"elah el+ar ari seolah ini' ang ersang+"an "ia a&a" i"erima emali i seolahang i"inggalan.

Sisa "erse+" i "erima

Tanggal :

0i Kelas : No. In+ :

-enge"ah+i ' 3, -are" 2,15

Ke&ala #PT TK an S0 Ke&ala

888888888888888888888888888888888888888 888888888888888888888888An. Ke&ala 0inas Peniian Ka+&a"en ..

Kai Peniian TK/S0

……………………………….

Pemina

 NIP. ..