KEMENTERIAN PENDIDIKAN DAN KEBUDAYAANPUSAT DATA DAN STATISTIK PENDIDIKAN Jl. Jenderal Sudirman-Senayan, Jakarta 10270Tele!n"021-#7$1177, %ak&imile" 021-#7212'$ (aman " ))).kemdikna&.*!.id FORMULIR PENGAJUAN NISN BARU ( Form A.1)NPSN " '0$01$+7Nama Sek!la, " SD Inre& (!-!n*Tan**al Pen*a-uan " 1$ .ei 201$NO Nama Siswa Tm!a" La#ir Ta$%%a& La#irJ$isK&ami$A%ama A&ama"Ti$%'a"(K&as)Nama I()Ka$*)$%Asa& S'o&a#1 Putri .ailani Sari .alaka-i 0'-0#-200$ P I&lam .alaka-i I/ N!rma SD Inre& (!-!n*2 Putri Tiara 0a&inta .alaka-i 11-0+-2002 P I&lam.alaka-iII Nur,udaya,. ASD Inre& (!-!n*$ .u,. 3e4a Pa5liun*an 12-0+-200# ( I&lam.alaka-iII 6ati SD Inre& (!-!n*' I&7ar Saar .alaka-i 1$-0$-2007 ( I&lam(!-!n*I 8elmiatiSD Inre& (!-!n*# A&)ar 6a,yudi Jene!nt! 12-0'-2002 ( I&lam.alaka-iI 8am&iaSD Inre& (!-!n*2 .u,ammad A*un* Patta57akkan* 17-0#-200' ( I&lamPatta57akkan*I T!ken*SD Inre& (!-!n*7 .u,. Dima& San-aya .alaka-i 21-10-2002 ( I&lam.alaka-iI NaiaSD Inre& (!-!n*+ Indriani .alaka-i 0#-02-2007 P I&lam.alaka-iI Nur,ayatiSD Inre& (!-!n*1 Nur9adila :adien* 01-01-2007 P I&lam:adien*I 3aiya,SD Inre& (!-!n*10 Salma)ati .alaka-i 0+-01-2002 P I&lam.alaka-iI Sukma)atiSD Inre& (!-!n*11 Siti Nur,ali&a :adien* 02-02-2002 P I&lam:adien*I Syam&inarSD Inre& (!-!n*12 3i&al7i .alaka-i 10-12-2002 ( I&lamJan*!an*I NuraemaSD Inre& (!-!n* (!-!n*, 1$ .ei 201$Keala Sek!la,+,. ROSMIATI- S.P*i NIP. 112212$1 11+'11 2 012