Buku Induk Santri [PDF]

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LEMBAR BUKU INDUK SANTRI NOMOR INDUK SANTRI ................



A. KETERANGAN IDENTITAS



30.Penghasilan per bulan



: ......................................................................................................



1. Nama Lengkap



: ...............................................................................................



31.No Telpon/ HP



: ......................................................................................................



2. Tempat/ Tgl. Lahir



: ................................................................................................



32.Meninggal dunia



: Tanggal...........................................di............................................



3. Jenis Kelamin



: ................................................................................................



33.Sebab meninggal



: .......................................................................................................



4. Anak keberapa



: ..................................... dari .............................................



5. Status Anak ( Yatim /Yatim piatu ) .............................................................................................. :



E. KETERANGAN TENTANG WALI



6. Kewarganegaraan



: ................................................................................................



34.Nama Lengkap



: ......................................................................................................



7. No Kartu Keluarga (KK)



: ................................................................................................



35.Tempat dan tanggal lahir



: ......................................................................................................



8. Nomor Induk Kependudukan (NIK)............................................................................................... :



36.Nomor KTP/ NIK



: .......................................................................................................



9. Agama



: ...............................................................................................



37.Agama



: ......................................................................................................



10.Bahasa sehari-hari dirumah



: ...............................................................................................



38.Kewarganegaraan



: ......................................................................................................



39.Pendidikan Terakhir



: ......................................................................................................



40.Pekerjaan



: ......................................................................................................



41.Penghasilan per bulan



: ......................................................................................................



Pasfoto 3 cm x 4 cm waktu masuk ke dayah ini



B. KETERANGAN ALAMAT 11.Alamat a. Jalan



: ................................................................................................



42.No Telpon/ HP



: ......................................................................................................



b. Desa/ Kelurahan



: ...............................................................................................



43.Alamat rumah



: Jln..................................................................................................



c. Kecamatan



: ...............................................................................................



a. Desa/ Kelurahan



: ......................................................................................................



d. Kabupaten /Kota



: ...............................................................................................



b. Kemukiman



: .......................................................................................................



e. Propinsi



: ................................................................................................



c. Kecamatan



: ......................................................................................................



f. Kode Pos



: ................................................................................................



d. Kabupaten



: ......................................................................................................



e. Propinsi



: .......................................................................................................



f. Kode POS



: ......................................................................................................



C. KETERANGAN TENTANG AYAH KANDUNG



Pasfoto 3 cm x 4 cm waktu meninggalkan dayah ini



12.Nama Lengkap



: ...............................................................................................



13.Tempat dan tanggal lahir



: ...............................................................................................



44.Kesenian



: ......................................................................................................



14.Nomor KTP/ NIK



: ................................................................................................



45.Olahraga



: ......................................................................................................



15.Agama



: ...............................................................................................



46.Kemasyarakatan/Organisasi : ......................................................................................................



16.Kewarganegaraan



: ...............................................................................................



47.Lain-lain



17.Pendidikan Terakhir



: ...............................................................................................



18.Pekerjaan



: ...............................................................................................



48.Meninggalkan Dayah



19.Penghasilan per bulan



: ...............................................................................................



49.Tanggal meninggalkan dayah : ......................................................................................................



20.No Telpon/ HP



: ...............................................................................................



50.Alasan



: .......................................................................................................



21.Meninggal dunia



: Tanggal...........................................di.....................................



51.Akhir Pendidikan



: .......................................................................................................



22.Sebab meninggal



: .......................................................................................................



52.Tamat belajar



: ......................................................................................................



53.STTB Nomor



: ......................................................................................................



D. KETERANGAN TENTANG IBU KANDUNG



F.



KEGEMARAN SANTRI



: ......................................................................................................



G. KETERANGAN PENDIDIKAN



H. KETERANGAN SETELAH SELESAI PENDIDIKAN



23.Nama Lengkap



: ......................................................................................................



54.Melanjutkan di



: ......................................................................................................



24.Tempat dan tanggal lahir



: ......................................................................................................



55.Bekerja



: ......................................................................................................



25.Nomor KTP/ NIK



: .......................................................................................................



a. Tanggal mulai bekerja



26.Agama



: ......................................................................................................



b. Nama perusahaan/lembaga dan lain-lain.................................................................................... :



27.Kewarganegaraan



: ......................................................................................................



c. Penghasilan



28.Pendidikan Terakhir



: ......................................................................................................



29.Pekerjaan



: ......................................................................................................



: ......................................................................................................



: .......................................................................................................