No. : ....................BUKU INDUK

1. Nama Murid : .............................................................................................................................. L/P2. Tempat / tanggal lahir : ...............................................................................................................3. Kebangsaan warga negara golongan asing / bangsa : .................................................................4. Agama : ..........................................................................................................................................5. Riwayat sekolah : A. Sekolah Dasar ( semua SD yang pernah di kunjungi , nama sekolah ( jelas ) , tempat masuk / keluar di kelas berapa , tanggal berapa )1. ............................................................................................................................................2. ............................................................................................................................................B. Sekolah Lanjutan ( seperti di atas sebab keluar ) I. Bukan SLTP Negeri 1. ............................................................................................................................................2. ............................................................................................................................................II. SLTP Negeri lain1. ............................................................................................................................................2. ............................................................................................................................................C. Sekolah Ini Masuk tanggal ..............................................................................di kelas VII , VIII , IX (Dengan / tidak dengan)* ujian hasil ujian masuk Sekolah Menengah Pertama di ............................... tanggal ....................................... Angka nilai : Bahasa Indonesia : .............................................................................................................. Matematika : .............................................................................................................. IPA : ..............................................................................................................6. Nama orang tua ayah / ibu : .............................................................................................................( nama ibu diisi bila ayah sudah meninggal ) Pekerjaan : ................................................................................................................................ Alamat : ...............................................................................................................................7. Nama pemangku : ............................................................................................................................Pekerjaan : .......................................................................................................................................Alamat : ...........................................................................................................................................Menjadi pemangku sebab : .............................................................................................................Hubungan keluarga dengan murid : ................................................................................................8. Meninggalkan sekolah ini :A. Belum tamat keluar dari kelas : ..................................... tanggal : .............................................Sebab : .....................................................................................................................................Kemana : ........................................... No. ................................................................................. B. Tamatn menerima ijasah : .........................................................................................................9. Keterangan / lain lain : ..................................................................................................................Pas foto 3 x 4