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Jenis Kelamin
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Laki-laki
Perempuan
Tempat Lahir
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Tanggal Lahir
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Usia
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Anak Ke-
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Jumlah Saudara
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Asal Sekolah
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Nama Ayah
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NIK
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Tempat Lahir
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Tanggal Lahir
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Pendidikan Terakhir
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SD
SMP
SMA
D1
D3
D4
S1
S2
S3
Pekerjaan Ayah
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Nomor HP Ayah
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Upload Scan KTP Ayah (Format file .pdf, .jpg, .jpeg, .png)
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Mohon Scan KTP Ayah dalam 1 lembar utuh
Nama Ibu
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NIK
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Tempat Lahir
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Tanggal Lahir
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Pendidikan Terakhir
*
SD
SMP
SMA
D1
D3
D4
S1
S2
S3
Pekerjaan Ibu
*
Nomor HP Ibu
*
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Mohon Scan KTP Ibu dalam 1 lembar utuh
Penghasilan Orangtua
*
Rp 1.500.000 s.d Rp. 2.500.000
Rp. 2.500.000 s.d Rp. 5.000.000
Rp. 5.000.000 s.d Rp. 10.000.000
Lebih dari Rp. 10.000.000
Upload Bukti Pembayaran Pendaftaran (Format file .pdf, .jpg, .jpeg, .png)
*
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Biaya Pendaftaran Rp 300.000,- Transfer Ke Rekening BSI No. Rek 6667775677 (a.n MI Takhasus Darul Ulum)
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Mohon Scan Akte Kelahiran dalam 1 lembar utuh
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Mohon Scan Kartu Keluarga dalam 1 lembar utuh
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