Contoh Surat Pernyataan Peserta Didik Baru Dan Orang Tua Wali Untuk PPDB

SURAT PERNYATAAN PESERTA DIDIK BARU

 

Contoh

Yang bertanda tangan di bawah ini: 1.

Na m a

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

2.

N I SN / 

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

!.

 Tem"at/tangga# #ahir

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

$.

 %eni& Ke#amin

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

'.

Agam a

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

(.

N)m)r Penda*taran

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

+.

Diterima di ,e#a&

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

-.

Nama rang ta/wa#i

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

0.

Pe,eraan rang Ta rang  Ta

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

1. Agama rang Ta rang Ta

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

11. Nama 3a#i

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

12. Pe,eraan 3a#i

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

1!. 4bngan Ke#arga dengan wa#i

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

1$. A#amat )rang ta/wa#i

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

 Te#"/4P  Te#"/4 P

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Dengan ini ,ami men5ata,an dengan &e&ngghn5a6 bahwa &e#ama di adra&ah ini: 1. A,an be#aar dengan te,n6 &nggh7&nggh dan "enh &emangat8 2.

A,an menaga nama bai, diri &endiri6 ,e#arga6 ma&5ara,at dan madra&ah8

!.

Sangg" menaati &e#rh tata tertib dan "eratran 5ang ber#a,6 memathi "e#a,&anaan #ing,ngan "endidi,an terma&, ber"a,aian &eragam madra&ah6 SIS dan #ain7#ain.

$.

Sia" menerima &an,&i &e&ai ,etentan madra&ah.

Demi,ian &rat "ern5ataan ini ,ami bat dengan &ebenarn5a dan "enh ra&a tanggng  awab. engetahi : rang ta/wa#i

 9999999999999999.. ;

...................6 9...................... 21+ Yang membat "ern5ataan

 999999999999 9999999999999999.. 9999.. ; Contoh

SURAT PERNYATAAN RAN< TUA/3A=I

Yang bertanda tangan di bawah ini: 1. Nama )rang ta/wa#i

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

2. Pe,eraan )rang ta/wa#i

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

!. A#amat )rang ta/wa#i

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

$.  Te#e")n/4P )rang ta/wa#i

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

'. A g a m a

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

(. Nama Pe&erta Didi,

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

+.  %eni& Ke#amin Ke#ami n Pe&erta Didi,

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

-. Diterima di ,e#a&

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

0. 4bngan ,e#arga dgn >a#)n "e&erta didi,

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

ENYATAKAN Bahwa Sa5a &e#a, )rang ta/wa#i dari "e&erta didi,  5ang bernama .................. ................. ,e#a& .............. RA/I/T&/A/AK ............................... en5ata,an dengan &e&ngghn5a: 1. Ber&edia membimbing dan mengawa&i "e&erta didi, ter&ebt di ata& nt, menaati tata tertib madra&ah 2.  Tida, ,eberatan "e&erta di di, di ata& menerima &an,&i &e&ai dengan ,etentan madra&ah.

Demi,ian &rat "ern5ataan ini &a5a bat dengan &ebenarn5a &erta "enh ra&a tanggng awab.

engetahi 8 Ke"a#a adra&ah

.......................6 9..99999.. 21+ Yang membat "ern5ataan rang Ta / 3a#i

 9999999999999999.. ;

 9999999999999999.. ;