The undersigned below ............... Head Elementary School. Subdistrict ............ .. Central Lampung Regency of Lampung Province, explained truthfully that:
1. Number of the National School (NPSN):
2. National Student Identification Number (NISN):
3. Identification Number School (NIS):
4. Students Full Name:
5. Type Kelaim:
6. Address Students:
:
7. Religion:
8. Father Name Bladder:
9. Name of Mother Sibling:
Has applied for mutation / move students at the request of parents / guardians reason for the move:
Basically we approve / authorize transfer / relocate the students and the bersamgkutan not allowed to come back to the elementary school district .................. ......... Central Kab.lampung .......
Interest Movements / move to:
1. NPSN:
2. The name of the school:
3. District:
4. Province:
Thus Permit Mutation / Move was made with actual students to be used as appropriate