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Formulir Santri Asrama PPI04CJR
Formulir khusus calon santri asrama Pesantren Persatuan Islam 04 Cianjur. Pastikan anda telah mengisi formulir utama terlebih dahulu (WAJIB melalui tautan https://rebrand.ly/psb_ppi04cjr)
Sebelum mengisi, mohon dipersiapkan foto/scan Kartu Keluarga.
Tingkat
Tingkat
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Date
Time
Tsanawiyyah (MTs)
Mu'allimien (MA)
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Tahun ajaran
Tahun ajaran
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2024/2025
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Nama lengkap santri
Nama lengkap santri
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Jenis kelamin
Jenis kelamin
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Laki-laki
Perempuan
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Tempat lahir santri
Tempat lahir santri
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Tanggal lahir santri
Tanggal lahir santri
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Alamat lengkap
Alamat lengkap
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Kabupaten/Kota
Kabupaten/Kota
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Kodepos
Kodepos
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Nafaqoh pendaftaran asrama
Nafaqoh pendaftaran asrama
Nominal nafaqoh asrama sebesar:
- Rp. 4.220.000 untuk pondok MTS, atau
- Rp. 4.250.000 untuk pondok MA
- Nafaqoh pada periode pertama (wajib lunas selama 1 semester; November 2024).
- Nafaqoh minimal 200.000 (infaq pendaftaran).
- Ditulis nominal dibawah tanpa "titik" atau "koma"
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Nafaqoh pertama (WAJIB transfer)
Nafaqoh pertama (WAJIB transfer)
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Rp. 200.000
Lunaskan
Other…
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Nomor kontak orang tua/wali
Nomor kontak orang tua/wali
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No diawali dengan 62. Contoh: 6281237490404. Diutamakan nomor yang tersedia "whatsapp/telegram"
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Nomor kontak santri
Nomor kontak santri
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No diawali dengan 62. Contoh: 6281237490404. Diutamakan nomor yang tersedia "whatsapp/telegram"
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Foto/scan Kartu Keluarga (KK)
Foto/scan Kartu Keluarga (KK)
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Gambar harus terlihat jelas terutama bagian nomor NIK. Maksimal file sebesar 10MB. File yang diijinkan .png, .jpg, jpeg, .pdf
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1
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10
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Lembar pernyataan
Lembar pernyataan
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Dengan ini saya menyatakan data yang diisi diatas merupakan data sebenarnya dan dapat dipertanggung-jawabkan. Serta saya mendaftarkan diri sebagai santri pondok (Asrama) Pesantren Persatuan Islam 04 Cianjur yang sanggup mentaati peraturan dan Tata Tertib di Pondok
Saya setuju
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Lembar kesediaan
Lembar kesediaan
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Dengan ini pula saya siap melakukan transfer nafaqoh maksimal 2x24 jam ke:
BSI (Bank Syariah Indonesia) 7182385896 a.n. Pesantren Persatuan Islam 04 Cianjur, atau
Bank Mandiri 1330002039352 a.n. Rina Karlinawati.
Lalu mengirim bukti transfer ke nomor Telegram/WA 08123-749-0404
Saya siap transfer maksimal 2x24 jam setelah formulir ini diisi
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