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NAAYADUBEK NAD NAKIDIDNEP NAIRETNEMEK NAINATREP SATLUKAF AYAJIWARB SATISREVINU

NAINATREP AYADIDUB NASURUJ

NAITILENEP LASOPORP RANIMES ARAC ATAT

PS ( lasoporP ranimeS oknalB aumeS isigneM - PS iapmas 1 – ek ilabmek nakhareyneM nad ) 7

suruJ isartsinimda nainatreP ayadiduB na

PS ( lasoporP ranimeS naujutesreP - ) 1 rabmel 3 : ) (

PS ( lasoporP ranimeS nagnadnU - ) 2 rabmel 3 : ) (

PS ( namumugneP – ) 3 rabmel 1 : ) (

PS ( lasoporP ranimeS aracA atireB - )4 rabmel 1 : ) (

PS ( lasoporP ranimeS ialiN – ) 5 rabmel 3 : ) (

PS ( lasoporP nakiabreP naatnimreP – ) 6 rabmel 3 : ) (

PS ( lasoporP ranimeS ridaH ratfaD – ) 7 rabmel 1 : ) (

iujutesid halet gnay lasoporp nakkujnuneM

gnibmibmep

ledneb 2 : ) (

ata lasoporP ranimeS itukignem halet itkuB lisah u

idutS nataigeK ukuB id ipokid( ilak 01 laminim

)awsisahaM

rabmel 1 : ) (

satrek pamfots ek nakkusamid sakreB aumeS am adaP .uajih anraw p nad laggnaT/iraH ,idutS margorP nad ,MIN ,amaN ,ranimeS isilutid

ranimeS gnauR irah ) hujut ( 7 ranimes napakgnelek nahareynep rihka sataB ajrek

ranimes naanaskalep mulebes

PS -1 NAAYADUBEK NAD NAKIDIDNEP NAIRETNEMEK

NAINATREP SATLUKAF AYAJIWARB SATISREVINU NAINATREP AYADIDUB NASURUJ

NAITILENEP LASOPORP RANIMES NAUJUTESREP

maN ..……………………………………………………… : awsisahaM a

…………………………… : kokoP romoN

PH/.pleT .oN ..…………………………… :

..……………………………………………………………………… : lasoporP luduJ

..………………………………………………………………………

.………………………………………………………………………

.………………………………………………………………………

……………………………………………………………………… : laggnaT/iraH

……………………………………………………………………… : maJ

tapmeT ……………………………………………………………… :

iujuteyneM

,gnipmadneP gnibmibmeP ,amatU gnibmibmeP

____________________ _________________

,sahabmeP nesoD

3 : pakgnar taubiD

PS -2 NAAYADUBEK NAD NAKIDIDNEP NAIRETNEMEK

NAINATREP SATLUKAF AYAJIWARB SATISREVINU NAINATREP AYADIDUB NASURUJ

lasoporP ranimeS nagnadnU : lahireP

..………………………………htY : ADAPEK treP ayadiduB nasuruJ naina warbinU nainatreP satlukaF gnalaM

halet gnay natakapesek iauseS ubI /kapaB id tubesret awsisaham nagned taub gnadnugnem imak ini amasreb ,ini hawab ubI /kapaB ranimes adap ridah kutnu

: awsisahaM lasoporP amaN ……………… : ..………………………… MIN .…………………………………………:

: adap laggnaT/iraH ..………………………………… : maJ .BIW..………………………………… : tapmeT ..………………………………… : naitahreP sata nad naikimeD ubI /kapaB .hisak amiret nakpacuid …………………………,gnalaM ,nasuruJ siraterkeS

_________________

3 : pakgnaR taubiD

PS -3 NAAYADUBEK NAD NAKIDIDNEP NAIRETNEMEK

NAINATREP SATLUKAF AYAJIWARB SATISREVINU NAINATREP AYADIDUB NASURUJ

N A M U M U G N E P

kadaid nagned naanekreB : luduj nagned lasoporP ranimeS aynna

………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………………

..……………………………………………

awabmeP ……………………………………………… : ...……………………… MIN ...……………………………………………………………………… :

adap nakanaskaliD ...……………………………………………………………………… : iraH ...……………………………………………………………………… :

laggnaT ...……………………………………………………………………… : maJ ..……………………………………………………………………… :

tapmeT ………………………………………………………… : ..…… husagneP nesoD nagneD

amatU gnibmibmeP ..……………………………………………………………… : gnipmadneP gnibmibmeP ..……………………………………………………………… :

nesoD sahabmeP ..……………………………………………………………… : awsisahaM sahabmeP ..……………………………………………………………… :

yadiduB nasuruJ awsisaham igab akaM .ridah nakbijawid sataek IIV retsemeS nainatreP a

.nagnadnu itnaggnep iagabes ini namumugneP

.…………………………,gnalaM ,nasuruJ siraterkeS __________________________

1 : pakgnar taubiD

PS -4 KIDIDNEP NAIRETNEMEK NAAYADUBEK NAD NA

NAINATREP SATLUKAF AYAJIWARB SATISREVINU NAINATREP AYADIDUB NASURUJ

AWSISAHAM NAITILENEP LASOPORP RANIMES ARACA ATIREB

irah adaP …………………………………………………… : laggnaT …………………………………………………… :

NAKRANIMESID HALET

awsisahaM amaN ……… : ……………………………………………

M I N …………………………………………………… : lasoporP luduJ .…………………………………………………………………… :

…………………………………………………………………… ……………………………………………………………………

nagned ispirkS nasilunep akgnar malad naitilenep nakukalem tapad kutnU : ialin lisah

ialiN

lasoporP ialiN

lasoporP ranimeS amatU gnibmibmeP

gnibmibmeP

gnipmadneP

sahabmeP nesoD

latoT

atar ialiN - )akgnA( atar

atar ialiN - )furuH( atar

.………………………, gnalaM PPD / UPD

: natataC meP nesoD = UPD amatU gnibmib

gnipmadneP gnibmibmeP nesoD = PPD

PS -5 NAAYADUBEK NAD NAKIDIDNEP NAIRETNEMEK

NAINATREP SATLUKAF AYAJIWARB SATISREVINU NAINATREP AYADIDUB NASURUJ

AWSISAHAM NAITILENEP LASOPORP RANIMES IALIN

awsisahaM amaN ……………………………………………………… : nI romoN .shM kud ……………………………………………………… :

naijU laggnat /iraH ..……………………………/……………………… : …………………………………………………………………………… : lasoporP luduJ

.………………………………………………………………………….. .…………………………………………………………………………..

oporP sahabmeP silejaM napadahid nakranimesid gnaY nakukalem tapad kutnu naitileneP las

:bbs lisah nagned ispirkS nasilunep akgnar malad naitileneP

) * lasoporP ialiN

)* lasoporP ranimeS ialiN

akgna malad )*

………………,gnalaM HPD / PPD / UPD nesoD

----------------------------------

: natataC PD amatU gnibmibmeP nesoD = U

gnipmadneP gnibmibmeP nesoD = PPD sahabmeP nesoD = HPD

3 pakgnar taubiD

PS -6 NAAYADUBEK NAD NAKIDIDNEP NAIRETNEMEK

NAINATREP SATLUKAF AYAJIWARB SATISREVINU NAINATREP AYADIDUB NASURUJ

SOPORP NAKIABREP NAATNIMREP AWSISAHAM NAITILENEP LA

awsisahaM amaN ……………………………………………………………… : awsisahaM kudnI romoN ……………………………………………………………… :

ranimeS laggnaT/iraH ……………………………………………………………… : lasoporP luduJ ……………………………………………………………… :

……………………………………………………………… …………………… …………………………………………

nakiabreP naatnimreP ……………………………………………………………… : ……………………………………………………………… ………………………………………………………………

ikiabrepid haleT ..………………… ,gnalaM .………………… nesoD iuhategneM ..………………………… nesoD

-------------------------------- --------------------------------------------

3 : pakgnar taubiD

PS -7 NAAYADUBEK NAD NAKIDIDNEP NAIRETNEMEK

NAINATREP SATLUKAF AYAJIWARB SATISREVINU NAINATREP AYADIDUB NASURUJ

RANIMES RIDAH RATFAD )* NAITILENEP LISAH/LASOPORP

eP narasarm M I N

repaP luduJ

laggnaT/iraH .ON AWSISAHAM AMAN M I N ADNAT - NAGNAT

ulrep kadit gnay teroC )*

NAINATREP AYADIDUB NASURUJ NAINATREP SATLUKAF

AYAJIWARB SATISREVINU

NAANUGGNEP NAUJUTESREP RABMEL GNAUR

ayadiduB nasuruJ UT rotanidrooK .htY adapeK nainatreP satlukaF

: ini hawab id awsisaham nakataynem nagneD amaN :

miN :

muirotarobaL id lasoporP ranimeS )* naknijiid kadit / naknijiiD amluG / namanaT naailumeP nahubmuT igolokE / S gnauR / ranime : adap )*

laggnaT / iraH : maJ :

.hisak amiret nakpacu ayas aynnaaitahrep sata naikimeD ,gnalaM ,narobaL

).……………………………( : natataC - .ulrep kadit gnay teroC = )*

NAINATREP AYADIDUB NASURUJ

NAINATREP SATLUKAF AYAJIWARB SATISREVINU

NAANUGGNEP NAUJUTESREP RABMEL GNAUR

ayadiduB nasuruJ UT rotanidrooK .htY adapeK nainatreP satlukaF

: ini hawab id awsisaham nakataynem nagneD amaN :

miN : muirotarobaL id )* lasoporP ranimeS )* naknijiid kadit / naknijiiD / amluG / namanaT naailumeP

nahubmuT igolokE ranimeS gnauR / : adap )* laggnaT / iraH :

maJ : .hisak amiret nakpacu ayas aynnaaitahrep sata naikimeD

,gnalaM ,narobaL

).……………………………( : natataC - .ulrep kadit gnay teroC = )*

gnotop sirag adap gnitnuG - narobaL kutnu 1 ,UT rotanidrooK kutnu 1 : gnotop