| NO. | FORMULIR | NAMA LENGKAP | TANGGAL MASUK ISLAM | ALAMAT | TELEPON | SURAT KETERANGAN |
|---|---|---|---|---|---|---|
| 1021 | - | SUDIRMAN HARAHAP | 02 Jul 2015, Thursday | BUKIT SEROJA C 301 | - | 0 |
| 1022 | - | NAUNGAN DUHA | 02 Jul 2015, Thursday | BUKIT SEROJA C 301 | - | 0 |
| 1023 | - | YULY WIDAYANTI | 05 Jul 2015, Sunday | PERMATA REGENCY B 34 | 0822 8369 0913 | 0 |
| 1024 | - | HERMANTO | 07 Jul 2015, Tuesday | CENDANA 004/004 | 0878 4247 9104 | 0 |
| 1025 | - | SRI UTAMI | 08 Jul 2015, Wednesday | TAMAN PUTRI INDAH BLOK B 16 | - | 0 |
| 1026 | - | SATRIA FERNANDO | 29 Jul 2015, Wednesday | BENGKONG SWADAYA | 0857 6524 3659 | 0 |
| 1027 | - | BENSON BIN MIAU | 24 Aug 2015, Monday | - | - | 0 |
| 1028 | - | HERY YENCE | 25 Aug 2015, Tuesday | BALOI VILA NO. 5 | 0852 7288 8663 | 0 |
| 1029 | - | EDUARDIE | 28 Aug 2015, Friday | VILLA MELATI MAS BLOK G7 19 | 0813 1016 2008 | 0 |
| 1030 | - | HERYANTO PURBA | 31 Aug 2015, Monday | BIDA ASRI 1 BATAM CENTER | 0812 6111 0982 | 0 |
| 1031 | - | CAHAYA SIAHAAN | 07 Sep 2015, Monday | KOMP DITPAM BLOK I 4 | 0852 0540 3703 | 0 |
| 1032 | - | RAMANITHARA SHANMUGAM | 09 Sep 2015, Wednesday | NONGSA VILLA TELUK MAJA | 0811 7718 825 | 0 |
| 1033 | - | AWAN WIJAYANTO | 11 Sep 2015, Friday | SINGOSARI KEPATIHAN MADIUN | 0857 7604 7771 | 0 |
| 1034 | - | ENDANG PRIANTI | 28 Sep 2015, Monday | GREEN LANE | 0819 0811 9021 | 0 |
| 1035 | - | LUSIA LONGA | 15 Oct 2015, Thursday | BUKIT SENYUM RT 4 RW 7 | - | 0 |