| NO. | FORMULIR | NAMA LENGKAP | TANGGAL MASUK ISLAM | ALAMAT | TELEPON | SURAT KETERANGAN |
|---|---|---|---|---|---|---|
| 1111 | - | DAMARIS LIBING DAWA | 25 May 2015, Monday | KP BELIMBING KEC BENGKONG | - | 0 |
| 1112 | - | SUJELI | 25 May 2015, Monday | JL KARTINI DABO SINGKEP | 0822 8569 1818 | 0 |
| 1113 | - | ERIYANTO | 30 May 2015, Saturday | BECERLY PARK 2 BLOK M3 | 0852 6486 1200 | 0 |
| 1114 | - | DARMAYANTI | 04 Jun 2015, Thursday | KALISARI PS REBO JAKARTA TIMUR | 0858 8346 2150 | 0 |
| 1115 | - | HOLITA | 04 Jun 2015, Thursday | BALOI KOLAM RT 7 RW 16 | 0853 6515 6261 | 0 |
| 1116 | - | KATRINA PARDEDE | 15 Jun 2015, Monday | TIBAN LAMA | 0823 8375 6609 | 0 |
| 1117 | - | JOHAN | 15 Jun 2015, Monday | PERUM CAHAYA GARDEN BLK G7 | 0852 7234 9568 | 0 |
| 1118 | - | ELIZABETH THEODORA HINGIR | 19 Jun 2015, Friday | BLOK II NAGOYA BATAM | 0812 7767 7707 | 0 |
| 1119 | - | ROSENTA PURNAMA SONDANG PURBA | 21 Jun 2015, Sunday | GRIYA BATU AJI ASRI U2 NO 25 | 0812 6892 4595 | 0 |
| 1120 | - | TUKMAIDA PASARIBU | 29 Jun 2015, Monday | GMP BLOK M1 | 0821 2129 9981 | 0 |
| 1121 | - | SUDIRMAN HARAHAP | 02 Jul 2015, Thursday | BUKIT SEROJA C 301 | - | 0 |
| 1122 | - | NAUNGAN DUHA | 02 Jul 2015, Thursday | BUKIT SEROJA C 301 | - | 0 |
| 1123 | - | YULY WIDAYANTI | 05 Jul 2015, Sunday | PERMATA REGENCY B 34 | 0822 8369 0913 | 0 |
| 1124 | - | HERMANTO | 07 Jul 2015, Tuesday | CENDANA 004/004 | 0878 4247 9104 | 0 |
| 1125 | - | SRI UTAMI | 08 Jul 2015, Wednesday | TAMAN PUTRI INDAH BLOK B 16 | - | 0 |