| NO. | FORMULIR | NAMA LENGKAP | TANGGAL MASUK ISLAM | ALAMAT | TELEPON | SURAT KETERANGAN |
|---|---|---|---|---|---|---|
| 16 | - | TANTRI MATHILDA MEGASARI | 26 Sep 2004, Sunday | KAPLING BARU | 0813 6159 9974 | 0 |
| 17 | - | MARIA NGATINEM | 02 Oct 2004, Saturday | DORMITORY C3/6 MK | - | 0 |
| 18 | - | MIKAHIL SUSANTO SENAN | 08 Oct 2004, Friday | PANGKALAN PETAI | 0813 6464 4457 | 0 |
| 19 | - | UNIK TRIANA | 10 Oct 2004, Sunday | GENTA 1 F/7 | 0813 6454 3501 | 0 |
| 20 | - | TERESIA ESTER | 13 Oct 2004, Wednesday | MEDITERANIA KK1/27A | 0813 6471 5050 | 0 |
| 21 | - | YOHANES ARYMARA WIDHIATMAJA | 15 Oct 2004, Friday | KOMP WIJAYA KUSUMA NAGOYA | - | 0 |
| 22 | - | LISMAWATI SIBURIAN | 19 Oct 2004, Tuesday | GRIYA PELOTA EE/5 | 0813 6441 8671 | 0 |
| 23 | - | NATARIA SARUMPAET | 25 Oct 2004, Monday | MKGR | - | 0 |
| 24 | - | MANAHAN MANURUNG | 27 Oct 2004, Wednesday | SPBU SEI PANAS | 0778 4502 12 | 0 |
| 25 | - | BINTANG S HERLINA LAIA | 27 Oct 2004, Wednesday | GREEN LAND BLK F/20 | 0813 6430 9030 | 0 |
| 26 | - | JUWOTA RIA BR HUTABARAT | 30 Oct 2004, Saturday | BALOI KOLAM | - | 0 |
| 27 | - | FENNY | 30 Oct 2004, Saturday | BALOI MAS PERMAI A/23A | 0812 7725 886 | 0 |
| 28 | - | CAROLINA | 19 Nov 2004, Friday | BENGKONG INDAH | 0812 7729 724 | 0 |
| 29 | - | HOTMA ULY SIMANJUNTAK | 29 Nov 2004, Monday | PELITA VII | 0813 6462 4357 | 0 |
| 30 | - | REALITA AMBARITA | 02 Dec 2004, Thursday | BUIDA AYU | 0813 6442 3097 | 0 |