Date of Birth 
                                                
                                                                                                        01 02 03 04 05 06 07 08 09 10 11 12 13 14 15 16 17 18 19 20 21 22 23 24 25 26 27 28 29 30 31                                                  
                                                
                                                                                                        January February March April May June July August September October November December                                                  
                                                
                                                                                                        1970 1971 1972 1973 1974 1975 1976 1977 1978 1979 1980 1981 1982 1983 1984 1985 1986 1987 1988 1989 1990 1991 1992 1993 1994 1995 1996 1997 1998 1999 2000 2001 2002 2003 2004 2005 2006 2007 2008 2009 2010 2011 2012 2013 2014                                                  
                                                
                                             
                                            
                                                No Handphone Siswa (WA Only) 
                                                
                                                    
                                                                                                                    (+93) Afghanistan 
                                                                                                                    (+355) Albania 
                                                                                                                    (+213) Algeria 
                                                                                                                    (+1684) American Samoa 
                                                                                                                    (+376) Andorra 
                                                                                                                    (+244) Angola 
                                                                                                                    (+1264) Anguilla 
                                                                                                                    (+0) Antarctica 
                                                                                                                    (+1268) Antigua and Barbuda 
                                                                                                                    (+54) Argentina 
                                                                                                                    (+374) Armenia 
                                                                                                                    (+297) Aruba 
                                                                                                                    (+61) Australia 
                                                                                                                    (+43) Austria 
                                                                                                                    (+994) Azerbaijan 
                                                                                                                    (+1242) Bahamas 
                                                                                                                    (+973) Bahrain 
                                                                                                                    (+880) Bangladesh 
                                                                                                                    (+1246) Barbados 
                                                                                                                    (+375) Belarus 
                                                                                                                    (+32) Belgium 
                                                                                                                    (+501) Belize 
                                                                                                                    (+229) Benin 
                                                                                                                    (+1441) Bermuda 
                                                                                                                    (+975) Bhutan 
                                                                                                                    (+591) Bolivia 
                                                                                                                    (+387) Bosnia and Herzegovina 
                                                                                                                    (+267) Botswana 
                                                                                                                    (+0) Bouvet Island 
                                                                                                                    (+55) Brazil 
                                                                                                                    (+246) British Indian Ocean Territory 
                                                                                                                    (+673) Brunei Darussalam 
                                                                                                                    (+359) Bulgaria 
                                                                                                                    (+226) Burkina Faso 
                                                                                                                    (+257) Burundi 
                                                                                                                    (+855) Cambodia 
                                                                                                                    (+237) Cameroon 
                                                                                                                    (+1) Canada 
                                                                                                                    (+238) Cape Verde 
                                                                                                                    (+1345) Cayman Islands 
                                                                                                                    (+236) Central African Republic 
                                                                                                                    (+235) Chad 
                                                                                                                    (+56) Chile 
                                                                                                                    (+86) China 
                                                                                                                    (+61) Christmas Island 
                                                                                                                    (+672) Cocos (Keeling) Islands 
                                                                                                                    (+57) Colombia 
                                                                                                                    (+269) Comoros 
                                                                                                                    (+242) Congo 
                                                                                                                    (+242) Congo, the Democratic Republic of the 
                                                                                                                    (+682) Cook Islands 
                                                                                                                    (+506) Costa Rica 
                                                                                                                    (+225) Cote D'Ivoire 
                                                                                                                    (+385) Croatia 
                                                                                                                    (+53) Cuba 
                                                                                                                    (+357) Cyprus 
                                                                                                                    (+420) Czech Republic 
                                                                                                                    (+45) Denmark 
                                                                                                                    (+253) Djibouti 
                                                                                                                    (+1767) Dominica 
                                                                                                                    (+1809) Dominican Republic 
                                                                                                                    (+593) Ecuador 
                                                                                                                    (+20) Egypt 
                                                                                                                    (+503) El Salvador 
                                                                                                                    (+240) Equatorial Guinea 
                                                                                                                    (+291) Eritrea 
                                                                                                                    (+372) Estonia 
                                                                                                                    (+251) Ethiopia 
                                                                                                                    (+500) Falkland Islands (Malvinas) 
                                                                                                                    (+298) Faroe Islands 
                                                                                                                    (+679) Fiji 
                                                                                                                    (+358) Finland 
                                                                                                                    (+33) France 
                                                                                                                    (+594) French Guiana 
                                                                                                                    (+689) French Polynesia 
                                                                                                                    (+0) French Southern Territories 
                                                                                                                    (+241) Gabon 
                                                                                                                    (+220) Gambia 
                                                                                                                    (+995) Georgia 
                                                                                                                    (+49) Germany 
                                                                                                                    (+233) Ghana 
                                                                                                                    (+350) Gibraltar 
                                                                                                                    (+30) Greece 
                                                                                                                    (+299) Greenland 
                                                                                                                    (+1473) Grenada 
                                                                                                                    (+590) Guadeloupe 
                                                                                                                    (+1671) Guam 
                                                                                                                    (+502) Guatemala 
                                                                                                                    (+224) Guinea 
                                                                                                                    (+245) Guinea-Bissau 
                                                                                                                    (+592) Guyana 
                                                                                                                    (+509) Haiti 
                                                                                                                    (+0) Heard Island and Mcdonald Islands 
                                                                                                                    (+39) Holy See (Vatican City State) 
                                                                                                                    (+504) Honduras 
                                                                                                                    (+852) Hong Kong 
                                                                                                                    (+36) Hungary 
                                                                                                                    (+354) Iceland 
                                                                                                                    (+91) India 
                                                                                                                    (+62) Indonesia 
                                                                                                                    (+98) Iran, Islamic Republic of 
                                                                                                                    (+964) Iraq 
                                                                                                                    (+353) Ireland 
                                                                                                                    (+972) Israel 
                                                                                                                    (+39) Italy 
                                                                                                                    (+1876) Jamaica 
                                                                                                                    (+81) Japan 
                                                                                                                    (+962) Jordan 
                                                                                                                    (+7) Kazakhstan 
                                                                                                                    (+254) Kenya 
                                                                                                                    (+686) Kiribati 
                                                                                                                    (+850) Korea, Democratic People's Republic of 
                                                                                                                    (+82) Korea, Republic of 
                                                                                                                    (+965) Kuwait 
                                                                                                                    (+996) Kyrgyzstan 
                                                                                                                    (+856) Lao People's Democratic Republic 
                                                                                                                    (+371) Latvia 
                                                                                                                    (+961) Lebanon 
                                                                                                                    (+266) Lesotho 
                                                                                                                    (+231) Liberia 
                                                                                                                    (+218) Libyan Arab Jamahiriya 
                                                                                                                    (+423) Liechtenstein 
                                                                                                                    (+370) Lithuania 
                                                                                                                    (+352) Luxembourg 
                                                                                                                    (+853) Macao 
                                                                                                                    (+389) Macedonia, the Former Yugoslav Republic of 
                                                                                                                    (+261) Madagascar 
                                                                                                                    (+265) Malawi 
                                                                                                                    (+60) Malaysia 
                                                                                                                    (+960) Maldives 
                                                                                                                    (+223) Mali 
                                                                                                                    (+356) Malta 
                                                                                                                    (+692) Marshall Islands 
                                                                                                                    (+596) Martinique 
                                                                                                                    (+222) Mauritania 
                                                                                                                    (+230) Mauritius 
                                                                                                                    (+269) Mayotte 
                                                                                                                    (+52) Mexico 
                                                                                                                    (+691) Micronesia, Federated States of 
                                                                                                                    (+373) Moldova, Republic of 
                                                                                                                    (+377) Monaco 
                                                                                                                    (+976) Mongolia 
                                                                                                                    (+1664) Montserrat 
                                                                                                                    (+212) Morocco 
                                                                                                                    (+258) Mozambique 
                                                                                                                    (+95) Myanmar 
                                                                                                                    (+264) Namibia 
                                                                                                                    (+674) Nauru 
                                                                                                                    (+977) Nepal 
                                                                                                                    (+31) Netherlands 
                                                                                                                    (+599) Netherlands Antilles 
                                                                                                                    (+687) New Caledonia 
                                                                                                                    (+64) New Zealand 
                                                                                                                    (+505) Nicaragua 
                                                                                                                    (+227) Niger 
                                                                                                                    (+234) Nigeria 
                                                                                                                    (+683) Niue 
                                                                                                                    (+672) Norfolk Island 
                                                                                                                    (+1670) Northern Mariana Islands 
                                                                                                                    (+47) Norway 
                                                                                                                    (+968) Oman 
                                                                                                                    (+92) Pakistan 
                                                                                                                    (+680) Palau 
                                                                                                                    (+970) Palestinian Territory, Occupied 
                                                                                                                    (+507) Panama 
                                                                                                                    (+675) Papua New Guinea 
                                                                                                                    (+595) Paraguay 
                                                                                                                    (+51) Peru 
                                                                                                                    (+63) Philippines 
                                                                                                                    (+0) Pitcairn 
                                                                                                                    (+48) Poland 
                                                                                                                    (+351) Portugal 
                                                                                                                    (+1787) Puerto Rico 
                                                                                                                    (+974) Qatar 
                                                                                                                    (+262) Reunion 
                                                                                                                    (+40) Romania 
                                                                                                                    (+70) Russian Federation 
                                                                                                                    (+250) Rwanda 
                                                                                                                    (+290) Saint Helena 
                                                                                                                    (+1869) Saint Kitts and Nevis 
                                                                                                                    (+1758) Saint Lucia 
                                                                                                                    (+508) Saint Pierre and Miquelon 
                                                                                                                    (+1784) Saint Vincent and the Grenadines 
                                                                                                                    (+684) Samoa 
                                                                                                                    (+378) San Marino 
                                                                                                                    (+239) Sao Tome and Principe 
                                                                                                                    (+966) Saudi Arabia 
                                                                                                                    (+221) Senegal 
                                                                                                                    (+381) Serbia and Montenegro 
                                                                                                                    (+248) Seychelles 
                                                                                                                    (+232) Sierra Leone 
                                                                                                                    (+65) Singapore 
                                                                                                                    (+421) Slovakia 
                                                                                                                    (+386) Slovenia 
                                                                                                                    (+677) Solomon Islands 
                                                                                                                    (+252) Somalia 
                                                                                                                    (+27) South Africa 
                                                                                                                    (+0) South Georgia and the South Sandwich Islands 
                                                                                                                    (+34) Spain 
                                                                                                                    (+94) Sri Lanka 
                                                                                                                    (+249) Sudan 
                                                                                                                    (+597) Suriname 
                                                                                                                    (+47) Svalbard and Jan Mayen 
                                                                                                                    (+268) Swaziland 
                                                                                                                    (+46) Sweden 
                                                                                                                    (+41) Switzerland 
                                                                                                                    (+963) Syrian Arab Republic 
                                                                                                                    (+886) Taiwan, Province of China 
                                                                                                                    (+992) Tajikistan 
                                                                                                                    (+255) Tanzania, United Republic of 
                                                                                                                    (+66) Thailand 
                                                                                                                    (+670) Timor-Leste 
                                                                                                                    (+228) Togo 
                                                                                                                    (+690) Tokelau 
                                                                                                                    (+676) Tonga 
                                                                                                                    (+1868) Trinidad and Tobago 
                                                                                                                    (+216) Tunisia 
                                                                                                                    (+90) Turkey 
                                                                                                                    (+7370) Turkmenistan 
                                                                                                                    (+1649) Turks and Caicos Islands 
                                                                                                                    (+688) Tuvalu 
                                                                                                                    (+256) Uganda 
                                                                                                                    (+380) Ukraine 
                                                                                                                    (+971) United Arab Emirates 
                                                                                                                    (+44) United Kingdom 
                                                                                                                    (+1) United States 
                                                                                                                    (+1) United States Minor Outlying Islands 
                                                                                                                    (+598) Uruguay 
                                                                                                                    (+998) Uzbekistan 
                                                                                                                    (+678) Vanuatu 
                                                                                                                    (+58) Venezuela 
                                                                                                                    (+84) Viet Nam 
                                                                                                                    (+1284) Virgin Islands, British 
                                                                                                                    (+1340) Virgin Islands, U.s. 
                                                                                                                    (+681) Wallis and Futuna 
                                                                                                                    (+212) Western Sahara 
                                                                                                                    (+967) Yemen 
                                                                                                                    (+260) Zambia 
                                                                                                                    (+263) Zimbabwe 
                                                                                                                
                                                     
                                                
                                                
                                             
                                            
                                                No Handphone Orang Tua 
                                                
                                                    
                                                                                                                    (+93) Afghanistan 
                                                                                                                    (+355) Albania 
                                                                                                                    (+213) Algeria 
                                                                                                                    (+1684) American Samoa 
                                                                                                                    (+376) Andorra 
                                                                                                                    (+244) Angola 
                                                                                                                    (+1264) Anguilla 
                                                                                                                    (+0) Antarctica 
                                                                                                                    (+1268) Antigua and Barbuda 
                                                                                                                    (+54) Argentina 
                                                                                                                    (+374) Armenia 
                                                                                                                    (+297) Aruba 
                                                                                                                    (+61) Australia 
                                                                                                                    (+43) Austria 
                                                                                                                    (+994) Azerbaijan 
                                                                                                                    (+1242) Bahamas 
                                                                                                                    (+973) Bahrain 
                                                                                                                    (+880) Bangladesh 
                                                                                                                    (+1246) Barbados 
                                                                                                                    (+375) Belarus 
                                                                                                                    (+32) Belgium 
                                                                                                                    (+501) Belize 
                                                                                                                    (+229) Benin 
                                                                                                                    (+1441) Bermuda 
                                                                                                                    (+975) Bhutan 
                                                                                                                    (+591) Bolivia 
                                                                                                                    (+387) Bosnia and Herzegovina 
                                                                                                                    (+267) Botswana 
                                                                                                                    (+0) Bouvet Island 
                                                                                                                    (+55) Brazil 
                                                                                                                    (+246) British Indian Ocean Territory 
                                                                                                                    (+673) Brunei Darussalam 
                                                                                                                    (+359) Bulgaria 
                                                                                                                    (+226) Burkina Faso 
                                                                                                                    (+257) Burundi 
                                                                                                                    (+855) Cambodia 
                                                                                                                    (+237) Cameroon 
                                                                                                                    (+1) Canada 
                                                                                                                    (+238) Cape Verde 
                                                                                                                    (+1345) Cayman Islands 
                                                                                                                    (+236) Central African Republic 
                                                                                                                    (+235) Chad 
                                                                                                                    (+56) Chile 
                                                                                                                    (+86) China 
                                                                                                                    (+61) Christmas Island 
                                                                                                                    (+672) Cocos (Keeling) Islands 
                                                                                                                    (+57) Colombia 
                                                                                                                    (+269) Comoros 
                                                                                                                    (+242) Congo 
                                                                                                                    (+242) Congo, the Democratic Republic of the 
                                                                                                                    (+682) Cook Islands 
                                                                                                                    (+506) Costa Rica 
                                                                                                                    (+225) Cote D'Ivoire 
                                                                                                                    (+385) Croatia 
                                                                                                                    (+53) Cuba 
                                                                                                                    (+357) Cyprus 
                                                                                                                    (+420) Czech Republic 
                                                                                                                    (+45) Denmark 
                                                                                                                    (+253) Djibouti 
                                                                                                                    (+1767) Dominica 
                                                                                                                    (+1809) Dominican Republic 
                                                                                                                    (+593) Ecuador 
                                                                                                                    (+20) Egypt 
                                                                                                                    (+503) El Salvador 
                                                                                                                    (+240) Equatorial Guinea 
                                                                                                                    (+291) Eritrea 
                                                                                                                    (+372) Estonia 
                                                                                                                    (+251) Ethiopia 
                                                                                                                    (+500) Falkland Islands (Malvinas) 
                                                                                                                    (+298) Faroe Islands 
                                                                                                                    (+679) Fiji 
                                                                                                                    (+358) Finland 
                                                                                                                    (+33) France 
                                                                                                                    (+594) French Guiana 
                                                                                                                    (+689) French Polynesia 
                                                                                                                    (+0) French Southern Territories 
                                                                                                                    (+241) Gabon 
                                                                                                                    (+220) Gambia 
                                                                                                                    (+995) Georgia 
                                                                                                                    (+49) Germany 
                                                                                                                    (+233) Ghana 
                                                                                                                    (+350) Gibraltar 
                                                                                                                    (+30) Greece 
                                                                                                                    (+299) Greenland 
                                                                                                                    (+1473) Grenada 
                                                                                                                    (+590) Guadeloupe 
                                                                                                                    (+1671) Guam 
                                                                                                                    (+502) Guatemala 
                                                                                                                    (+224) Guinea 
                                                                                                                    (+245) Guinea-Bissau 
                                                                                                                    (+592) Guyana 
                                                                                                                    (+509) Haiti 
                                                                                                                    (+0) Heard Island and Mcdonald Islands 
                                                                                                                    (+39) Holy See (Vatican City State) 
                                                                                                                    (+504) Honduras 
                                                                                                                    (+852) Hong Kong 
                                                                                                                    (+36) Hungary 
                                                                                                                    (+354) Iceland 
                                                                                                                    (+91) India 
                                                                                                                    (+62) Indonesia 
                                                                                                                    (+98) Iran, Islamic Republic of 
                                                                                                                    (+964) Iraq 
                                                                                                                    (+353) Ireland 
                                                                                                                    (+972) Israel 
                                                                                                                    (+39) Italy 
                                                                                                                    (+1876) Jamaica 
                                                                                                                    (+81) Japan 
                                                                                                                    (+962) Jordan 
                                                                                                                    (+7) Kazakhstan 
                                                                                                                    (+254) Kenya 
                                                                                                                    (+686) Kiribati 
                                                                                                                    (+850) Korea, Democratic People's Republic of 
                                                                                                                    (+82) Korea, Republic of 
                                                                                                                    (+965) Kuwait 
                                                                                                                    (+996) Kyrgyzstan 
                                                                                                                    (+856) Lao People's Democratic Republic 
                                                                                                                    (+371) Latvia 
                                                                                                                    (+961) Lebanon 
                                                                                                                    (+266) Lesotho 
                                                                                                                    (+231) Liberia 
                                                                                                                    (+218) Libyan Arab Jamahiriya 
                                                                                                                    (+423) Liechtenstein 
                                                                                                                    (+370) Lithuania 
                                                                                                                    (+352) Luxembourg 
                                                                                                                    (+853) Macao 
                                                                                                                    (+389) Macedonia, the Former Yugoslav Republic of 
                                                                                                                    (+261) Madagascar 
                                                                                                                    (+265) Malawi 
                                                                                                                    (+60) Malaysia 
                                                                                                                    (+960) Maldives 
                                                                                                                    (+223) Mali 
                                                                                                                    (+356) Malta 
                                                                                                                    (+692) Marshall Islands 
                                                                                                                    (+596) Martinique 
                                                                                                                    (+222) Mauritania 
                                                                                                                    (+230) Mauritius 
                                                                                                                    (+269) Mayotte 
                                                                                                                    (+52) Mexico 
                                                                                                                    (+691) Micronesia, Federated States of 
                                                                                                                    (+373) Moldova, Republic of 
                                                                                                                    (+377) Monaco 
                                                                                                                    (+976) Mongolia 
                                                                                                                    (+1664) Montserrat 
                                                                                                                    (+212) Morocco 
                                                                                                                    (+258) Mozambique 
                                                                                                                    (+95) Myanmar 
                                                                                                                    (+264) Namibia 
                                                                                                                    (+674) Nauru 
                                                                                                                    (+977) Nepal 
                                                                                                                    (+31) Netherlands 
                                                                                                                    (+599) Netherlands Antilles 
                                                                                                                    (+687) New Caledonia 
                                                                                                                    (+64) New Zealand 
                                                                                                                    (+505) Nicaragua 
                                                                                                                    (+227) Niger 
                                                                                                                    (+234) Nigeria 
                                                                                                                    (+683) Niue 
                                                                                                                    (+672) Norfolk Island 
                                                                                                                    (+1670) Northern Mariana Islands 
                                                                                                                    (+47) Norway 
                                                                                                                    (+968) Oman 
                                                                                                                    (+92) Pakistan 
                                                                                                                    (+680) Palau 
                                                                                                                    (+970) Palestinian Territory, Occupied 
                                                                                                                    (+507) Panama 
                                                                                                                    (+675) Papua New Guinea 
                                                                                                                    (+595) Paraguay 
                                                                                                                    (+51) Peru 
                                                                                                                    (+63) Philippines 
                                                                                                                    (+0) Pitcairn 
                                                                                                                    (+48) Poland 
                                                                                                                    (+351) Portugal 
                                                                                                                    (+1787) Puerto Rico 
                                                                                                                    (+974) Qatar 
                                                                                                                    (+262) Reunion 
                                                                                                                    (+40) Romania 
                                                                                                                    (+70) Russian Federation 
                                                                                                                    (+250) Rwanda 
                                                                                                                    (+290) Saint Helena 
                                                                                                                    (+1869) Saint Kitts and Nevis 
                                                                                                                    (+1758) Saint Lucia 
                                                                                                                    (+508) Saint Pierre and Miquelon 
                                                                                                                    (+1784) Saint Vincent and the Grenadines 
                                                                                                                    (+684) Samoa 
                                                                                                                    (+378) San Marino 
                                                                                                                    (+239) Sao Tome and Principe 
                                                                                                                    (+966) Saudi Arabia 
                                                                                                                    (+221) Senegal 
                                                                                                                    (+381) Serbia and Montenegro 
                                                                                                                    (+248) Seychelles 
                                                                                                                    (+232) Sierra Leone 
                                                                                                                    (+65) Singapore 
                                                                                                                    (+421) Slovakia 
                                                                                                                    (+386) Slovenia 
                                                                                                                    (+677) Solomon Islands 
                                                                                                                    (+252) Somalia 
                                                                                                                    (+27) South Africa 
                                                                                                                    (+0) South Georgia and the South Sandwich Islands 
                                                                                                                    (+34) Spain 
                                                                                                                    (+94) Sri Lanka 
                                                                                                                    (+249) Sudan 
                                                                                                                    (+597) Suriname 
                                                                                                                    (+47) Svalbard and Jan Mayen 
                                                                                                                    (+268) Swaziland 
                                                                                                                    (+46) Sweden 
                                                                                                                    (+41) Switzerland 
                                                                                                                    (+963) Syrian Arab Republic 
                                                                                                                    (+886) Taiwan, Province of China 
                                                                                                                    (+992) Tajikistan 
                                                                                                                    (+255) Tanzania, United Republic of 
                                                                                                                    (+66) Thailand 
                                                                                                                    (+670) Timor-Leste 
                                                                                                                    (+228) Togo 
                                                                                                                    (+690) Tokelau 
                                                                                                                    (+676) Tonga 
                                                                                                                    (+1868) Trinidad and Tobago 
                                                                                                                    (+216) Tunisia 
                                                                                                                    (+90) Turkey 
                                                                                                                    (+7370) Turkmenistan 
                                                                                                                    (+1649) Turks and Caicos Islands 
                                                                                                                    (+688) Tuvalu 
                                                                                                                    (+256) Uganda 
                                                                                                                    (+380) Ukraine 
                                                                                                                    (+971) United Arab Emirates 
                                                                                                                    (+44) United Kingdom 
                                                                                                                    (+1) United States 
                                                                                                                    (+1) United States Minor Outlying Islands 
                                                                                                                    (+598) Uruguay 
                                                                                                                    (+998) Uzbekistan 
                                                                                                                    (+678) Vanuatu 
                                                                                                                    (+58) Venezuela 
                                                                                                                    (+84) Viet Nam 
                                                                                                                    (+1284) Virgin Islands, British 
                                                                                                                    (+1340) Virgin Islands, U.s. 
                                                                                                                    (+681) Wallis and Futuna 
                                                                                                                    (+212) Western Sahara 
                                                                                                                    (+967) Yemen 
                                                                                                                    (+260) Zambia 
                                                                                                                    (+263) Zimbabwe 
                                                                                                                
                                                     
                                                
                                                
                                             
                                            
                                            
                                            Dengan mendaftar melalui form ini calon siswa menyatakan bahwa nilai rapor yang disertakan diatas adalah benar dan sesuai dengan rapor asli.    Jika ditemukan ketidaksesuaian nilai diatas dengan rapor asli maka ranking beasiswa yang diterima otomatis dinyatakan GUGUR DAN TIDAK BERLAKU .