| IDENTITAS IDUKA | |
| Nama IDUKA | : MPM Motor Babat |
| Alamat IDUKA | : Jl. Raya Babat Kel.Babat, Kec. Babat, Kabupaten Lamongan, Jawa Timur 62271 |
| Pelaksanaan | : 13 Oktober 2025 s/d 13 Februari 2026 |
| Nama Direktur/ Pimpinan *) | : ........................................................................ |
| Nama Pembimbing *) | : ........................................................................ |
| No HP/ WA Pembimbing | : ........................................................................ |
| IDENTITAS PESERTA | |
| Nama Siswa | : IMAM ROHLI / XII TSM |
| HP Siswa | : 085739221844 |
| HP Orangtua | : 085755150800 |
| No | Tanggal Kunjungan | Uraian Kegiatan | Catatan | Paraf/stempel Pembimbing IDUKA | Petugas Monitoring |
| 1 | |||||
| 2 | |||||
| 3 |
| Hasil Pelaksanaan PKL :
.............................................................................................................................................................................................................................................. .............................................................................................................................................................................................................................................. .............................................................................................................................................................................................................................................. |
| Panitia PKL .................... NBM : |