| IDENTITAS IDUKA | |
| Nama IDUKA | : Bengkel Mobil New Surya Motor |
| Alamat IDUKA | : Jl. Babat - Jombang No.KM 14, Wates/ Jubak, Nguwok, Kec. Modo, Kabupaten Lamongan, Jawa Timur 62275 |
| Pelaksanaan | : 13 Oktober 2025 s/d 13 Februari 2026 |
| Nama Direktur/ Pimpinan *) | : ........................................................................ |
| Nama Pembimbing *) | : ........................................................................ |
| No HP/ WA Pembimbing | : ........................................................................ |
| IDENTITAS PESERTA | |
| Nama Siswa | : BAGUS FEBRIYAN SYAIFULLAH / XII TKR |
| HP Siswa | : 085935378614 |
| HP Orangtua | : 087757051656 |
| No | Tanggal Kunjungan | Uraian Kegiatan | Catatan | Paraf/stempel Pembimbing IDUKA | Petugas Monitoring |
| 1 | |||||
| 2 | |||||
| 3 |
| Hasil Pelaksanaan PKL :
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| Panitia PKL .................... NBM : |