WAWANOHAN
Abdi wasta pun ..............................
Dibabarkeun di ............ Kaping ....................................Taun............
ti pasangan Bapak ....................... sareng Ibu....................................
Abdi teh putra ka ............ tina jumlah saderek .................................
Padumukan abdi ayeuna di Kampung........................ Rt..... Rw........
Desa .......................... Kecamatan .....................................................
Kabupaten ................................. Kode Pos .......................................
Pangalaman nyuprih elmu, ngawitan abdi lebet sakola SD/MI ........
Taun ............. lulus taun............. neraskeun deui sakola ka ..............
tug dugi ka kiwari kacatet salaku siswa kelas ......... di eta sakola.
