Dengan hormat,
Nama : ..........................................................................................
Tempat/Tgl. Lahir : ..........................................................................................
Jenis Kelamin : ..........................................................................................
Status : ..........................................................................................
Pendidikan Terakhir : ..........................................................................................
Alamat : ..........................................................................................
..........................................................................................
..........................................................................................
Demikianlah kiranya yang dapat saya sampaikan, atas perhatiannya saya ucapkan
terima kasih.
Hormat saya,
..........................................