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PT.

SOLUSI BALAD LUMAMPAH


WISMA BUMI PUTERA 7th Floor Suite 707
Jl. ASIA AFRIKA No. 141-149 Bandung
Telp. 022 4267139, Fax. 022 4267109

SURAT MUTASI

Tanggal :

Saya yang bertanda-tangan di bawah ini :


Nama

: .................................................................................................
..........................

ID

: .................................................................................................
..........................

No Telp/HP
: .........................................................................................................
.................
Alamat

: .......................................................................................
....................................

......................................................................................................................
............................
( disebut sebagai Pihak I )
Dengan
ini
menyatakan
pindahtangankan kepada :
Nama
........................

ID

sahabat

................................

di

: .......................................................................................

No. Telp/HP
: ..........................................................................................................
.....
E-mail
: ..........................................................................................................
.....
Tempat/Tgl
Lahir
: ..........................................................................................................
.....
No. KTP
: ..........................................................................................................
.....
Alamat
: ..........................................................................................................
.....
................................................................................................................ ........

PT. SOLUSI BALAD LUMAMPAH


WISMA BUMI PUTERA 7th Floor Suite 707
Jl. ASIA AFRIKA No. 141-149 Bandung
Telp. 022 4267139, Fax. 022 4267109

Ahli Waris / Hubungan


:

.
No Rek / BANK
:

( disebut sebagai Pihak II )


Demikian surat ini saya buat dengan sebenar-benarnya, atas perhatiannya
saya ucapkan terimakasih.
Pihak I

Pihak II

(....................................
..)

(....................................
..)

Saksi (Leader):
No
.
1.
2.
3.

Nama

ID

TTD

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