KRONOLOGIS KEJADIAN

No. ______________

Benar pada hari ini ...................... tanggal ........ bulan ..................... tahun ........ jam........ WIB. -

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Jabatan : ......................................................................................................................................

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Demikian Laporan Kejadian ini saya buat dengan sebenarnya sesuai dengan apa yang saya lihat
dan alami sebagai pertanggung jawaban tugas serta mengingat sumpah dan jabatan yang ada.

Yang Membuat Laporan Mengetahui

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Saksi Saksi :

Saksi I Saksi II Saksi III

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