NOMOR ././//..
TENTANG
........................................................................
1. .......................................................................................................................................................
....................... PIHAK KE I
2. .......................................................................................................................................................
....................... PIHAK KE II
............................................................................................................................................................
............................................................................................................................................................
......................................................................................................
...............................................................................................................................
PIHAK KE II PIHAK KE I
materai
SAKSI-SAKSI :
1. .. : (tanda tangan).
2. : (tanda tangan).