SURAT KUASA

Yang bertanda tangan dibawah ini :

Nama : .................................................................................................

Alamat : .................................................................................................

Jabatan / Status : .................................................................................................

No. Identitas : .................................................................................................

(KTP / SIM / PASPORT)

No. Tlp / Hp : .................................................................................................

Menguasakan sepenuhnya kepada :

Nama : .................................................................................................

Alamat : .................................................................................................

Jabatan / Status : .................................................................................................

No. Identitas : .................................................................................................

(KTP / SIM / PASPORT)

No. Tlp / Hp : .................................................................................................

Atas Pengurusan izin :

Nama Perusahaan : .................................................................................................

Alamat Perusahaan : .................................................................................................

Jenis Izin : .................................................................................................

Demikian Surat Kuasa ini, kami buat dengan sebenar – benarnya dan dapat dipertanggungjawabkan
di hadapan hukum.
Karawang, .............................. 20 ....
Yang menerima kuasa Yang member kuasa,

Materai

Rp. 6000,-
( .................................... ) ( ..................................... )

Keterangan ;

Lampiri fotocopy identitas (KTP/SIM/PASPORT) masing – masing