BIDAN

ANI WENDARI AM. KEB

Kp. Sumurwangi No 123 rt 03/05 Kel. Mekarwangi Kec. Tanah Sareal
Kota Bogor. No Telp 087878333887

SURAT KETERANGAN CUTI HAMIL

Yang bertanda tangan di bawah ini, Bidan Praktik Swasta menerangkan bahwa :

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

Umur : .................................................................................................................................

Pekerjaan : .................................................................................................................................

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

Sesuai Hasil Pemeriksaan Tgl ................................... Telah Hamil ± ..................................

Minggu ( .................. Bulan ), maka perlu mendapatkan ijin cuti bersalin mulai
tanggal ................................................. s/d ......................................... ( selama .........................
bulan ).

Demikian untuk dapat dipergunakan seperlunya.

...................., ....................................

BIDAN

( .................................................... )
 BIDAN

ANI WENDARI AM. KEB

Kp. Sumurwangi No 123 rt 03/05 Kel. Mekarwangi Kec. Tanah Sareal
Kota Bogor. No Telp 087878333887