05 Surat Kuasa
05 Surat Kuasa
Nama :_______________________________________________
NIM :_______________________________________________
Prodi :_______________________________________________
Alamat :________________________________________________________________
________________________________________________________________
Malang,
_________________2016
(.................................) (........................................)
NIM.____________________
Catatan :
- Wajib membawa kelengkapan daftar ulang (Kartu Identitas asli pemberi kuasa)