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RT. 007 RW.

007
Kelurahan Gunung Sindur Kecamatan Gunung Sindur Kabupaten Bogor

SURAT KETERANGAN PENGANTAR


Nomor : 430/043/X/2018

Yang bertanda tangan di bawah ini :


Nama : Abdul Maman Syarif
Jabatan : Ketua RT. 007/007
Alamat : Jl. Atma Asnawi , Gn. Sindur, Bogor, Jawa Barat 16340

Menerangkan dengan sesungguhnya bahwa :

Nama Lengkap : ..........................................................................................................................................


Jenis Kelamin : ..........................................................................................................................................
Tempat, Tanggal Lahir : ........................................., ..............................................................................................
NIK : ..........................................................................................................................................
Pekerjaan : ..........................................................................................................................................
Alamat : ..........................................................................................................................................
..........................................................................................................................................
Keperluan : ..........................................................................................................................................
..........................................................................................................................................
Keterangan Lain-lain : ..........................................................................................................................................
..........................................................................................................................................
Berlaku mulai : ................................................... 20… s.d. ………….……………..…… 20…

Demikian Surat Keterangan ini dibuat untuk dapat digunakan seperlunya.

Dibuat di : . ..........................................................
Pada tanggal : ........................................................ 20…

Tanda Tangan Pemegang Ketua RT........./..........

( …………………..………………. ) ( .................................................. )
Nomor : ...........................................................................
Mengetahui :
Ketua RW. ...............

( ................................................. )

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