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I.

Berangkat dari : RSU dadi Keluarga


Ke :
Pada Tanggal :
Direktur RSU Dadi Keluarga

dr. Eggy Jita Pradana


II. Tiba di : Berangkat dari :
Pada Tanggal : Ke :
Kepala Pada Tanggal :
Kepala

(....................................................) (..................................................)
III.Tiba di : Berangkat dari :
Pada Tanggal : Ke :
Kepala Pada Tanggal :
Kepala

(....................................................) (..................................................)
IV. Tiba di : Berangkat dari :
Pada Tanggal : Ke :
Kepala Pada Tanggal :
Kepala

(....................................................) (..................................................)
V. Tiba di : RSU Dadi Keluarga Telah diperiksa dengan keterangan bahwa
Pada Tanggal : perjalanan dinas tersebut atas perintahnya dan
semata-mata untuk kepentingan jabatan dalam
waktu yang sesingkat-singkatnya.
Direktur RSU Dadi Keluarga Direktur RSU Dadi Keluarga

dr. Eggy Jita Pradana dr. Eggy Jita Pradana


Catatan lain-lain
PERHATIAN :
Pejabat yang berwenang menerbitkan SPPD Pegawai yang melakukan perjalanan dinas para pejabat yang
mengesahkan tanggal berangkat/ tiba, serta Bendahara bertanggung jawab berdasarkan peraturan-
peraturan keuangan negara apabila negara/daerah menderita rugi akibat kesalahan, kelalaian dan
kealpaannya.
RISALAH KEGIATAN
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Yang Mengikuti Pelatihan

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