Nama : ...................................................................................................
NPWP : ...................................................................................................
Alamat : ...................................................................................................
Nama : ...................................................................................................
NPWP : ...................................................................................................
Alamat : ...................................................................................................
Demikian surat pernyataan ini dibuat dan saya sanggup menerima akibat hukum apabila
ternyata dikemudian hari Surat Pernyataan ini terbutkti tidak benar.
……………………., ……………………………..
(meterai Rp6.000,-)
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