SURAT PERNYATAAN
Yang bertandatangan dibawah ini:
Nama :
Tempat / Tanggal Lahir :
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No. KTP :
Menyatakan bahwa nama tersebut tidak melakukan praktik kefarmasian di Provinsi Daerah
Istimewa Yogyakarta.
Demikian surat pernyataan ini saya buat dengan sebenar benarnya.
Tangerang, 11 Oktober 2019
Yang membuat pernyataan,
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