Lamp I (untuk di kecamatan)

DATA BUMDESA

DESA ................................................. KECAMATAN ......................................

1. NAMA BUMDESA : .................................................................................................

NOMOR PERDES
2. .................................................................................................
(NomoR / Tahun)
TGL PERDES
3. .................................................................................................
(Tgl / Bln / Thn)

4. NAMA PENGURUS : 1. KETUA : ..............................................................................

2. .............................................................................................

3. .............................................................................................

4. .............................................................................................

NO. SK PENGURUS
5. .................................................................................................
(Nomor / Tahun)
TGL SK
6. .................................................................................................
(Tgl / Bln / Thn)

7. ALAMAT KANTOR .................................................................................................

8. ALAMAT EMAIL .................................................................................................

9. NO. TELP / HP .................................................................................................

10. MODAL AWAL .................................................................................................

11. JENIS USAHA .................................................................................................

Desa ................................, ......................... 2018

Kepala Desa ................................

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