Anda di halaman 1dari 1

UNIVERSITAS GADJAH MADA

RUMAH SAKIT GIGI DAN MULUT UGM PROF.


SOEDOMO
Jl. Denta Sekip Utara No. 1 Yogyakarta 55281 Telp : 0274-555312
email: rsgm@ugm.ac.id

SURAT PERINTAH
NOMOR :…………

Nama : ...........................................................................
NIP : ...........................................................................
Pangkat/gol. : ...........................................................................
Jabatan : ...........................................................................

MEMERINTAHKAN
Kepada :
Nama : ...........................................................................

NIP : ...........................................................................

Pangkat/gol. : ...........................................................................

Jabatan : ...........................................................................

Untuk
......................................................................................................
......................................................................................................

......................................................................................................
......................................................................................................
......................................................................................................

Tanggal

Direktur,

Dr. drg. Julita Hendrarti, M.Kes, AAK


NIP 196107101989032001

Anda mungkin juga menyukai