LAMPIRAN BUKTI FISIK

Melakukan Kunjungan/Tatap Muka pada Petani Perseorangan

1. Nama kegiatan :
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2. Tujuan :
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3. Tempat dan waktu pelaksanaan :
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4. Materi yang disampaikan :
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Jombang, …………………… 2021

Penerima
konsultasi/bimbingan Penyuluh Pertanian

____________________ ____________________
NIP.
 LAMPIRAN BUKTI FISIK
Melakukan Kunjungan/Tatap Muka pada Kelompok Tani

1. Nama kegiatan :
________________________________________________________________________________
________________________________________________________________________________
2. Tujuan :
________________________________________________________________________________
________________________________________________________________________________
3. Tempat dan waktu pelaksanaan :
________________________________________________________________________________
________________________________________________________________________________
4. Materi yang disampaikan :
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
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________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________
________________________________________________________________________________

Jombang, …………………… 2021

Penerima
konsultasi/bimbingan Penyuluh Pertanian

____________________ ____________________
 NIP.

DAFTAR HADIR

Kegiatan :
Kelompok Tani :
Desa :
Kecamatan :
Kabupaten/Kota :
Waktu Pelaksanaan :

No
Nama Jabatan Tanda Tangan
.
1 1

2 2

3 3

4 4

5 5

6 6

7 7

8 8

9 9

10 10

11 11

12 12

13 13

14 14

15 15

16 16

17 17

18 18

19 19

20 20

Mengetahui,
Ketua Kelompok Tani
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