FORMULIR PERMOHONAN KEND R2 KARYAWAN

1. NIK (Nomor Induk Karyawan) :................................................................................................ ( wajib diisi )

Nama Lengkap :...........................................................................................................
Tempat,Tgl.Lahir :...........................................................................................................
Nomor Telepon :...........................................................................................................
Email :...........................................................................................................
Alamat :...........................................................................................................
Status Perkawinan :...........................................................................................................
Anak :...........................................................................................................

2. Depo /Divisi :...........................................................................................................

Alamat :...........................................................................................................
Jabatan :...........................................................................................................
Lama Bekerja :...........................................................................................................
Nama Atasan Langsung : ..........................................................................................................
No. Telp. Atasan Langsung : ..........................................................................................................
Email Resmi Atasan Langsung : ..........................................................................................................
Nama Atasan Tidak Langsung : ..........................................................................................................
No. Telp. Atasan Tidak Langsung : ..........................................................................................................
Email Resmi Atasan Tidak Langsung : ..........................................................................................................

3. Jenis Kendaraan :...........................................................................................................

4. Harga Kendaraan : Rp.....................................................................................

Angsuran Perbulan : Rp. ....................................................................................
Jangka Waktu : ......... Bulan ( maksimal 36 bulan )

5. Pengambilan Barang : Kirim ke kantor Ybs Ambil di KSP Sejati Makmur Jaya
Ambil di Toko Rekanan ( Toko yg bkerja sama dgn KSP SMJ)

6. Cara Pembayaran : Potong Gaji Tiap Bulan

Surat permohonan ini saya buat dengan sebenarnya. Saya bersedia menaati dan tunduk pada peraturan Koperasi Simpan
Pinjam Sejati Makmur Jaya . Atas terkabulnya permohonan ini, saya sampaikan terima kasih.

Tempat, Tanggal : ........................................

Pemohon, Pasangan,

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

*Form harap diisi dengan lengkap, jelas dan benar

**Form akan kami kembalikan bila ada data/keterangan yang kurang lengkap.