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SURAT PERNYATAAN / SURAT KETERANGAN

Yang bertanda tangan di bawah ini :

Nama :.......................................................................

Alamat :..........................................................................

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No. HP :.........................................................................

Pekerjaan :.......................................................................

Adalah orang tua /wali dari mahasiswa baru Fakultas Teknik UGM ssb :

Nama :.....................................................................

Alamat :...................................................................

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

No. HP :...................................................................

Program studi :..................................................................

Dengan ini menyatakan / menjelaskan mengenai detail dari pekerjaan /usaha/wiraswasta yang saya
miliki :

1. Nama Pekerjaan /
Usaha/wiraswasta ................................................................................
Bidang
2. Modal

3. Nilai usaha (Rp)

4. Aset yang dimiliki 1.......................................................................................................

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

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

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

5. .....................................................................................................
5 Jumlah pegawai ........................................................................................................

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6 Rata – rata
penghasilanper bulan ........................................................................................................

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7 Lain- lain (uraikan
tentang usaha ...........................................................................................................
/pekerjaan tersebut
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Yogyakarta , ................................................

Yang menyatakan

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