UNIVERSITAS NEGERI JAKARTA

RACANA UNIVERSITAS NEGERI JAKARTA

GUGUS DEPAN JAKARTA TIMUR 03.221-03.222
Sanggar Bakti: Gd. G, Lt. III, R. 306, Kampus A UNJ Rawamangun, Jakarta, 13220
Surel: racana.unj@gmail.com

FORMULIR PEMINJAMAN BARANG

Nama Peminjam : ................................................................................................

No. Hp : ................................................................................................
Nama Organisasi : ................................................................................................
Nama Kegiatan : ................................................................................................
Tanggal Peminjaman : ................................................................................................
Durasi Peminjaman : ................................................................................................
Tanggal & Waktu Pengembalian : ................................................................................................
(Tanggal, Jam pengembalian)

SPESIFIKASI
NO NAMA BARANG (Warna, jumlah, KETERANGAN
bentuk, dll.)

Jakarta,................................2021

Mengetahui, Hormat Kami,

Biro URT/Mewakili Peminjam

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