SAKSI PENGGUGAT/PEMOHON.TERGUGAT/TERMOHON
SAKSI I
1. Nama : ...............................................................................................................
2. Umur : ...............................................................................................................
3. Pendidikan : .........................................................................................................
......
4. Pekerjaan : ...............................................................................................................
5. Alamat : ............................................................No...........Rt...........Rw...............
Desa/Kelurahan ........................... Kecamatan ......................................
Kabupaten/Kota ....................................................................................
SAKSI II
1. Nama : ...............................................................................................................
2. Umur : ...............................................................................................................
3. Pendidikan : .........................................................................................................
......
4. Pekerjaan : ...............................................................................................................
5. Alamat : ............................................................No...........Rt...........Rw...............
Desa/Kelurahan ........................... Kecamatan ......................................
Kabupaten/Kota ....................................................................................
Catatan :
1. Mohon data identitas ini diisi dengan benar
2. coret yang tidak perlu*