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DATA SAKSI-SAKSI

(YANG AKAN DIHADIRKAN DI PERSIDANGAN)


Perkara Nomor : ............... /Pdt....../20......./PA.Srg

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

6. No. KTP : ...............................................................................................................


7. Hubungan Saksi : Saudara kandung / Orangtua Kandung / Paman / Saudara / Saudara
Misan / Sepupu / Tetangga / ...... ..........................................................................................

SAKSI II
1. Nama : ...............................................................................................................
2. Umur : ...............................................................................................................
3. Pendidikan : .........................................................................................................
......
4. Pekerjaan : ...............................................................................................................
5. Alamat : ............................................................No...........Rt...........Rw...............
Desa/Kelurahan ........................... Kecamatan ......................................
Kabupaten/Kota ....................................................................................

6. No. KTP : ...............................................................................................................


7. Hubungan Saksi : Saudara kandung / Orangtua Kandung / Paman / Saudara / Saudara
Misan / Sepupu / Tetangga / ...... ..........................................................................................

Catatan :
1. Mohon data identitas ini diisi dengan benar
2. coret yang tidak perlu*

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