Nama : ..........................................................................................................................
Instansi/Lembaga : ..........................................................................................................................
Alamat Kantor : ..........................................................................................................................
: ..........................................................................................................................
Jabatan : ..........................................................................................................................
No. HP : ..........................................................................................................................
Bersedia menerima mahasiswa/i Fakultas Ekonomi dan Bisnis Islam UIN Mataram,
sejumlah .................... orang untuk melaksanakan Praktik Kerja Lapangan di
.................................................. selama kurang lebih 45 hari.
Demikian formulir ini kami sampaikan, untuk dapat dipergunakan sebagaimana mestinya.
Mataram,.............................. 2022
Pimpinan/ Pejabat
.............................................