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KOP SURAT INSTANSI

SURAT PERINTAH TUGAS


Nomor : ................................................................................

Sehubungan dengan Surat Kepala Dinas Kesehatan Provinsi Jawa Timur Nomor 440/9073/102.1/2019 tanggal 15 Juli
2019 perihal Undangan Workshop PIS-PK Terpadu, dengan ini kami menugaskan kepada :

1. Nama : ...........................................................................................................................
NIP : .......................................................
Pangkat/Golongan : ................................... / ................
Jabatan : ...........................................................................................................................

2. Nama : ...........................................................................................................................
NIP : .......................................................
Pangkat/Golongan : ................................... / ................
Jabatan : ...........................................................................................................................

3. Nama : ...........................................................................................................................
NIP : .......................................................
Pangkat/Golongan : ................................... / ................
Jabatan : ...........................................................................................................................

4. Nama : ...........................................................................................................................
NIP : .......................................................
Pangkat/Golongan : ................................... / ................
Jabatan : ...........................................................................................................................

5. Nama : ...........................................................................................................................
NIP : .......................................................
Pangkat/Golongan : ................................... / ................
Jabatan : ...........................................................................................................................

6. Nama : ...........................................................................................................................
NIP : .......................................................
Pangkat/Golongan : ................................... / ................
Jabatan : ...........................................................................................................................
KOP SURAT INSTANSI

Untuk : Mengikuti Workshop PIS-PK Terpadu yang akan dilaksanakan pada hari Rabu–Sabtu, tanggal
31 Juli – 3 Agustus 2019 di Hotel Novotel Samator Surabaya Timur, Surabaya, sebagai
Peserta Aktif.

Demikian surat perintah tugas ini dibuat untuk dapat dipergunakan sebagaimana mestinya.

............................................, .............. Juli 2019


Kepala Dinas Kesehatan
Kabupaten/Kota........................

...................................................................
NIP. ..........................................

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