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PT.

GARDA CIPTA MANDIRI


Your Security Solution
LOKASI HAMPTON’S PARK APARTMENT

SURAT PERNYATAAN
No : …… / SPN / GCM - HP / …… / 2022

Saya yang bertanda tangan di bawah ini :


Nama Lengkap : .......................................................................
Tempat / Tgl. Lahir : .......................................................................
No Identitas KTP / SIM : .......................................................................
Agama : .......................................................................
Pekerjaan : .......................................................................
Jabatan : .......................................................................
Alamat : ...........................................................................................................................
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No Telepon : .......................................................................

Menyatakan bahwa :
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Demikian surat pernyataan ini saya buat dengan sebenar-benarnya tanpa adanya paksaan,
tekanan dan pengaruh dari pihak manapun.

Jakarta, .....................
Hormat Saya

(....................)

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