Assalamu’alaikum Wr.Wb.
Nama : ...................................................................................................................................
NIM : ...................................................................................................................................
Telepon : ...................................................................................................................................
Jabatan : ...................................................................................................................................
Bersama ini mengajukan permohonan untuk meminjam alat di Laboratorium Rekayasa Transportasi
untuk keperluan : .......................................................................................................................................
....................................................................................................................................................................
1. .........................................................................................................................................................
2. .........................................................................................................................................................
3. .........................................................................................................................................................
4. .........................................................................................................................................................
5. .........................................................................................................................................................
Demikianlah permohonan ini kami sampaikan, atas terkabulnya dan perhatiannya diucapkan terima
kasih.
Wassalamu’alaikum Wr.Wb.
.......................,................................
Peminjam
( )