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RUKUN TETANGGA.

008
RUKUN WARGA. 009
KELURAHAN CISARANTEN KIDUL KEC. GEDEBAGE
KOTA BANDUNG

SURAT KETERANGAN
Nomor : ..... / RT. 008/RW.009/....../20 .....

Pengurus RT 008 RW 009 Kelurahan Cisaranten Kidul Kecamatan Gedebage Kota Bandung
dengan ini menerangkan bahwa :

Nama : ..............................................................................................
Jenis Kelamin : ..............................................................................................
Tempat / Tgl Lahir : ..............................................................................................
Kewarganegaraan : ..............................................................................................
Status : ..............................................................................................
Pekerjaan : ..............................................................................................
NIK : ..............................................................................................
Alamat : ..............................................................................................
..............................................................................................

Maksud dan tujuan :


..............................................................................................................................................................
..............................................................................................................................................................
Catatan:
1. ............................................................................................................................................
2. ............................................................................................................................................
3. ............................................................................................................................................
Demikian agar yang berkepentingan menjadi maklum dan mohon pertimbangannya.

Bandung, ................................ 20 ........


Nomor : ........ /Ket/RW.007/ .......
20 ........

Ketua RW 009 Ketua RT 008

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

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