Blanko Pelayanan Pernyataan Penghasilan
Blanko Pelayanan Pernyataan Penghasilan
Blanko Pelayanan Pernyataan Penghasilan
Nama : ...................................................................................................................................
Alamat : ...................................................................................................................................
NIK : ...................................................................................................................................
NOP : ...................................................................................................................................
Pekerjaan : ..........................................................................................................................
Penghasilan/(Perbulan) : Rp......................................................................................................................
Demikian pernyataan ini kami buat dengan sebenar-benarnya dan penuh rasa tanggung jawab.
Singaraja, ...............................................
Materai
10000
( ........................................................... )
Alamat : .................................................................................................................................................
Surat Keterangan ini diberikan dan hanya dapat dimanfaatkan untuk kepentingan mengajukan
Pengurangan/Keberatan
( .................................................................................... )