BERITA ACARA

Pada hari ini ..................., tanggal ............... bulan ...................... tahun ............ yang bertanda tangan

di bawah ini saya :

Nama : .................................................................................................................

Departemen : ....................................................................................

Menerangkan bahwa :

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Demikian Berita Acara ini dibuat dengan sebenar-benarnya.

Bekasi, ...........................................

Mengetahui,

1. ________________________

Yang Membuat

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2. ________________________