Surat Pernyataan
2
PERNYA T AAN KESANGGUPAN (Mahasiswa Program Sarjana dan Diploma III) Ya ng !r"anda#"angan diawah ini $ Nama $ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Nomor P!s!r"a $ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% NPM $ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Pr og % S" &d i $ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% 'a &l"as $ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% T! mpa" "anggal lahir $ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Alama" s!s&ai KTP $ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% Nomor T !lp*+P $ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%% S!"!la h din, a"aan di"!rima s!agai mahasiswa Uni-!rsi "as Tidar s!ja tahun akademik 2015/ 2016 d!ngan p!n&h !sadaran dan !r"angg&ngjawa m!n,a"aan s!agai !ri&" $ .% /!r s!di a m!ma"&h i s!gala p!r &nd ang#&ndan gan s!r"a !" !n"&an N!gara R!p&l i Indon!sia% 0% /!r s!dia m!ma"&h i s!gala nor ma1 !"ia1 "a"a ra ma1 p!ra" &ra n dan !"!n "&a n ,a ng !rla& di Uni-!rsi"as Ti dar% 2% /! rs!dia m!njaga o nd isi ! "! n" rama n di li ng & ngan a mp&s da n "i da a an m!la&an p!langgaran non aad!mi (riminal)% 3% /!rs!di a m!ng!"ah &i1 m!mahami dan m!n" aa"i !"!n"&an#!"!n "&an ,ang "!r"&an g di dalam P!ra"&ran Aad!mi /idang P!ndidian Uni-!rsi"as Tidar % 4% Ti da p!r nah m!n gg& na an nar o a dan "id a aa n "!rl ia " dal am p!n,a lahg&n aan naroa dan 5a" adi"i6 dalam !n"& apap&n% 7% S!nan"iasa !r&pa,a m!maj&an dan m!njaga in"!gri"as almama"!r% Apaila sa,a "ida m!n"aa"i p!rn,a"aan ini sa,a sangg&p m!n!rima sansi s!s&ai d!ngan !"!n"&an ,ang!rla&1 "!rmas& di!l&aran s!agai mahasiswa Uni-!rsi"as Tidar% 8rang "&a* 9ali (:::::::::::::) Mag!lang1 0;.4 M!ng!"ah&i * m!n,!"&j&i Mahasiswa ,s (:::::::::::::) <a"a"an $ Diisi d!ngan ollpoin" "in"a hi"am d!ngan h&r&6 =!"a% Ma"!rai Rp%7%;;;1#
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Transcript of Surat Pernyataan
7/17/2019 Surat Pernyataan
http://slidepdf.com/reader/full/surat-pernyataan-568decad5118d 1/1
PERNYATAAN KESANGGUPAN(Mahasiswa Program Sarjana dan Diploma III)
Yang !r"anda#"angan diawah ini $
Nama $ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
Nomor P!s!r"a $ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
NPM $ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
Prog% S"&di $ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
'a&l"as $ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
T!mpa" "anggal lahir $ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
Alama" s!s&ai KTP $ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
Nomor T!lp*+P $ %%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%%
S!"!lah din,a"aan di"!rima s!agai mahasiswa Uni-!rsi"as Tidar s!ja tahun akademik
2015/ 2016 d!ngan p!n&h !sadaran dan !r"angg&ngjawa m!n,a"aan s!agai !ri&" $
.% /!rs!dia m!ma"&hi s!gala p!r&ndang#&ndangan s!r"a !"!n"&an N!gara R!p&li
Indon!sia%
0% /!rs!dia m!ma"&hi s!gala norma1 !"ia1 "a"a rama1 p!ra"&ran dan !"!n"&an ,ang
!rla& di Uni-!rsi"as Tidar%
2% /!rs!dia m!njaga ondisi !"!n"raman di ling&ngan amp&s dan "ida aan
m!la&an p!langgaran non aad!mi (riminal)%
3% /!rs!dia m!ng!"ah&i1 m!mahami dan m!n"aa"i !"!n"&an#!"!n"&an ,ang "!r"&ang di
dalam P!ra"&ran Aad!mi /idang P!ndidian Uni-!rsi"as Tidar%4% Tida p!rnah m!ngg&naan naroa dan "ida aan "!rlia" dalam p!n,alahg&naan
naroa dan 5a" adi"i6 dalam !n"& apap&n%
7% S!nan"iasa !r&pa,a m!maj&an dan m!njaga in"!gri"as almama"!r%
Apaila sa,a "ida m!n"aa"i p!rn,a"aan ini sa,a sangg&p m!n!rima sansi s!s&ai d!ngan
!"!n"&an ,ang!rla&1 "!rmas& di!l&aran s!agai mahasiswa Uni-!rsi"as Tidar%
8rang "&a* 9ali
(:::::::::::::)
Mag!lang1 0;.4
M!ng!"ah&i * m!n,!"&j&i Mahasiswa ,s
(:::::::::::::)
<a"a"an $
Diisi d!ngan ollpoin" "in"a hi"am d!ngan h&r&6 =!"a%
Ma"!rai
Rp%7%;;;1#
