Minggu, 22 Juli 2012

Surat Keterangan/Pengantar


       PENGURUS PONDOK PESANTREN
           ‘‘GAPURO’’
       KARANGDOWO - WELERI - KENDAL

     Head Office: Jln. Cempaka Limbangan Karangdowo Weleri Kendal 51355 Telp. (0294) 642569



SURAT KETERANGAN / PENGANTAR
Nomor : ........ / .......... /20......

Yang bertanda tangan di bawah ini :
a.     Nama                                              : .....................................................................................................
b.     Jabatan                                           : Pimpinan Pesantren Gapuro Kendal

dengan ini menerangkan bahwa:
a.     Nama Lengkap                             : .....................................................................................................
b.     Jenis Kelamin                                 : .....................................................................................................
c.     Tempat & Tanggal Lahir             : .....................................................................................................
d.     Kewarganegaraan/Agama          : .....................................................................................................
e.     Pekerjaan                                       : .....................................................................................................
f.      Alamat Rumah                             : .....................................................................................................
  .....................................................................................................
  .....................................................................................................
g.     Berlaku Mulai                                : .....................................................................................................
-          Keperluan/Maksud               : .....................................................................................................
-          Keterangan                             : .....................................................................................................
  .....................................................................................................
  .....................................................................................................

Kepada yang bersangkutan/berwenang untuk menjadikan periksa dan selanjutnya dapat digunakan seperlunya.

                                                                                                Weleri, ......................................
Mengetahui,
      Tanda Tangan Pemegang                                                                  Pimpinan Pesantren
GAPURO Kendal



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