Surat Kuasa Pengambilan Ijazah

SURAT KUASA PENGAMBILAN IJAZAH

Yang bertanda tangan di bawah ini : Nama Tempat, Tanggal Lahir Tanda Pengenal Alamat

: ............................................. .................................................................... ............................................. ...................... : ............................................. .................................................................... ............................................. ...................... : KTP/SIM No. ............................................ ................................................................. ..................... : ............................................. .................................................................... ............................................. ...................... ............................................. .................................................................... ............................................. ......................

Dengan ini memberikan kuasa kepada : Nama Tempat, Tanggal Lahir Tanda Pengenal Alamat

: ............................................. .................................................................... ............................................. ...................... : ............................................. .................................................................... ............................................. ...................... : KTP/SIM No. ............................................ ................................................................. ..................... : ............................................. .................................................................... ............................................. ...................... ............................................. .................................................................... ............................................. ......................

Untuk Pengambilan Ijazah dan Transkrip Nilai ke Universitas Persada Indonesia Y.A.I. Demikian surat kuasa ini dibuat, untuk dapat dipergunakan sebagaimana mestinya.  Jakarta, ......................................... ......................................... 20........ Penerima Kuasa,

Pemberi Kuasa, Materai Rp 6000,00

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