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  • Contoh Surat Pernyataan

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    RODUAN ARIFIN
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    CONTOH SURAT PERNYATAAN.docx

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    5 views1 page

    Contoh Surat Pernyataan

    Uploaded by

    RODUAN ARIFIN

    Copyright:

    © All Rights Reserved
    Download as DOCX, PDF, TXT or read online from Scribd
    Flag for inappropriate content
    of 1

    SURAT PERNYATAAN

    Yang bertanda tangan di bawah ini :


    Nama :
    Jabatan :
    Alamat :
    No. Telp :
    Email :

    Dengan ini menyatakan atas nama PKM/Klinik/DPP ……………………………..


    bersedia :
    1. Mematuhi seluruh ketentuan peraturan perundangan program Jaminan Kesehatan
    Nasional (JKN) yang berlaku.
    2. Memberikan kemudahan akses rekam medis.

    Demikian surat pernyataan ini dibuat untuk dapat digunakan sebagaimana


    mestinya.

    …………..…, ………..........…..2018

    Yang Membuat Pernyataan

    Materai
    Rp. 6.000

    (………………….……)

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