Surat Kuasa

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Saya yang bertanda tangan di bawah ini: Nama Tempat, Tgl lahir NIM Alamat Nama Tempat, Tgl

lahir NIM Alamat 072210101026. Demikian surat kuasa ini untuk digunakan sebagaimana mestinya. Penerima Kuasa, Pemberi Kuasa : Laily Mufarrihah : Madiun, 03 Januari 2011 : 072210101026 : Ds. Banjarsari RT 7 RW 2 Kec./ Kab. Madiun : Luqman Hakimul Irsyad : Lamongan, 31 Januari 1989 : 072210101064 : Ds. Deketagung RT 3 RW 3 Kec. Sugio-Lamongan

memberikan kuasa kepada:

dengan maksud mengambil transkrip saya atas nama Laily Mufarrihah dengan NIM

Luqman Hakimul Irsyad

Laily Mufarrihah

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