You are on page 1of 1

AFFIDAVIT

Signed below
Name : Lia Ernawati
Place and date of birth : Garut, 15-09-1987
Address : kp.cikurantung RT.001 RW.009
Kel.cirapuhan kec.selaawi Garut West
Java

As husband of listed below

Name : Cepi Budimansyah


Place and date of birth : Bandung 09-05-1985
Address : Jln.Embah Malim RT.06 RW.18
kec.kiaracondong Kel.Babakansari
Bandung West Java

With this statement of fact, that I am Lia Ernawati :

Hereby give my husband Cepi budimansyah permission to work on a cruise


holland america line and will not be asked to go home before the contract
expires.
The above permit me responsible reimburse the departure if the person
concerned resigned after proceedings or asked to return after the departure to
the destination country (before the expiry of the contract).

So this Statement I make with the truth without coercion from any party
Bandung, 11 march 2017

Concerned Who gave statements

You might also like