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    Form Pengajuan Dana Atau Barang

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    Shen-se Se

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    © All Rights Reserved
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    of 1

    PERGURUAN SETIA BHAKTI PERGURUAN SETIA BHAKTI

    Jl. Kisamaun No. 171 Jl. Kisamaun No. 171


    Tangerang 15118 Tangerang 15118

    PENGAJUAN BARANG PENGAJUAN BARANG

    UNIT : …………………………………………………… UNIT : ……………………………………………………


    Keperluan : …………………………………………………… Keperluan : ……………………………………………………
    1. …………………………………………………………………………………… Rp. …………………………… 1. …………………………………………………………………………………… Rp. ……………………………
    2. …………………………………………………………………………………… Rp. ……………………………. 2. …………………………………………………………………………………… Rp. …………………………….
    3. …………………………………………………………………………………… Rp. ……………………………. 3. …………………………………………………………………………………… Rp. …………………………….
    4. …………………………………………………………………………………… Rp. ……………………………. 4. …………………………………………………………………………………… Rp. …………………………….
    5. …………………………………………………………………………………… Rp. ……………………………. 5. …………………………………………………………………………………… Rp. …………………………….
    6. …………………………………………………………………………………… Rp. ……………………………. 6. …………………………………………………………………………………… Rp. …………………………….
    7. …………………………………………………………………………………… Rp. ……………………………. 7. …………………………………………………………………………………… Rp. …………………………….
    TOTAL PENGAJUAN Rp. ……………………… TOTAL PENGAJUAN Rp. ………………………

    Diperiksa, Tangerang, ……..………… 20…. Diperiksa, Tangerang, ……..………… 20….


    Bagian Keuangan Koord./Kepala Sekolah Pemohon Bagian Keuangan Koord./Kepala Sekolah Pemohon

    ( ………………………… ) ( ………………………………….. ) ( …………………………….. ) ( ………………………… ) ( ………………………………….. ) ( …………………………….. )

    Mengetahui Mengetahui

    Edy Kurniawan Edy Kurniawan


    Kepala PLH Kepala PLH

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