Surat Kuasa

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Surat Kuasa

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SURAT KUASA

Yang bertanda tangan di bawah ini :

Nama : dr. Faris Azhar

Jenis Kelamin : Laki-laki

Tempat/Tgl Lahir : Jakarta, 21 Maret 1993

No. KTP : 7371092303930011

Alamat : Kompleks Panaikang Indah B23 Jl. Haji Kalla, Makassar

Melalui surat ini memberikan kuasa untuk pengambilan STR (Surat Tanda Registrasi)
Dokter saya kepada :

Nama : dr. Prilly Pricilya Theodorus

Alamat : Jl. Bukit Gading Mediterania Blok Ab/30

No. KTP : 3172065504920003

Demikianlah Surat Kuasa ini saya buat untuk dipergunakan sebagaimana mestinya.

Makassar, 1 Desember 2017

Penerima Kuasa, Pemberi Kuasa,

(dr. Prilly Pricilya Theodorus) (dr. Faris Azhar)

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